Bhanu Dhakal, a Kathmandu resident who is in his early 70s, was referred to a psychiatrist by his primary care doctor for symptoms of depression after not responding to medications. According to Dhakal’s granddaughter, his behaviour begun to change in his late 60s, a few years after his wife passed away. He had stopped playing bagh chal, a Nepali board game, which he had enjoyed for decades. He was no longer interested in going out of the house and refused to socialise. Instead, he sat on the couch all day and watched TV or napped. He slept for almost 10-13 hours a day than his usual 7-8 hours sleep.
This made other members of his family worry that his retirement from his job and the passing away of his wife had left Dhakal depressed. Then they mentioned their concerns to their primary care doctor and Dhakal was prescribed an antidepressant. However, his condition did not improve and later Dhakal was diagnosed with Alzheimer's.
Dr Ramesh Kandel says that Alzheimer’s is a progressive, degenerative ailment of the brain that affects the memory and behaviour of an individual at a later age. “The neurons start to degenerate, and the individual starts to forget and it progresses with the age of the patient,” he informs. Dr Kandel is the first registered Geriatrician (senior citizen specialist) and Dementia specialist in Nepal.
Chhatra Pradhan, former president of the National Senior Citizen Federation says that most Nepalis think Alzheimer’s just as a problem that comes with old age. "This is why the majority of Nepalis don't know about this disease," he adds.
September is marked as World Alzheimer’s Month and September 21 as World Alzheimer’s Day. This year was the 28th anniversary of Alzheimer's Day. However, very little has been done to raise awareness about Alzheimer’s in Nepal.
According to Dr Kandel, senior citizens above 80 years of age have a 45 percent chance of suffering from Alzheimer's, while it is 10 percent for people between 65-75 years. "In the medical context, Alzheimer's condition has been classified into mild, moderate and severe stages,” says Dr Kandel, adding, “During the initial stage, patients suffer from a gradual loss of memory, difficulty in recognising their family members and friends and places, taking more time to do things than before, losing or misplacing objects and experiencing increased trouble in planning and organising while gradual deterioration in behaviour and personality are observable.”
The symptoms in the middle stage are generally being forgetful of events or personal history, feeling moody or withdrawn, especially in socially or mentally challenging situations, being unable to recall information about themselves like their address or telephone number, living in a highly confused state, experiencing changes in sleep patterns such as sleeping during the day and becoming restless at night, facing problems in reading, writing and handling simple mathematical works, having problems with new things and work, getting lost in the daily walk, repeating the same thing and doubting everything.
In the third or the severe stage, the condition of patients suffering from Alzheimer's aggravates and more problems appear. They usually lose the ability to respond to their surroundings, to engage in conversation easily with others and control their movements. They may also suffer from pneumonia with gradual problems in eating/chewing/swallowing, weight loss, increased laziness and sleepiness and inability to control defecation. As memory and cognitive skills further decline, the patients need extensive medical care.
According to Kandel, the Covid-19 pandemic has restricted the movement of old-aged people outside of their homes making them more susceptible to Alzheimer's. "As their personal and social activities and interactions have been restricted, it has increased the risks related to Alzheimer's," he mentions.
According to Pradhan, the pain and suffering of patients of this disease can be lowered if other members of their family understand the problems and act accordingly. "The other family members of the patients need to avoid feeling disgusted and frustrated by their behaviour. Showing care and responsibility towards the patients can make a big difference in terms of medical treatment and making lives easier," he says.
There is no definitive cure for Alzheimer's disease. Physicians generally teach ways to manage memory loss and other brain functions. Regular physical exercise, social and intellectual activity, etc. can slow down the progression of the disease.
Some lifestyle choices can also reduce the risk of Alzheimer's. Being more active in social activities and engaging in intellectual exercises can help in keeping brain functions active. At the same time, regular physical activity to keep the circulatory system healthy also can prevent the brain from slowing down. "Regular consumption of fresh vegetables and low-fat and low-sugar diets is also a way to reduce the risk of Alzheimer's disease," shares Dr Kandel.
Alzheimer's is the most common form of Dementia, a medical term used for impaired ability to remember, think and make decisions during everyday activities. It contributes to 60 to 70 percent of cases. According to WHO data, about 500 million people worldwide suffer from dementia and 100 million new cases are registered every year. The total number of people with dementia is estimated to reach 820 million by 2020 and 1.22 billion by 2050. This medical condition is most prevalent in low and middle-income countries.
"Dementia is a misunderstood condition. Many people believe it is just a common problem related to aging and don't think beyond memory loss when it comes to symptoms. The reality is that Dementia is a condition that can be caused by different problems, most commonly Alzheimer’s which damages different areas of the brain," says Pradhan.
In Nepal, the Alzheimer's and Related Dementia Society and the National Senior Citizen Federation have been helping people for diagnosis of Alzheimer's, providing counselling and care training to family members of the patients.
In 2013, the government announced that it would provide Rs 100,000 to Dementia patients for their treatment. "Although the amount is small, this is the first step the government has taken in terms of controlling the disease," says Pradhan. But Dr Kandel points to the problems related to this subsidy programme. According to him, the treatment under the programme is available only at a few health centres making it very inconvenient for patients across the country to get treatment. "Besides, the government should also realise that the development of health infrastructure and medical workforce for geriatric care is crucial to cope with aging diseases like Alzheimer's," mentions Dr Kandel.