INTRODUCTION

1. INTRODUCTION • What is a degenerative disorder? The diseases which are characterized by progressive deterioation of the nerve cells eventually leading to cell death. • Alzheimers disease is one of the degeneratice nerve disorder.

2. Alzheimer's Disease • We are the 6th most populated country in the world • Ranked on 20th from top to bottom with a death rate of 14.3 due to Alzheimer's. • It affects more than 45 million people in the world. • 11million people are currently suffering from Alzheimer’s disease in Pakistan • Most significant social and health issue of the 21st century • Prevalence is slow in youth and more in adults • America has the highest rate of Alzheimer’s patients. • Alzheimers is the 6th leading cause of death amoung all dementia's. • At age 65,----- 1 in 5 people get Alzheimer's.

3. Defining Alzheimers • Neurodegenerative disorder • It is the most common form of dementia (persistant disorder) • First described by psychiatrist and neuropathologist Alois Alzheimer in 1906. • In this disease the patient suffers with memory loss, and the decrease in the ability of attention, ability of decision making, and ability of conversation. • May affect body's activities such as balance, movement, talking, breathing and heart function. • This dementia affects 5% over the age of 65 and 20 % over the age of 80. • Alzheimers is not detectable at the early stage. • And it is not curable.

4. Stages of Alzheimers • Three stages- MILD/MODERATE/SEVERE. MILD • Diagnosis does not occur in this stage • Getting lost • Trouble handling bills and money • Repeating questions • Taking longer time to complete normal tasks • Using pooer judgement • Mood and personality changes

5. Stages of Alzheimers MODERATE • Hallucinations • May behave impulsivly • Damage occurs in brain areas which control language, reasoning, sensory processing and concious thoughts. • Worse memory and confusion • Recognition problems • Unable to learn new things • Problems in getting dressed up...!

6. Stages of Alzheimers SEVERE • Plaques and Tangles have spread throughout the brain • Shrinkage of brain occurs • The person is dependent on others • Cannot communicate and eat • Stays in bed mostly • Cannot recognize people • Decline in thinking abilities • Cannot control their body functions • Memory worsens and may become non existant. • May lead to death.

7. Epidimology • There were about a million people living with Alzheimer’s and dementia in Pakistan. • This disease mainly affects elderly people, especially those over 65 years of age. Its prevalence doubles every five years • Alzheimer prevalence would nearly double every 20 years to 65.7 million in 2030 and 115.4 million in 2050. • Alzheimer’s day is celebrated on 21st Sept, also called as World's Alzhimers Day. • Pakistan has also established a society like other countries for assistance of Alzheimer patients named , Pakistan Alzheimer’s Society (PAS) and its main motto is to educate the people about dementias, the earliest sign and symptoms and management. To eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health.

8. Epidimology • How often it occurs? • Age Incidence rate/1000 person 65-69 ------- 3 % 70-74 ------- 6 % 75-79 ------- 9 % 80-84 ------- 23% 85-89 ------- 40% 90- above ------- 69%

9. Etiology- Symptoms • Symptoms may include: • Stress, confusion, irritability, aggression, mood swings, trouble with the language and often long term memory loss. • The most common symptoms are difficulty in remembering recent events. • memory, attention span, language capability and problem solving • Emotional problems • Lack of ability to recognize his own wife or children, • Tendency to wander out of the house and get lost in a neighbourhood one had known for decades • Sudden inability to drive and his mood swings are symptoms of mental ill-health

10. Etiology- Causes • No particular cause has been found or you can say the cause and the progression of the disease are still not well understood...! • May be some abnormal proteins are present in the brain that cause a degenerative disorder. • But these stated below can play a role: • Alcoholism • A tumor • A stroke may be • Toxins/ Chemicals • Viruses • And sometimes no particular cause is known.

11. Effects • Depend upon person to person • Person may withdraw from family and society • Family and closely realted people are highly affected • Extensive care is expected by the patient that causes a distress in the family environment and disturbs thier normal life.

12. Pathology • Alzheimer's disease spread through the outer layer of the brain----- Cerebral cortex • It is associated with the plaques and tangles in the brain. • ''Accumilation of amyloid plaques between nerve cells ( neurons) in the brain''. Or may be some abnormal proteins interfare with the normal proteins and spread throughout the brain. • As the nerve cells die continously, the brain shirks and there is deficiency of Acetyl cholene in the brain. • Acetyl cholene is a neurotransmitter that is deficient in Alzheimers Patient. • It can be genetic as well.

