During a recent radio talk show on the topic of ‘love’, a listener phoned-in to convey a message to a person very dear to his heart. The monologue went on something like this, ‘I would like to wish my loving wife a Happy Valentine’ s Day. We have been married for 51 years now. Sadly, even though she is still among us, she is however not with us. She has Alzheimer’s Disease’.
Years ago, I remember reading in the newspaper a story on a similar subject. It tells of the stress, helplessness and despair experienced by those caring for their mother who was suffering from Alzheimer’ s Disease. ‘She used to be so clean, so composed, so conscious of her health and beauty. She used to be immaculate, and weIl-balanced. She travelled abroad, and she read a lot’.
‘But Alzheimer’s Disease changed all that. We had to bathe and brush her teeth, too. We had to feed her. She did not know what to do with food herself. She would put the plate on her head, and instead put objects like plastic, in her mouth. She would pluck the leaves off the plants and eat them. This is my mother, I had to keep reminding myself.
Such comments echo the sentiment of those being left with having to care for their loved ones suffering from one of the most dreadful and debilitating disease to inflict mankind. Alzheimer’ s Disease is the number one cause of dementia, or mental deterioration, among people aged 65 and above. A slowly degenerative brain disorder, the disease is manifested by changes in behaviour and personality. The severity varies from person to person, as does the duration of the disease which average s from 4 to 8 years.
The symptoms of the disease were first described by Dr. Alois Alzheimer in 1906. Here are some of the notes of the case presented by the good doctor at a meeting in Tubingen, Germany. ‘A woman, 51 years old, showed jealousy towards her husband as the first notable sign of the disease. Soon, rapidly increasing loss of memory was noticed so that she could not find her way around in her own apartment. ‘
‘She carried objects back and forth and hid them, at times she would think that someone wanted to kill her and would begin shrieking loudly. Periodically she was totally delirious, dragged her bedding around, called her husband and her daughter and seemed to have auditory hallucinations. She was unable to read or write, but her movement was normal and there were no other physical signs. However, generalised dementia progressed, and at the end the patient was completely stuporous. Death occurred after four and half years of the disease.’
The picture painted by Dr. Alzheimer of his patient is grim indeed. Once diagnosed as having Alzheimer’ s Disease, the patient begins to experience that sinking feeling. Often there is an irreversible decline in intellectual abilities. Thinking, memory and judgement are also impaired, in stages, ranging from mild forgetfulness to severe dementia.
For example, you know that your wife always misplaces her keys. But strangely, last weekend she could not remember what they were for. Your grandfather likes to take daily strolls around the neighbourhood. But four times in the past month he has gotten lost and had to be brought home by the neighbours. Your favourite uncle cannot recall your name or the names of your husband or children. These are possible early indicators of the coming of the Alzheimer’s Disease.
Alzheimer’s Disease patients tend to forget how to do simple tasks, that is, things we take for granted doing, like brushing the teeth and combing the hair. They may try to put their legs through the sleeves of a jacket or put a blouse or a shirt on back to front. Forgetting how to toilet themselves is another common trait of those suffering from the disease.
Frequently though, they mistakenly assume that such behaviour is a normal part of growing old. It is not. Thus, the symptoms may develop gradually and go unnoticed for a long time. Eventually they become completely indifferent to the surrounding and are totally dependent on others for their care. In other words, they are transformed to being little children again. The term ‘second childhood’ has been used to describe this condition.
What causes Alzheimer’s Disease? At present this remains a mystery. The symptoms do indicate that there is a selective, yet perpetual breakdown, of communication between nerve cell s in the brain. Groups of nerve cell s in the brain have certain jobs. They may be involved in thinking, learning, remembering, planning and decision making. Nerve cells communicate via chemical messengers. Loss or absence of these chemicals, as in Alzheimer’s Disease, disrupts cell-to-cell communication and can interfere with normal brain function.
The second possible cause of the disease is deficiency in the metabolism of the nerve cells. Metabolism is the process where by cells breaks down chemicals and nutrients into energy. Failure of this system, which may be due to a host of yet to be determined causes, can be fatal to the nerve cells.
The third contributing factor of Alzheimer’s Disease is the disruption of the cellular repair and clean-up systems. When damage d or injured cells are not able to be nurtured to normal functioning, they become obsolete. Research shows that the pathology of Alzheimer’s Disease is associated with changes in all three systems, that is, nerve cell communication, metabolism and repair.
Although the actual cause of the disease is still unknown, there are however, a number of possible risk factors. Age, genetic defects, aluminium contamination and Down’s Syndrome are some of the factors implicated in the disease. Despite extensive research and inquiries, treatment of Alzheimer’s Disease remains elusive. A handful of drugs have been approved to help alleviate the disease. These drugs mainly act as substitutes for the depleted chemical messengers.
One thing is certain though. The risk of Alzheimer’s Disease increases with advancing age. After the age of 65, the percentage of people who suffer from the disease doubles every decade of life. However, Alzheimer’s Disease is not part of normal aging. Not every old-aged person or geriatric, has to suffer from the disease. Only those who are unfortunate enough to have their brain chemistry fail, would bear the brunt of Alzheimer’s Disease. Otherwise, the human brain is more than capable of functioning well, often into the centennial of life.
