PAKISTAN: Elderly Fuel Alzheimer's Relentess March

. KARACHI (The International News), September 21, 2008: By Imtiaz Ali As the population of the elderly has started to swell in Pakistan, so has the number of people afflicted with the progressive neurological disorder without a cure: Alzheimer's disease. Alzheimer's disease is the most common cause of dementia, or memory and cognitive decline, in the world, and is most prevalent in countries where elderly population is high. In the United States of America, as much as 10 per cent of the population above the age of 65 suffers from Alzheimer's. According to Dr Mughis Sheerani, Assistant Professor, Section of Neurology, Department of Medicine, Aga Khan University, there are no definite estimates for Pakistan, but the disease is becoming more prevalent with the rise of the elderly population. "This is a disease of the elderly, and is widely unrecognised in our country," he said while talking to The News. "There is lack of awareness amongst both physicians and common individuals." The disease is a progressive neurological disorder, meaning that the patient's memory and cognition get worse every year. It does not have a cure at this time. Problems start with minor memory deficits that escalate to the point where patients have trouble performing daily tasks, such as eating and going to the bathroom, etc., and are unable to recognise close family members. Eventually, they are bed-ridden, although medication can slow the progression of the disease and allow patients to live a relatively normal life for several years. "There are no preventive measures," said Sheerani. "The medication is not made in Pakistan and has to be imported, which makes treatment quite expensive." If medication is started early, it can slow the rate of progression of the disease, but Sheerani maintained that Alzheimer's disease needs more recognition at both an individual and government level. He said that at a government level, medication can be subsidised so that the elderly or pensioners can afford them. He also suggested that local pharmaceuticals should be encouraged to manufacture these medications to bring down the cost. "Unfortunately, a loss of memory, or dementia in medical terms, happens to many people in this world," said Sheerani, "Alzheimer�s disease is the most common form of dementia, but there is no good treatment available despite extensive research in the field. "Strokes, increased fluid in the brain (called normal pressure hydrocephalus, or NPH), a deficiency of vitamin B12, or a deficiency of the thyroid hormone, all cause memory loss, too, but according to Sheerani, these diseases can be treated if caught early, and the memory loss can be improved. However, Alzheimer's disease has a relentless downward course with only modest benefits from current therapies. It can strike both males and females, rich, poor, powerful, or weak. Recently, former president of the United States, Ronald Regan, was diagnosed with Alzheimer's disease. "What causes this disease is a mystery," Sheerani said. In small number of cases it is caused by the gene known as apo E2 allele, which can now be tested for. However, in the majority of patients, the cause is unknown. Lots of theories have been put forward, but the jury is still out. "What doctors do know is that when brain cells start to die without any definite reason, the brain shrinks, which affects the frontal and temporal lobes. The temporal lobe is where memory and emotions are stored, and gets severely damaged in Alzheimer's. The frontal lobe handles cognition and intellect, and when it stops to function properly, patients start to show 'primitive' reflexes that resemble those of animals. The palmo-mental reflex is one such example. If the palm of a patient with dementia is scratched, muscles near the lips also move. In cheetahs, this is a very strong reflex - when a cheetah grabs at prey, its mouth opens simultaneously. The symptoms of Alzheimer's arise when brain cells start to die, which depletes chemicals in the brain. Medication, for the disease, or 'acetylcholinestrase inhibitors', can replace these chemicals to some extent. Examples include the medicines Tacrine, Donepezil, and Rivastigmine. But these are not enough. "The disease is progressive, so medication will eventually fail," said Sheerani. "To stop the progression of Alzheimer, another medication, 'Memantine', has been developed but this, too, only helps to a certain extent. After a point, the disease continues unabated." SOURCE: thenews.com.pk