In the absence of any known cure, Alzheimer's disease, a debilitating malaise that afflicts the elderly, continues to be regarded as the most dreaded manifestation of ageing.

Alzheimer's inspires many fears and misconceptions. Anxious queries about the disease range from the normal "Is it a mental disease, is it hereditary or is it the result of normal ageing", to the more ludicrous "Are past life events responsible for the onset of Alzheimer's disease".

Relatively little is known about Alzheimer's in India; and doctors here caution that people must now sit up and take notice of a disease which, according to one estimate, kills one out of four Indians over the age of 80. Without getting into the numbers game, Dr Kalyan Bagchi, President of the Society for Gerontological Research, a Delhi-based NGO, says, "It is quite possible that today, there may be thousands of patients totally undetected and undiagnosed."

Seema Puri, senior lecturer (her PhD work is related to gerontology) at the Institute of Home Economics, Delhi University, describes Alzheimer's as a condition of unknown origin that causes a gradual loss of abilities in memory, thinking, reasoning, orientation and concentration. It is not the
result of ageing but it does occur more frequently in persons 65 years of age or older, she explains.

The early stage of Alzheimer's is often overlooked and incorrectly labeled both by professionals as well as by family and friends as "old age" or a normal part of the ageing process. In an illustrative case, a 69-year-old retired Colonel in south Delhi started exhibiting moody behavior, alternating between bouts of animation and depression. His family however, attributed what they felt were temper tantrums to the onset of advancing years. They realized something was wrong only when he began to show signs of disorientation and uncharacteristic behavior which included cracking inappropriate jokes before guests.

Dr Bagchi explains that Alzheimer's affects each patient in a different way. The symptoms can broadly include difficulties with language, significant short-term memory loss, time disorientation, difficulty in making decisions, showing signs of depression and aggression and lack of initiative and motivation.

In the case of the retired Colonel, he started referring to the calendar to remember dates and had major gaps in memory. Most of his behavioral problems began in the evenings when he fell into a state of cognitive decline or dementia.

Dementia is defined as the loss of intellectual functions severe enough to interfere with an individual's daily function. Dementia is not a disease in itself but a group of symptoms that may appear in certain diseases or conditions; Alzheimer's is the most common among such conditions.

With the rapid increase of the grey population in India, Alzheimer's and other forms of dementia are becoming more prevalent among the elderly. Life expectancy has gone up from 20 years at the beginning of the 20th century to 62 years today, says Ms Nidhi Raj Kapoor of the Delhi-based NGO, HelpAge India. At present, India has an ageing population of 77 million; by 2025, the country will have 177 million elderly people.

Creating mass awareness about this tragic condition can help detect Alzheimer's at an early stage and create avenues for appropriate support and care to patients, says Dr Bagchi. The Society for
Gerontological Research (SGR) has taken a concrete step in this direction with the recent launch of a publication titled 'Alzheimer's Disease in India'.

The book covers all aspects of the disease, presented by eminent experts who have spent decades in researching its various facets. Dissemination of this information is of great importance to the masses, or the people who are the real caregivers when Alzheimer's strikes someone in the family,
observes Dr Bagchi.

The book is also an invaluable guide for general practitioners to diagnose the symptoms early on. Age-associated cognitive decline as well as dementia are substantially prevalent in elderly people seeking health care. And therefore, it is essential for the geriatrician to be able to differentiate between the two, points out Dr A B Dey, Chief of Geriatric Services at the All India Institute of Medical Sciences (AIIMS), Delhi.

In a chapter devoted to early detection of dementia, Dr Dey observes that cognitive impairment should be suspected when the patient is passive and unresponsive, easily irritable, suspicious or misinterprets auditory and visual stimuli.

Other indicators for assessment include inability of the patient to get the appropriate words to express what he or she wants to say, difficulty in learning and retaining new information, or performing tasks such as cooking, and loss of interest in usual hobbies, activities and current events.

At the same time, the clinician needs to be judicious and depend on his/her own skill and clinical judgement since these mental assessment instruments have some degree of false positivity. In addition, factors such as the patient's educational level, cultural background and socio-economic status need to be kept in mind when choosing appropriate tools for assessment and also while interpreting the results.

In the second stage - when Alzheimer's is most often detected - the disease takes a more serious turn; the glaring signs and symptoms are complete forgetfulness regarding events and faces, inability to speak in a coherent manner and the inability to write a logical sentence.

What is perhaps much more worrisome is the night wandering and spatial disorientation. Gradually, urinary and faecal incontinence, and finally the loss of mobility follow. "All said and done, the most important aspect of taking care of a patient with Alzheimer's is care giving; in the late stages, the attention of the caregiver is needed not only throughout the day, but even during the night," notes Dr Bagchi. Consequently, the psychological stress on caregivers can be tremendous, he adds.

What is needed, he says, is counseling and support services to help maintain the capacity of the caregivers. The training of volunteers and informal caregivers can be of immense help in supporting family caregivers. Pointing out that there are few trained geriatric caregivers in India, Dr Bagchi emphasizes that this area needs immediate attention, particularly in the National Plan of Action for Older Persons.