Understanding Alzheimer's Disease and Dementia

Alzheimer's disease is a progressive and permanent disorder that slowly destroys memory and thinking. It is the most common cause of dementia, a general term for memory loss, and changes in behavior and other intellectual capacities severe enough to interfere with daily life. It is estimated that 60% to 80% of the cases of dementia are caused by Alzheimer's. The incidence rate of Alzheimer's disease is rising, affecting millions of people worldwide. 

The most critical risk factor in developing Alzheimer's disease is age. Data shows that the number of people with Alzheimer's doubles every five years beyond 65 years of age. Even as a risk factor, acquiring the condition is not a normal part of old age. Risks in developing Alzheimer's also include a combination of lifestyle, genetics, and environmental factors. 

Individuals with Alzheimer's may experience various symptoms that progress over the years. These symptoms reflect the degree of damage in different parts of the brain, and the pacing and severity varies from person to person. Over time, people with this condition cannot do daily tasks because of the changes in mental conditioning.

As of writing, Alzheimer’s has no known cure. However, treatments for its symptoms are available. These treatments will not stop the disease from progressing, but they can slow the worsening of symptoms of dementia and improve the quality of life of individuals with Alzheimer's. Research to develop ways to prevent, delay, and cure the disease continues.

Signs of Alzheimer's and Dementia

• Pervasive forgetfulness and memory loss. Memory loss, notably forgetting recently gained information, is one of the most apparent indications of Alzheimer's disease. This can involve forgetting the names of people, locations, and holidays. They may also put things in odd places, lose them, and be unable to retrace their actions. This can occur more frequently over time as the disease progresses.
• Problems with orientation. People diagnosed with Alzheimer's may be confused with dates, events, and time. They sometimes forget where they are or how they got there, causing them to wander and get lost.
• Inability to express thoughts and deterioration of language. People with Alzheimer's may begin to have trouble following or holding a conversation. Alzheimer’s patients may stop in the middle of a sentence and have no idea how to continue, or they may repeat their questions and statements. They may also struggle with vocabulary, have problems finding the right word, or call things by the wrong name. 
• Poor judgment. People with Alzheimer's may experience changes in awareness or perception. This can result in poor decision-making and judgment. They may pay less attention to their hygiene and grooming. Some patients may require help with basic activities, such as bathing, dressing, and using the bathroom.
• Difficulties in planning, organizing, and completing tasks. Some may undergo changes in their ability to organize and finish work, especially involving numbers. This includes managing a budget, keeping track of monthly bills, taking medications, or counting change. They may have difficulty concentrating, and usually take much longer to do things than they did before. 
• Impaired ability to perceive images and spatial relationships. They may have difficulty reading and determining the distance of objects that may cause driving and mobility problems.
• Impaired social and occupational functioning. Changes in personality and mood may include loss of interest in previously enjoyed activities. They can become anxious, confused, or depressed. They may withdraw from people at home, at work, with friends, or in places out of their comfort zone.

Alzheimer's and Dementia in the Philippines

The increase in elderly population worldwide has predictably accompanied the rise in Alzheimer's cases. The disease also affects caregivers and society, amounting to healthcare costs. Furthermore, the Philippines is confronted with the epidemic of dementia, and thorough preparation is necessary to face this difficulty effectively. 

The Philippine Statistics Authority recorded 3,368 total deaths due to Alzheimer’s disease from 2012 to 2018. It is a growing problem and will increase in the coming years. Therefore, it is critical to raise awareness and advocate for improving health care and social strategies to address the epidemic.

For in-patient care for dementia due to Alzheimer's disease, PhilHealth can cover PHP10,000 worth of hospital costs, including the professional fee for the healthcare providers and institution. To avail of these benefits, you must meet specific requirements:

• Qualification as a PhilHealth dependent;
• Active PhilHealth membership or any qualifying contributions;
• Admission to a PhilHealth accredited facility (for more than 24 hours);
• Attended by a PhilHealth accredited physician
  

Currently, dementia diagnosis and management for outpatient settings are not covered by PhilHealth. Diagnosis and treatment costs for Alzheimer’s disease, including assessment, laboratory, rehabilitation sessions, caregiver education, and medications are estimated to reach average costs of Php 100,000. These services are all granted with a 20% senior citizen discount.