In Malaysia, the life expectancy of both male and female has increased from 64.3 and 68.7 years respectively, in 1975 to 69.5 and 74.1 years in 1995. This increase has been attributed to better health-care services and the overall improvement in living condition. More and more people are joining the ranks of geriatric. It is estimated that in 1996 there were 1.2 million Malaysians over the age of 60. This is expected to rise to 1.45 million and 3.2 million in the year 2000 and 2020, respectively. Geriatrics would therefore account for 6.6% and 11.3% of Malaysian population.
It has been estimated that the number of Alzheimer’s Disease patients in 1955 in the then Malaya was 99 per 1000 population over 60 year old. The figure rose to 120 per 1000 geriatrics in 1985. It is postulated that when Malaysia achieves the developed nation status in 2020, more than one-fifth of its sixty-something citizens would suffer from the disease.
Although sixty is considered as the breaking point age of becoming a geriatric, I would think that such oversimplification can be misleading. Therefore, it would be quite reasonable to say that one is a geriatric only five years after one’s complete retirement. This would be in line with the definition of a geriatric in other societies. Where the retirement age is achieved at 60, the geriatric stint begins when they celebrate their 65th. birthday.
The discussion on Alzheimer’ s Disease brings to mind some very pertinent issues, such as, aging, sickness and caring for the aged and the sick. Aging should be understood as a phase of growth and development. It is a universal biological phenomenon. Accordingly, the normal processes due to age alone need to be differentiated from change s induced by diseases.
Being old does not mean being sick or dependent. In fact, only a small percentage of old people have to forgo their independence. Verse 68 of Surah Yaasin somewhat summarizes these concepts, ‘If We grant long life to any, We cause him to be reversed in nature, will they not then understand?’
The interpretation of this verse is that as one grows, he undergoes both a physical and mental transformation, As a child, his body is fragile and his mind, rudimental. As he matures, both develop to a c1imax, only to dec1ine later as age catches up on him. In extreme old age, a second childhood seems to follow. The latter is not unlike someone who has to suffer from Alzheimer’s Disease.
The second issue is sickness or disease. Muslims are not to view sickness in the negative manner per se. There could be something positive in it. The Prophet Muhammad (peace be upon him) said, ‘No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls a Muslim, even if it were the prick he receives from a thorn, but that God makes up some of his sins for that. ‘
We are advised to be patient in ill-health and hope for a cure. A cure will certainly be found, if we persevere in our quest for it. ‘There is no disease that God has created, except that He also has created its treatment’, the Prophet assured us. Thus, we see the intensity and extent of research activity taking place throughout the world in trying to find remedies for the numerous hitherto incurable disease.
For illnesses like Alzheimer’s Disease, and other types of dementia or disorders attributed to the dysfunction of the brain and its nervous system, a cure is hopefully forthcoming. Recent advances in genetic research have provided interesting c1ues to the actual mechanisms which trigger these diseases. For example, researchers have discovered that two genes, presenilin I and presenilin 2, seem to be the culprit which push the brain cells towards suicide.
Cells normally go through a ‘programmed’ suicide process to rid the body ofthose which are old, worn-out, or unnecessary. It is also a key process for thinning out brain celIs, so that those that remain are not overcrowded. The problem in Alzheimer’s Disease is that the string of events towards cell suicide is triggered prematurely and uncontrollably.
The presenilin genes, normally going around their business within the cell in a subdued manner, are charged up by an enzyme and become the instigators which tum against their host. A drug that blocks the action of this enzyme may stop the cascade of cellular events that trigger cell death. This discovery may lead to novel treatment for Alzheimer’ s Disease, although this will likely take a number of years.
The third issue of the discussion is caring for the age d and the sick. More often than not, this responsibility is taken up by the children of the infirm. This is a noble gesture, indeed. Kindness to parents, especially those who are incapable of tending to themselves, is an act of piety.
The welI-known verses of surah Al-Israa’ is quoted here, ‘Your Lord has decreed that you worship none but Him, and show kindness to parents. If one or both of them attain old age with you, never say unto them any word expressive of disgust, nor reproach them, but address them with excellent speech. And lower to them the wing of humility out of tenderness. And say, My lord has mercy on them even as they cherished me in my childhood’.
An analysis of a study published in 1992 on family support for the elderly in Malaysia reveals a number of interesting facts. The survey on 1000 non-institutionalized senior citizens was conducted by trained interviewers. Almost 50% respondents were living in extended families. About 20% of unmarried and 15% of married respondents reported that they did not have a confidant, which is an indicator of loneliness.
Family members also appeared to be the most important helpers for 85% of the total respondents with basic tasks like eating and dressing, and practical tasks like shopping and traveling. The majority of subjects (60%) received financial support from their family. Although these figures indicate a positive trend, the fate of those who lack family support, like the 18% or so old people without confidant, and the 15% with no helpers, should not be neglected. Furthermore, a small number of those living in extended families (160) indicated that they were often lonely.
This is just a short review of the state of affairs of the geriatrics. It would seem that a lot still needs to be done in ensuring proper care for the nation’ s senior citizens, those who have built this wonderful country. In this respect, the formulation of the National Senior Citizen Policy would help expedite matters. Perhaps, it is also time to start the ball rolling for the setting up a National Institute of Aging, Malaysia.