Being ulyanin or forgetful is often deemed synonymous with aging in our culture. But how do we know when the lapses are no longer due to disuse but disease?
“Normal memory loss is just a slowing of general efficiency. You can’t find the right word, or [you] misplace your things—but you recall it later on,” says Michelle Anlacan, M.D., head of the Center for Memory and Cognition at the Philippine General Hospital. “It becomes abnormal or pathologic when it starts to interfere with daily life,” she says.
Such a handicap may be indicative of Alzheimer’s disease (AD), a leading cause of dementia or decline in thinking skills, especially among the elderly. “It is a serious condition,” says Dr. Anlacan, who is also a clinical associate professor of neurosciences in the University of the Philippines-College of Medicine. “Sometimes even educated people fail to realize that.”
Such was the case with Maria, whose father, then in his 70s, forgot the way to his daughter’s house. “He was last seen hailing a cab, then he went missing for almost a day!” she shares. He eventually turned up, so they dismissed it as an isolated incident.
“Among the elderly, the inabilities to keep track of own medicines, use the phone, handle money, or use public transportation are red flags,” Dr. Anlacan says. Other signs are disorientation, poor recall of recent events or conversations, and the inability to recognize friends or family.
Five years after the first incident, Maria’s dad developed the rest of the symptoms abruptly the day after a typical family dinner where he participated. “When he woke up the next day, he was an entirely different person,” she recalls. A neurologist confirmed their fears after a memory screening and a brain scan: Maria’s father had Alzheimer’s.
“We had to hire someone to watch him round-the-clock, because he could no longer care for himself. He also forgot our names, talked nonsense and threw tantrums all the time,” she says of her previously mild-mannered dad.
Like most patients afflicted with AD, he exhibited the ABC’s of the illness: changes in Activities of daily living, Behavior, and Cognition.
The probable cause
The specific cause of AD remains uncertain, but research points to genetic abnormality in protein metabolism as probable cause. Dr. Anlacan says that risk factors for stroke also contribute to AD, indicating that the problem may be related to blood flow. However, most commonly held beliefs are unfounded, and these include:
• sustaining head injuries, which may result in amnesia, but not necessarily lead to AD;
• drinking out of or cooking in aluminum containers; or
• ingesting aspartame, an ingredient used as artificial sweetener.
While the causes are unclear, AD’s anatomic consequences are well studied. On the microscopic level, insoluble neurofibrillary tangles (kinked proteins) and amyloid or starch-like plaques accumulate in certain areas of the brain, beginning with the centers for memory. The dense and matted proteins disrupt metabolism and block communication between brain cells, causing their eventual death.
Dealing with Alzheimer’s
There’s no cure for AD, but “when caught early, we can slow the progression of disease with medications. Patients can stay functional for as long as seven to 10 years,” says Dr. Anlacan, adding that the availability of generic medicine makes AD manageable, even for less fortunate patients.