On 15 June 2024, Seniors Today hosted their weekly Health Live Webinar with Dr Vishal Chafale, a leading Interventional Neurologist who spoke on and answered questions about Alzheimer’s Disease.
About Dr Vishal Chafale:
Dr Vishal Chafale is a highly regarded neurologist with extensive experience, practising at Apollo Hospitals CBD Belapur in Mumbai. With years of expertise in the field, Dr Chafale specialises in treating a wide range of neurological conditions, ranging from stroke treatment and prevention to headache, epilepsy, parkinsonism, and neuromuscular disorders
Dr Chafale’s comprehensive knowledge and experience enable him to provide precise and effective treatment to his patients. He understands that neurological ailments can manifest in various ways, from minor headaches to more complex disorders. As such, he emphasises the importance of consulting a neurologist, especially for persistent or severe symptoms. In addition to diagnosing and treating neurological conditions, Dr Chafale recommends specialised tests such as electroencephalogram, cerebrospinal fluid analysis, and blood tests for a thorough evaluation. He also collaborates with physical therapists to develop management strategies for patients with neuromuscular disorders, aiming to improve their overall movement and quality of life. Dr Chafale’s dedication to the field of neurology is evident through his numerous publications in medical and neurology journal
A graduate of prestigious institutions and holds degrees including MBBS, MD, DM in neurology, and DNB, Dr Chafale has earned a fellowship for interventional neurology, showcasing his commitment to advancing his expertise and providing the highest standard of care to his patients.
Alzheimer’s disease is a common disease found in the elderly.
With the advancement in the medical world and techniques, our population is living longer, hence ageing. This is why all the elderly issues are now more prevalent. And Alzheimer’s disease is one such problem and is more frequently diagnosed, occasionally it is also neglected or misdiagnosed/ undiagnosed.
Alzheimer’s disease is a form of dementia. It is one of the more common types of dementia.
Dementia in simple terms is “forgetfulness”. The capacity of our brain, to reason, calculate, logic, retaining new information and forming new memories is affected in dementia.
The brain helps maintain our cognition and cognitive function. The brain helps in cognition by identifying objects, logical thinking, thought perception and remembering and retaining information.
When cognition, formation of new memories is affected to an extent where it starts to affect the individuals day to day life and activities, it is labelled dementia.
Dementia is an acquired disease.
It leads to impairment in personality and functionality. But the patient is conscious.
In clinical practice, when the disease leads to impairment of daily activities, it is labelled as dementia. Otherwise it is labelled as minimal cognitive impairment- such patients may remain in the same stage without further progression of disease and are managed and treated with memory boosters.
Dementia is a slowly progressive disease which does not present with severe symptoms overnight. Which is why, in the initial stages of the disease, it is often overlooked. And by the time the symptoms become significant, the disease has progressed to involve a large portion of the brain and its function leading to neurodegenerative processes which have progressed.
Normally, we have a compensatory process in the brain, wherein, let’s say 5% of the neuron’s are lost, the individual will not show any symptoms/ significant manifestation because the 95% of the brain is functional and compensates for the lost 5 %.
But after a certain point, the rest of the neuron’s cannot make up for the degeneration/ loss of neurons, and this is called decompensation- which is when the patient starts presenting with symptoms such as forgetfulness.
By the time we notice the first symptom, it is likely that the process had begun at least a year ago and is now being manifested as symptoms.
Dementia can be of 2 types:
- Primary Dementia:
- Secondary Dementia: this can be due to a disease/ cause which leads to dementia such as – stroke, medication, deficiencies of certain vitamins and minerals such Vit B12, untreated thyroid disorder, subdural hematoma/ tumour growing in the brain, etc
There are different types of dementias, such as:
- Alzheimers dementia
- Lewy body dementia (LBD)
- Parkinson’s disease- an individual with advanced Parkinson’s will have dementia
- Frontotemporal dementia
Alzheimer’s dementia is a chronic, irreversible disease which affects the function of the brain ultimately leading to impairment of intellectual functioning.
A patient with dementia ultimately, even if slowly, loses his capacity to reason, remember, imagine and learn.
Causes for dementia:
- Age
- 1 in 6 women and 1 in 10 men are prone to dementia (Females > Males)
- Family history- less than 10% of individuals with dementia/ Alzheimer’s disease have a positive history. Individuals with a history of Alzheimer’s do however have a higher risk as compared to those without a family history of the same.
- Genetic dementia/ Alzheimer’s is seen in the younger age group i.e. less than 60 years of age. It is however relatively rare
- Individual with Down’s syndrome
- Recurrent stroke
- History of head injury
Modifiable risk factors include:
- Uncontrolled hypertension
- Dyslipidemia
- Uncontrolled diabetes mellitus
- Excessive smoking and drinking
Environmental factors:
- Recurrent infections
- Metal and toxins
- Excess amounts of metals such as Zn and Cu in the brain
- Deficiency of certain vitamins such as B12, B6 and folate
Dementia as a disease is a burdensome one- on the patient and the caregivers.
Pathologically, there is a deposition of neurofibrillary triangles, and amyloid plaque formation in the neuron’s which leads to degeneration of the neurons causing damage to the microtubules, in the brain.
Predominantly, the memory area is affected which is in the temporal lobe. Which is why patients with Alzheimer’s will commonly present with memory loss/ memory related symptoms. It also does affect other parts of the brain as well, but the most common and predominantly affected are the frontal, temporal and parietal lobe.
Sometimes, all lobes are equally affected, at other times, only one is affected the most in comparison to others- leading to variability in symptoms depending on the affected area.
Clinical features of dementia:
- Personality changes: lack of interest in day to day activities, easy mental fatigability, withdrawn, self centred, negligence of personal hygiene
- Episodic memory disturbance: recent memory is more affected than remote memory
- Disorientation to time, place and person
- Difficult in abstract thinking
- Reduced attention span
- Difficulty in reasoning and logical thinking
- Behavioural variant: these patients are difficult to manage, due to a higher extent of personality changes they might be aggressive, have hallucinations, etc.
