Managing Alzheimer's holistically

"The effects of Alzheimer's are devastating in South Africa because there is little support for patients and their families," says specialist geriatrician at Akeso Clinic in Parktown, Dr Ryan Fuller. "Because our healthcare system is not designed with senior citizens in mind, caring for someone with Alzheimer's can be lonely and relentless. For many, the distress of watching a loved one succumb to the disease can feel overwhelming."

Dr Fuller says the risk of developing Alzheimer's doubles every five years of age from the age of 65. While five in every 100 people over the age of 65 develop the disease, by the time they reach 80 years old, approximately more than half of elderly folk will have developed a dementia syndrome.

Symptoms

The causes of the Alzheimer's are not yet well understood. Genetic as well as environmental factors, such as an unhealthy diet, lack of exercise and cognitive stimulation, other physical illness such as high blood pressure and diabetes and the general aging process are thought to play a role. Early symptoms include memory loss, which over time becomes persistent and pervasive - affecting the person's ability to complete simple day-to-day tasks.

"The first signs may be asking repetitive questions, difficulty with finances, forgetting the names of friends and family and getting lost while driving a regular route home. In the more advanced stages of the disease, patients may experience mood swings, aggressive outbursts, or even display psychotic behaviour."

He adds that one of the major challenges in treating Alzheimer's is the fragmented approach to healthcare for senior citizens. Overcoming this is why Dr Fuller is pioneering a memory care team-based approach to treating patients with Alzheimer's. The treatment philosophy is based on tackling all aspects of the disease - the physical, psychological and social.

Medication may exacerbate symptoms

"Many elderly patients, for example are on a variety of medications for various chronic conditions, as well as for mental health problems such as depression or anxiety. This 'polypharmacy' approach may actually worsen the progression of the disease.

"One of the first steps in treating the disease is determining which medication is really necessary and which may be causing more harm. Once we are able to 'detox' a patient in a managed environment, we are in a better position to make a proper diagnosis."

Because there is yet no definitive test for Alzheimer's, it is important to rule out any other factors that may be causing memory loss, such as serious losses from grief reactions, physical functions, social support, depression, diabetes, hypertension, or vascular problems, such as a stroke.

Family members should try to keep a detailed medical history of all tests and doctor visits, including a list of medications, for later use when seeing healthcare providers.

Although there is yet no cure for the disease, which worsens as it progresses, the symptoms can be managed through an integrated care programme using a team of health professionals - including a general practitioner; geriatrician or other relevant specialists; psychiatrist; physiotherapist; occupational and speech therapist; dietician; and social worker.

"Each of these health professionals conducts an assessment of the person and we are then able to establish a baseline against which we can measure. For example, we would do one-on-one consultations with the patient every six months and measure any improvement or deterioration in their condition."

Early diagnosis critical

He explains that the earlier a patient is diagnosed with Alzheimer's the better the chance that various therapies may slow its progression. Medications called cognitive enhancers can slow down memory loss and help to relieve psychological symptoms, while physiotherapy and occupational therapy can help patients to remain physically active and more independent. Those with mild or moderate Alzheimer's may also benefit from group cognitive stimulation therapy programmes, which give patients an opportunity to socialise as well as participate in themed memory-enhancing activities.

"Although the symptoms of Alzheimer's gradually worsen over time, we can equip patients as well as their caregivers and families to manage the care journey as best as possible."

Independent functioning at home should be prioritised but sometimes whether a patient is being taken care of at home or in a frail care setting, they can also benefit from specialised interventions in the clinic to improve symptom control and optimise physical functioning."

He is also working with medical schemes to develop innovative senior care programmes, focusing on improving co-ordination by healthcare providers in order to promote community care.

"Patients with Alzheimer's suffer a double discrimination - ageism where people openly discriminate against old people and then there is the stigma attached to mental illness. What Alzheimer patients really need is to be given the best quality care, in an environment geared to their needs -with respect and dignity," concludes Fuller.