Care for Loved Ones with Alzheimer's Disease 

The goal of caring for Alzheimer's disease with dementia should be maintaining good health, maximizing independence, providing adequate nutrition, and reducing anxiety. It also helps to improve communication, increase socialization and intimacy. Here are some ways you can help and care for your afflicted loved one:

1. Orient them to the environment as needed if their short-term memory is intact. This can promote their sense of self and reality and can aid them in differentiating day and night. Use of calendars, radio, newspapers, books, magazines, and television are also encouraged.
2. Allow them to wander in a controlled and familiar environment. This increases their security and decreases hostility and agitation by permitting behaviors that are difficult to prevent within the confines of a safe, supervised environment. Provide a safe area in your home to move about (e.g., secured circular path).
3. Obtain and have them wear identification jewelry, such as a bracelet or necklace showing name, phone number, and diagnosis. This facilitates their safe return if they get lost. Because of poor verbal ability and confusion, they may not be able to state their name, address, and phone number. They may wander, exhibit poor judgment, be confused, irritable, or have violent outbursts. Having identifiable jewelry may be helpful.
4. Maintain a daily regular routine to prevent problems resulting in thirst, hunger, lack of sleep, or inadequate exercise. If your loved one's needs are not met, it may cause them to become agitated and anxious. Predictable behavior is less threatening to them and does not limit their ability to function with activities of daily living.
5. Give simple instructions, one at a time, or step-by-step directions, using short words and simple sentences. Alzheimer's disease may impair their ability to process and comprehend complex messages. Simplicity is the key to communicating verbally and nonverbally in individuals with Alzheimer's disease and dementia.
6. Avoid anger and expectation of your loved one to remember or follow instructions. Do not expect more than what they are capable of doing. Negative emotional responses are prompted by a failure to complete a task when they feel expected to perform beyond their ability. Responding calmly can validate their feelings and causes less stress and frustration.
7. Determine their hygienic needs and assist as needed, including care of hair, nails, skin, brushing teeth, and cleaning glasses. As the disease progresses, they may forget basic hygienic activities. This can result in infection, gum disease, disheveled appearance, harm, and other health complications.
8. Seek local resources such as Alzheimer’s Association, adult daycare, respite care, home care services, or a virtual support group for caregivers. Coping with taking care of your loved one with Alzheimer’s is a full-time, frustrating task. Respite and daycare may lighten the burden, reduce potential social isolation, and prevent family burnout and caregiver role strain. The Philippine Alzheimer's Support Group is a peer-led Facebook support group that can provide a social outlet for sharing grief and promote problem-solving regarding medical, financial, or legal advice.
9. Seek professional and supportive services as needed. Regularly consulting a healthcare professional to evaluate the progression of your loved one’s condition is essential to aid in the continuity of their care. Online consultations can provide medical information, referral programs, medication management, and behavior modification therapies.

Sources:

2018 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia, vol. 14, no. 3, Mar. 2018, pp. 367–429, doi:10.1016/j.jalz.2018.02.001.

Dominguez, Jacqueline, Ma. Fe de Guzman, Macario Reandelar, and Thien Kieu Thi Phung. Prevalence of Dementia and Associated Risk Factors: A Population-Based Study in the Philippines. Edited by Koji Abe. Journal of Alzheimer’s Disease 63, no. 3 (May 8, 2018): 1065–73. https://doi.org/10.3233/jad-180095.

Facts and Figures. Alzheimer’s Disease and Dementia, 2021. https://www.alz.org/alzheimers-dementia/facts-figures.