Alzheimer’s disease: Lest you forget

(First of Three Parts)

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


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 became 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.

“Memory loss may be the most apparent – and earliest – problem in Alzheimer’s disease but other symptoms are equally annoying to the patient and alarming to his relatives,” explains Dr. Simeon Marasigan, an associate professor at the department of neurology and psychiatry of the University of Santo Tomas in Manila.

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

No one knows how many Filipinos suffer from this common degenerative condition of the brain because statistics are hard to come by. Figures from the Population Commission, however, showed that the number of older people aged 65 and above have increased considerably – from 2.9% in 2004 to 4.3% in 2014.

In an interview with Philippine Daily Inquirer, Dr. Marc Evans Abat, consultant director of the Center for Healthy Aging at The Medical City, said older people are vulnerable to various illnesses like hypertension, heart disease, stroke, chronic obstructive lung disease, cancer, kidney failure, liver disease, cataract, hearing impairment, arthritis and osteoporosis.

They are also susceptible to Alzheimer’s. The disease often starts in late middle life with slight defects in memory and behavior. That was what had happened to my grandmother, who died of the complications of the disease.

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,” says 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 aging, although it strikes mostly adults. But memory loss is always the first sign of the disease. Charito, for instance, admits 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 admits. “But there are also instances that I don’t know what I am doing at all.”

“The loss of memory can progress to more serious problems like leaving the door open or the stove burning, becoming lost in places the patient is familiar with, and difficulty recognizing familiar people,” Dr. Abat said.

The disease becomes more serious when the patient shows behavioral problems like becoming paranoid (example: accusing people of stealing money or marital infidelity), becoming uninhibited (such as running around naked or getting into unprovoked fights), or having hallucinations.

The Alzheimer’s Disease Association of the Philippines (ADAP) lists the following as common symptoms of Alzheimer’s disease:

Difficulty performing familiar tasks: People with dementia often find it hard to complete everyday tasks. A person with Alzheimer’s disease Alzheimer’s disease may not know the steps in preparing a meal, using a household appliance or doing a hobby.

Problems with language: A person with Alzheimer’s disease often forget simple words or substitutes unusual words, making his or her speech or writing hard to understand. If he or she is unable to find his or her toothbrush, for example, he or she may ask for “that thing for my mouth.”

Disorientation to time and place: People with Alzheimer’s disease can become lost in their own street, forget where they are and how they got there, and not know how to get back home.

Poor or decreased judgment: Those with Alzheimer’s disease may dress without regard to the weather, wearing several shirts or blouses on a warm day or very little clothing in cold weather. They often show poor judgment about money, giving away large amounts of money to telemarketers or paying for home repairs or products they don’t need.

Problems with abstract thinking: Balancing a checkbook may be hard and the task more complicated than usual. Someone with Alzheimer’s disease could forget completely what the numbers are and what needs to be done with them.

Misplacing things: A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.

Changes in mood or behavior: Someone with Alzheimer’s disease can show rapid mood swings — from calm to tears to anger — for no apparent reason at all.

Changes in personality: People’s personalities ordinarily change somewhat with age. But that of a person with Alzheimer’s disease can change a lot, becoming extremely confused, suspicious, fearful or dependent on a family member.

Loss of initiative: A person with Alzheimer’s disease may become very passive, sitting in front of the television for hours, sleeping more than usual or not wanting to perform usual activities.

Since it is equated with aging, 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.

But 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.”