NZ likely to experience Alzheimer’s epidemic
New Zealand likely to experience Alzheimer’s epidemic
The number of people diagnosed with Alzheimer’s Disease and related dementia is expected to more than double over the next 25 years. This will impact significantly on the lives of both patients and their families - who are the main caregivers of Alzheimer’s patients, as well as the New Zealand healthcare system. And while talk of a cure for Alzheimer’s is ever present, the reality is any such breakthrough is not in the immediate future.
As Alzheimer’s Disease affects an estimated 10% of people over 65, it is our ageing population that is the main contributor to this phenomenon. By the year 2051 older people (over 65 years) will make up to 26 per cent of all New Zealand residents (compared with 12% in 1999).
Today, Alzheimer’s Disease is widespread. And the older people get the more likely they are to be affected - one in five over the age of 80 and one in three over 85. Taking into account even medium population projections and increasing life expectancies, the scale of the problem could be huge in 20 to 30 years time. As it stands a 65-year old women will live, on average a further 19 years, to 84 and 65-year old men live an expected 15 ½ years longer - by which time a significant proportion will have Alzheimer’s Disease.
And, Alzheimer’s Disease is not just a disease of the elderly. The Alzheimers Society reports increasing numbers of people being diagnosed in their 40s and 50s.
However, the group that may be most affected by the disease is not the patients – but the families.
Alzheimer’s has been labelled “the carers’ disease” due to the impact it has on the family of the patient. The cost in terms of personal health and lost income is usually high.
As an example, overseas figures suggest that as many as 80 per cent of family caregivers report high levels of stress and stress-related illness.
Elizabeth Chesterman, National Executive Director of the Alzheimers Society New Zealand, believes New Zealanders will face a huge challenge dealing with the increasing numbers of Alzheimer’s patients in the not so distant future.
“Alzheimer’s Disease has been dubbed “the silent epidemic” for good reason – there is considerable public ignorance about the disease as well as a lack of acknowledgement and openess. Alzheimer’s Disease is also a “silent” disease because of its insidious nature – it is often difficult to diagnose accurately especially when in the early stages it mimics normal ageing and simple forgetfulness. And finally Alzheimer’s Disease is silent because of the loneliness and isolation experienced by caregivers coping with a loved one who has demntia,” she explains.
“We urgently need community and support systems put in place now so we will cope in the future. It is also crucial that more people are diagnosed as early as possible because drug treatment may both retard development of the disease and improve the quality of life for patients. This allows people to plan for progression of the disease, put in place social support and legal mechanisms which will assist as the disease progresses.”
“However, early diagnosis requires better understanding of the disease and its symptoms by the public and also more effective early diagnoses from the medical profession,” she says.
Treatment of Alzheimer’s Disease
There is now hope for many Alzheimer’s sufferers that their condition can be slowed providing better quality of life and easing pressures on caregivers.
Promises of a cure for Alzheimer’s Disease are ever present in the media, but such research is still very much in its infancy and is unlikely to result in any major breakthrough for the immediate future. Currently drug treatment for Alzheimer’s Disease relies on slowing the disease which may also bring respite to the health industry in New Zealand, both in terms of resources and of funding. The cost of drugs to control is far outweighed by the cost of caring for people with advanced cases of the disease
One of the most recent drug treatments that has been proven to successfully treat some patients is Exelon® (rivastigmine). It has been studied in clinical trials throughout the world and has shown to play a role in helping patients and caregivers to delay the progression, or improve the key symptoms, of Alzheimer’s Disease
Current drug treatments such as Exelon are not a cure but a means of treating the symptoms. They are most useful in patients with mild to moderately severe Alzheimer’s Disease so its success is also dependent on an early diagnosis.
Dr Deepal Lecamwasam, a consultant physician based at Tauranga Hospital, has a special interest in caring for the elderly and has monitored closely new developments for Alzheimer’s Disease in particular.
Having followed the progress of Exelon in various international trials, he was impressed with the results, and since it became available in this country has become one of a number of local doctors having some success with his patients using the drug.
“I now have a number of patients who have done very well on Exelon and they are still managing at home. My impression is that without this treatment they would be in institutionalised care by now," he says.