13. Pathology • Amoylid are the protein fragments that the body produces normally. Plaques are dense deposits of a protein and cellular material outside and around the brain nerve cells. • Tangles are twisted fibres that build up inside the nerve cells (neurons)

19. Pathology Normal Brain Affected Brain • Protein fragments break Protein fragments down & get eliminated. accumilate to form hard insoluble plaques. • Normal Tau proteins Abnormal tau proteins • Normal microtubule Microtubule structure structure collaspe (disintegrade) • Normal brain tissues Brain tissues shrink

20. Pathology Normal Brain Affected Brain • Normal Ventricles Enlarged Ventricles • Normal cells Cells in Hippocampus degerate • Normal production of Acetylcholene deficient. Acetylcholene

21. Diagnoses • It may stay undiagnosed for years • Early stages are difficult to Diagnose • Severe symptoms lead to the diagnoses of the disease as discussed previously. • 7 years life expectancy after it is diagnozed. • There is no definite diagnostic test for Alzheimer’s, • But by examination of the brian tissues that can be done by Brain scans, information is obtained. • MRI • PET • CT • It is diagnised in adults, people over 65 years.

26. Drugs • People with Alzheimer's have a serious shortage of the chemical acetylcholine in their brains, affecting nerve cell communication and memory. • The new drugs maintain existing supplies of acetylcholine by blocking the production of the enzyme acetyl cholinesterase. This enzyme usually acts to clear away acetylcholine. These acetyl cholinesterase inhibiting drugs are: • Reminyl (also called galantamine) • Aricept (donepezil hydrochloride) • Exelon (rivastigmine)

27. Drug Side-effects • It is important to remember that these drugs are not a cure, but may stabilize some of the symptoms of Alzheimer's disease for a limited period of time. • Side-effects may include diarrhea, nausea, insomnia, fatigue and loss of appetite. • Though there is no cure for Alzheimer’s, drugs can slow its progression. Those marketed by multinational companies cost around US$100 a month, putting them beyond the reach of many families. Locally manufactured drugs cost $25-37 a month.

29. Other Medications • Medication is sometimes prescribed to treat some of the symptoms of dementia, such as restlessness, delusions and hallucinations. These include tranquillizers, antidepressants and anxiety-relieving drugs • Wherever possible it is advisable to avoid the use of drugs. By minimizing distress and agitation and by making sure the person with dementia feels safe and cared for it is often possible to avoid the use of drugs altogether.

30. Treatment • Researchers are still developing new and compelling ideas about the diagnoses and treatment of this disorder by slowing or stoping thier progression • Evaluation of thinking abilities and behaviour is a part of treatment • Treatments may help in relieving pain and stress only.

31. Treatment • Pharmacologic and Non Pharmacologic Pharmacologic: • Symptoms are treated by medications. Five drugs have been approved by the U.S food and Drug Administration that temporarily improve symptoms by increasing the amount of chemicals called neurotransmitters in the brain. • No means of curing the Alzheimer's disease. • Drugs available that may alleviate symptoms in some people in the mild to moderate stages of Alzheimer's, such as restlessness and depression can be treated or to improve someone's memory with medication at early stages.

32. Treatment Non Pharmacologic Maintaining a sense of well-being and individuality • Reducing the depression, agression, sleep disturbances, agitation, wandering. • But still there is no pharmacologic therapy for Alzheimers.

33. Prognosis • It is not curable, degeneratice diseases are not curable because continous degradation of cells is taking place.Treatments may help in relieving pain and stress but do not sure the disease as previously said. • Independent persons start living dependently. • Body funstions are lost leading to death. • It gets worse as it progresses and eventually leads to death • Life expectancy decreases • Men have a less favourable survival prognosis than women • It is the cause of death in 70% cases.

34. Prognosis • Good memories are the asset of human life they are to be delivered to the young ones so that they can learn from the experience of their elders. If these memories are lost it would not only be an individual loss but also a social one. • People who engage in intellectual activities such as reading, playing board games, completing crossword puzzles, playing instruments or regular social interaction show a reduced risk for Alzheimer disease. • Dr. Yasmin Raashid, Patron Alzheimer’s Pakistan, urged the participants to treat these patients with the utmost love, patience and tolerance. She further said that with the increase in the average life span of population of Pakistan, the prevalence of the disease is on the rise and Alzheimers Pakistan is working on it.

35. Prevention • Slightly cure is possible by mental stimulation, exerise and balanced diet. • By keeping stress in check • A healthy life style can prevent or reverse detoriation.

36. Conclusion

37. Important message.....! • Play chess and take it easy...!! Chess improves thinking ability... • Life is green....and you can take the best of it...!