Psychiatry and Society

Alzheimers dementia is usually diagnosed when memory loss and behavioural symptoms are readily apparent to their caregivers. At this stage the primary concern is to slow further deterioration. Caregivers at the clinic have often wished they could have looked into the future. Many have a history of Alzheimers disease in their elderly and wondered whether there was an earlier way of knowing. New knowledge gives us hope in this direction. Alzheimers disease before memory loss We now have the beginnings of a time line in the countdown to dementia. It is now possible to trace the beginnings of Alzheimers Dementia up to 20 years before its manifestation with memory loss and impaired function. 20 Beta-amyloid levels in the cerebrospinal fluid (CSF)   begin to drop 20 years before the onset of dementia. Alzheimer's Disease is characterized by toxic deposition of specific beta-amyloid (Aβ1-42) plaques around the brain cells. In normal aging beta-amyloid...

Microscopic picture of the brain showing amyloid plaques and  neurofibrillary tangles first seen by Alois Alzheimer in 1907 The diagnosis of Alzheimer's disease became headline news when the defence counsel of a prominent citizen of  Pune stated they were awaiting results of his brain MRI to finalise the diagnosis of dementia. Recently a patient's medication was stopped when his neuro-physician declared there were 'no plaques on MRI so it is not a case of Alzheimers'. The caregivers returned to me when his behaviour problems recurred. Dementia including that of the Alzheimer's type is a clinical diagnosis (Grand 2011). Dementia is characterised by a triad of Progressive deterioration of mental processes ( cognitive abilities ) Behavioural and psychological symptoms of dementia ( BPSD ) Difficulties carrying out day-to-day activities ( activities of daily living or ADL).   Alzheimer's Disease is commonest dementia after 65 years of age Alzheime...