Dr Lecamwasam is convinced Exelon offers many patients and their families an effective means of managing Alzheimer’s Disease.
“There are potentially huge financial savings both for Government and families if people with Alzheimer’s can be managed at home longer. Of course equally importantly, most patients much prefer to be at home and their families usually prefer to have them there.
"While Exelon does not provide a cure, in those patients who respond well it gives considerable symptomatic improvement, better quality of life and also delays the point where institutionalism becomes necessary."
Dr Lecamwasam has used Exelon in 31 patients (all but one were living at home, and continued to stay there while on the treatment). They range in age from 58 to 87 years (average age 75) and the longest period to date where Exelon has been used is 20 months.
From his own experience, Dr Lecamwasam agrees with the clinical trials that show Exelon works for two or three patients out of 10 and says that a good response is usually evident within the first four to six weeks of treatment. While various cognitive assessments are available to monitor the level of dementia associated with Alzheimer’s, he also believes the feedback of caregivers is one of the best indicators of the success of treatment.
“Where it does work, the families can see that the person is more alert and able to concentrate better. They have often resumed old habits like reading, watching television, and applying make-up, and in some cases even gone back to a hobby like floral arranging.
“For families, the best part is not so much a case of seeing improvement in the short-term memory but seeing the person they know become animated again, regaining the social graces and initiating conversation”.
Exelon is produced and distributed by Novartis and it continues to be a key part of the international pharmaceutical company’s research and development efforts.
Novartis New Zealand Managing Director, Patrick Geals says Exelon is becoming more and more accepted among medical practitioners as a valid treatment for some patients with Alzheimer’s. “While some people may improve while taking the drug, generally Exelon maintains or delays decline in cognition such as attention, learning, memory and language,” he says.
Exelon is not currently subsidised by the Health Funding Authority and patients pay about $200 for a month’s supply.
What is Alzheimer’s Disease?
Alzheimer’s Disease is a brain disorder that gradually destroys a person’s ability to think, to remember and to reason. It is not a normal part of ageing but the result of the disease process. It is different from the mild forgetfulness normally observed in older people. Eventually people with Alzheimer’s Disease no longer recognise themselves or much about the world around them and lose all independence. Depression, anxiety and paranoia often accompany these symptoms.
How is Alzheimer’s diagnosed?
Alzheimer’s is marked by placques and tangles within the brain cells. However, these cannot be diagnosed with 100 per cent certainty until a brain autopsy after the person’s death reveals these markers of the disease. Diagnosis of Alzheimer’s Disease is largely dependent on the doctor’s experience with dementia illnesses. It is important to make sure the GP understands that the person’s behaviour is out of character. If in doubt about his or her evaluation a thorough physical, neurological and social evaluation should be requested by the family member.
Diagnosis in the early stages of the disease is very important because it is then that treatments available are the most effective. It also means social and family support as well as legal procedures may be put in place while the person with Alzheimer’s Disease can still play an active role in the planning process.
Alzheimer’s Disease affects everyone in an individual and unique way and its severity and progress can vary considerably from person to person. However as a general guide the disease may develop as follows.
At its onset, Alzheimer’s Disease is marked by simple forgetfulness, especially of recent events or directions to familiar places. People with Alzheimer’s Disease may have personality changes, such as poor impulse control and judgement, distrust, increased stubbornness and restlessness.
The next stage of the disease is characterised by greater difficulty in doing things that require planning, decision making and judgement – for example working, balancing a chequebook or driving a car. Everyday skills such as personal grooming aren’t always affected but social withdrawal begins.
Eventually people with Alzheimer’s Disease can’t do simple tasks of daily living such as eating, bathing and using the toilet. They may lack interest in personal hygiene and appearance and lose their usual sexual inhibitions. They may have a hard time recognising all but their closest daily companions. Communication of all kinds becomes difficult as written and spoken language ability dwindles. Withdrawal from family members begins and the person may become agitated, displaying belligerence and a denial of the illness.
In the last stages of the disease, people with Alzheimer’s Disease become bedridden, unable to recognise themselves or their closest family members. They make small, purposeless movements and communicate only be screaming out occasionally. Eventually the brain forgets how to live. Death often results from pneumonia and from complications of immobility.