HEALTH: Unremembered but not forgotten

FOUR months after my grandmother, Modesta Tacio, turned 66, she started acting strange. She kept forgetting simple things: where she put her keys, if she had eaten lunch already, or if she had paid the electric and water bills. “Don’t worry.  Forgetfulness happens once in a while,” my aunt Lydia assured her.

But as months progressed, her forgetfulness was getting worse and worse. She could no longer remember the names of her grandchildren.  “What’s your name again?” she would often inquire.

During the 1998 Christmas, we came to her house before midnight as a family tradition.  We sang Christmas carols and five minutes before it struck 12, we went to the table to eat.  I was completely surprised when my grandmother asked me, “Who are you?”

As months passed by, my grandmother’s problem became more lucent.  At one time, she went alone – without my aunt Lydia’s knowledge – to the public market.  She used to this since the public market is about one kilometer away from home. But on her way back, she became disoriented and was completely lost.

We went frantic when my aunt Lydia told us that my grandmother never came home that day.  We searched for her all over the town but failed to find her.  “Have you seen this woman?” we inquired.  But most people we asked replied negatively.

Two days later, after a neighbor told us that he found an old woman in New Clarin, a barangay some eight kilometers away from the town proper.  We immediately went and sure enough, we found her sleeping under a mango tree.  “I could no longer remember the road,” she said crying as she embraced my dad.

Because of this incident, we brought my grandmother to a doctor who referred her for special assessment by a team of doctors consisting of a neurologist, psychiatrist and psychologist.  Certain tests were performed.  Their diagnosis: Alzheimer’s disease.

Actually, dementia is the name of the disease and Alzheimer’s disease is the most common form. “Alzheimer’s disease is seen more commonly in the older age group,” explains Dr. Manolette R. Guerrero, chairman of the Department of Nuerosciences at the Davao Medical School Foundation.

Forgetfulness or lapses of memory is, contrary to most belief, is not actually part of the aging process, although it strikes mostly adults.   But memory loss is always the first sign of the disease.

Such was what happened to 60-year-old Charito.  In an interview, she admitted she has trouble with words and sometimes, simple physical tasks such as preparing the table for dinner.   Her memory troubles, however, come and go.  “There are times when I don’t have any problem,” Charito said.  “But there are also instances that I don’t know what I am doing at all.”

The National Institutes of Health (NIH) of the University of the Philippines in Manila does not consider Alzheimer’s as normal part of aging.  “Alzheimer’s is not just a disease of old age,” it said in its website.  “Up to 5% of the people with the disease have early onset Alzheimer’s, which often appears when someone is in their 40s or 50s.  It worsens over time.”

But oftentimes, Alzheimer’s disease is equated with aging.  Because of this, most of those afflicted with the condition go untreated.  “Family members of people with Alzheimer’s disease tend to ignore the signs of the early stage of the disease,” says Dr. Grace Orteza, a neurologist and psychologist.

In the past, people died fairly of “old age” – succumbing to hardening of arteries, heart attacks, strokes and a myriad of opportunistic diseases.  But with advances in medicines, the increase of life expectancy, more people are now growing old.  And as a result, the Philippines is expected to have more people suffering from the disease. In fact, around 11% of older adults in the country have dementia.

Data from the Philippine Neurological Association in 2005 showed 179,000 Filipinos having dementia.  “By 2020, it is expected to affect 334,000 and by 2040, as many as 832,000,” claims the Alzheimer’s Disease Association of the Philippines (ADAP).

In his book, “Doctors’ Health Tips and Home Remedies,” Dr. Willie T. Ong – with his wife, Dr. Liza Ong as co-author – said Alzheimer’s disease affects 5% of those whose are between 65 to 74 years, and 30% of the people above 85 years.

If in the old days doctors had a hard time diagnosing Alzheimer’s disease, it the other way around now.  In fact, doctors can now diagnose the disease with 90% accuracy, but proof can only be obtained by examining the brain of the patient after death. Unfortunately, many other disease processes can mimic Alzheimer’s disease such as thyroid imbalances, vitamin B12 deficiency, brain injuries, tumors, and depression.

Health experts say memory is the first thing to go.  More precisely, it’s the first thing doctors consider in an evaluation.   Generally, it starts with subtle changes in memory function.  “What comes first gets out last with the most recent memory getting lost first,” explains Dr. Simeon Marasigan, associate professor at the department of neurology and psychiatry of the University of Santo Tomas.

In some instances, the patient may exhibit abnormal behavior.   “People suffering from Alzheimer’s may be unreasonable,” explains Dr. Victor Chong, a neurologist with special interest in dementia from the University Malaya Medical Centre in Kuala Lumpur.   “For example, a husband with Alzheimer disease may often accuse the wife of infidelity.”

But as the disease progresses, language skills diminish, along with the ability to perform calculations or planning activities.   A person who used to be very good at giving his opinions on certain topics, solving problems, and painting, may not be capable of doing them now.

Unlike in the past, doctors can now diagnose the disease with 90% accuracy, but proof can only be obtained by examining the brain of the patient after death. Unfortunately, many other disease processes can mimic Alzheimer’s such as thyroid imbalances, vitamin B12 deficiency, brain injuries, tumors, and depression.

“Don’t delay; getting early diagnosis and going public with the disease is really, really important,” suggests Lorna Drew Ferrari, who co-wrote the book, “Different Minds,” with her husband who suffered from the disease. “There is nothing to be ashamed of.”

However, there is no single cause of death associated with Alzheimer’s disease. Many sufferers die from problems related to the decrease in brain function. “When Alzheimer’s is the cause of death, patients often die because of the complications related to the disease like as pneumonia, urinary tract infection, and skin infection from pressure sores,” says Dr. Chong.

Alzheimer’s can run its course from insidious onset to death in just a few years, or play itself out over a period as long as 20 years.  “Most people with Alzheimer’s live for seven to 10 years after diagnosis, spending five years under vigilant care,” says Dr. Socorro Martinez, head of the memory center of St. Luke’s Medical Center in Manila.

According to most health experts, the basic responsibility for management of the patient with Alzheimer’s rests with the family.  “Alzheimer’s is a long-term illness that requires a lot of care and love from family members,” says Dr.  Paul Pasco, a neurologist working with the Philippine General Hospital.

For someone having Alzheimer’s disease, the family is the microcosm of the whole world.  The family has to become aware of the condition and how it is likely to progress.  In the beginning of the disease, family members must choose among themselves who will be responsible for taking care of someone with the disease.

Actually, Alzheimer’s has two victims: the patient and the caregiver.  In most cases, Alzheimer’s is more agonizing for the caregiver than for the patient.  It is not only physically demanding but also emotionally draining.  In most instances, a caregiver experience stress which usually manifest through denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability and lack of concentration.

Professor Kua Ee Heok, a consultant psychiatrist from the National University of Singapore, suggests that caregivers should be given a break by taking over caregiving responsibilities for a few days.  “We sometimes advise the caregivers to bring those with Alzheimer’s to a day care center where trained nurses could take care of them,” he says.

“Every age has its own way of dying,” wrote Lev Grossman in an article which appeared in “Time.”  “The 19th century had consumption, the 20th century had the heart attack, and the 21st century will be the age of Alzheimer’s disease.”