Hollywood actress Rita Hayworth had it. President Ronald Reagan suffered from it. Singer Perry Como and boxer Sugar Ray Robinson were afflicted by it. A slow devastating killer, Alzheimer's disease is no respecter of rank or class,
and can strike anyone anywhere. This is a disorder that gradually destroys cells in the brain causing progressive decline in memory, thinking, calculation comprehension, language, learning capacity and judgment. Alzheimer's is the most common form of dementia accounting for about 50 to 70 per cent of all dementia cases worldwide as proven by studies and research.
Alzheimer's is quite prevalent in the Gulf region where an obvious lack of awareness about the disease exists and it is not diagnosed or treated properly. Because people tend to think that patients who have the disease are merely experiencing symptoms of old age. Doctors say that the only time families take the patient seriously is when the symptoms have become worse.
In the Arab region, as of date, only limited studies have been performed on Alzheimer's disease.
Qatar, which has a specific geriatric department, conducted a hospital-based research to determine the different sub-types of dementia prevalent among elderly Qatari patients, the only known study undertaken so far.
To increase awareness about Alzheimer's disease in the region and to talk about the latest updates on treatment and care of the disease, Lundbeck, the manufacturer of Ebixa (memantine), organised a medical conference last week at Crowne Plaza. Over 300 physicians from the Gulf attended the meet where Ebixa was presented as the first in the NMDA receptor antagonists class and the only agent to treat moderately severe to severe Alzheimer's disease. The conference was chaired by Dr Abdul Razak Abyad, family physician and geriatrician, of the General Authority for Health Services for the Emirate of Abu Dhabi. Dr Abyad is also the chairperson of Middle East Academy for Medicine of Ageing and chief editor of the publications, Middle East Journal of Family Medicine and Middle East Journal of Age & Ageing. He spoke to City Times in this exclusive interview.
How prevalent is Alzheimer's disease in the Gulf region?
Alzhemier's is very common worldwide, with almost 18 million patients suffering from it. By 2025, this figure is expected to go up to 34 million. Statistics show that 60 per cent of Alzheimer's patients are in developing countries including India, Gulf region, Middle East and other places. According to the International Association of Alzheimer's disease, in the Middle East crescent there are one million patients. By 2025, this is expected to increase to 2.3 million. The number is huge. The reasons are multiple. If you look at the population here, it is ageing rapidly. Longevity in the Gulf is largest in the Middle East. Alzheimer's is known to start after the age of 65. Between 65 to 70 years of age, about two per cent of population has Alzheimer's between 70 to 75 years, it goes to 5 per cent; between 75 to 80 years, it goes to almost 10 percent. And above 85 years of age, almost 20 per cent will have Alzheimer's.
What are the misconceptions about Alzheimer's disease in the Gulf region?
One of the problems we are facing in the Gulf region is that Alzheimer's disease is not well recognised, even by doctors. So even if doctors diagnose it, they actually don't do anything about it because the family thinks it is the old age. But we know that there are lot of medicines and interventions and help that can be given to the elderly patients and the caregiver, who is an important person looking after the patient. An Alzheimer's patient becomes like a child, and sometimes-working families are stuck with a difficult situation. Which is why they need a lot of help.
Why is the awareness about Alzheimer's disease in the Gulf region so low?
For two reasons. There are several factors for the low awareness about elderly patients in the region. We don't have enough people trained in the field of geriatrics. I think there are only 15 to 20 geriatrics in the whole of Middle East. In the Gulf region, it comes down to only 4 or 5, one in Saudi Arabia, one in the Emirates, one in Qatar and maybe one in Bahrain. So the whole region is missing this field. Secondly, elderly patients are particular patients and people working in the Gulf's health fields are unwilling to create health services for the elderly because it is a cultural issue. Here, we like to take care of our elderly. If you put your elderly in a nursing home, it means you are doing something wrong. So, for this reason, culturally, it is not acceptable to develop nursing homes. Yet at time same time, a lot of elderly patients is living at home, with no help and even in isolation.
For example, as family consultants, we visited different homes in Kuwait, where many elderly patients were living in very big homes, in a part of the house with a maid. Nobody was talking to them except the maid who, of course, did not know the patient's language. So, I feel you need to have comprehensive services for the elderly including academic nursing homes when there is a need, and elderly care services during the day.
The elderly can spend the day in a club-like scenario where they get treatment and company of other patients, and then can go home in the night. In such a situation, everybody is happy.
So, you need to create the services that, technically, don't exist in the entire region. You need to create a team, because geriatrics is a team field, with physicians, nurses trained in geriatrics, social workers and nutritionists.
What are the symptoms family members should look for to distinguish Alzheimer's disease in their elderly relative, from the normal ageing process?
First is forgetfulness. If forgetfulness becomes persistent, if the elderly starts to forget important things: names, places etc, then it is a worrying sign. Another sign is when people start changing their way of life, like an active person suddenly starts withdrawing from life. A patient may know something is wrong with him or her, and may protect himself or herself. Then people may ask a question repeatedly because they have forgotten they have already asked it.
Other signs are, people going into depression, losing their appetite to eat, losing their judgment. It is important to discover Alzheimer's early because there are medications that can help the patients and improve their quality of life, although there is no cure for it. Unfortunately, patients go to different doctors who proclaim that their condition is the result of normal ageing process but whey they see a geriatric, it is found they have Alzheimer's and it is too late.
What should a family do to know an elderly relative's true condition in time, so that Alzheimer's is detected before it gets worse?
It is very important for a son, daughter, wife or husband to think that there is something wrong with their relative, so as to bring him or her early to a geriatric, who is the best person to do diagnosis. From there, a patient can be put under observation to see the progression of the disease. Also, if a family is warned about a person's Alzheimer's, family members are able to observe what is going with the patient. Moreover, there are some diseases that lead to Alzheimer's and these illnesses are reversible.
For instance, Hypothyroidism, meaning the thyroid gland is not producing enough thyroid. Another one is low vitamin B-12, which is vitamin B-12 deficiency. In such cases, if the condition is discovered early, the patient may not develop Alzheimer's. We call it the Window of Opportunity. No one knows exactly how long this period lasts, maybe from six months to one year. But if you miss this diagnosis for one year, it may be too late to treat a patient.