Transcript Health Professional`s Knowledge about

Health Professional’s Knowledge
about Alzheimer’s Disease and their
Practices in Coping with the
Challenges of the Disease
Syed Shayan Ali,
Medical college,
Aga Khan University.
What is Alzheimer’s Disease (AD)?
It is progressive mental deterioration that can occur in middle or
old age, due to generalized degeneration of the brain. It is the
commonest cause of premature senility
An acquired disorder, Alzheimer’s impairs cognitive and behavioral
aspects thus interfering with social and occupational functioning.
The disease is an incurable one with a long and progressive course.
The structure of the brain involved in encoding memories, known as
hippocampus, and other areas of the cerebral cortex involved in
thinking and decision making develop plaques. However it is yet to
be deciphered if these plaques cause AD or are just by-products of
AD process.
Alzheimer’s disease (AD), mainly affecting people in their sixth
or later decades of life, constitutes approximately 70% of all
dementia cases and is the seventh leading cause of death. Since
advancing age and genetic susceptibility are the most significant
risk factors for AD, the problem this disease poses in terms of its
financial and human cost cannot be underestimated.
According to General Secretary, Pakistan Society of Neurology,
AD is the most significant social and health issue of 21st century.
In Pakistan, 11 million people are currently suffering from AD.
Fortunately for us, the population of Pakistan comprises of youth
so the prevalence is increasing slowly. However with the rapid
westerniztion of lifestyle and advancement in health care in
Pakistan the population pyramid is widening at upper age
groups. It is speculated that in 20 years the prevalence may rise
to 65.7 million for this disease and by 2050 to 115.4 million
people.
METHODOLOGY
A descriptive cross-sectional survey was undertaken at two
public sector hospitals of Karachi - Jinnah and Civil from Dec
2012 to July 2013. Three hundred and eighteen conveniently
available clinicians were recruited ensuring their different
specialties and varying levels of expertise
Participant Profile
Intern
Medical Officer
Resident
Consultant
Other
Family Medicine
Medicine
Surgery
Others
RESULTS AND DISCUSSION
Seventy-Six percent of the participants recognized Alzheimer’s
Disease as an incurable and progressively deteriorating disease.
The popular risk factors were correctly identified by majority
of the participants which included advancing age (85%) and
family history (80%),
However, a vast majority showed complete unawareness of risk
factors like obesity (92%), Insulin resistance (88%), hypertension
(67%), Vitamin B12 deficiency (74%) and Down syndrome (67%).
When asked about the pathophysiology of the disease, an
overwhelming majority of 268 participants were able to
identify beta amyloid as the protein plaques that develop in
the hippocampus and in other areas of cerebral cortex and
cause impairment of thinking and decision making.
Twenty-two participants confused the involvement of prions
in causing AD and 18 linked it to fatty acid deposits.
Eleven percent were also unable to identify even the structure
that is involved in forming memory and incorrectly attributed
this to hypothalamus. However 85% still retained the basic
anatomy and identified correctly hippocampus as this region.
AD as a terminal disease and the level of mortality that may
result from it was not a very popular fact. Less than half of the
participants were able to recognize at as the 7th leading cause
of death.
Occurrence of depression in more than 30% of patients was
also identified by most with only a quarter not being able to see
the link.
A popular misconception was further reiterated when slightly
over half of the participants (56%) agreed with the fact that
mental exercise can prevent a person from developing AD. Albeit
a popular belief but lacks any scientifically proven source to date.
There was also a lot of confusion regarding the expectancy of
life after appearance of the symptoms. Usually it is 6 to 12 years.
However this fact was only recognized by 55% of the
interviewees.
The progression of Alzheimers disease may be prolonged
however there hasn’t been any case of complete recovery as
of yet. Surprisingly still, 60 % of the participating clinicians
believed that recovery from the disease is possible. Further,
confusion was also seen when asked if drugs are available to
prevent the disease from developing. Roughly equal
proportion answered with a yes or no to this question.
It was pleasing to see however that a vast majority (83%)
knew that drugs are available to slow down the progression of
the disease.
Confusion was also seen when asked about the behavior to be
adopted towards Alzheimer’s patients. Roughly equal number
agreed and disagreed to the fact that it is helpful to remind
alzheimers patient when they repeat the same question or story.
However it is advisable not to remind these patients when they
are repeating.
Alzheimer’s disease is not associated with hand tremors or
shaking. However even this area showed confusion among the
clinicians with around 52% accepting this symptom.
The deterioration of mental status that occurs with this disease
was still identified by a pleasing majority. Seventy percent
identified that such patients are not capable of making informed
decision about their own care.
The fact that severe depression can have symptoms similar to
that of AD was also identified by a pleasing number of 230
clinicians.
0
10
20
30
40
50
60
MEMORY LOSS
80
90
100
96
APHASIA
54
INSOMNIA
46
HALLUCINATIONS
42
TREMORS
39
ATAXIA
36
PARANOIA
16
PERCEPTUAL MOTOR PROBLEM
RECURRENT INFECTIONS
70
19
9
Symptom of Alzheimer’s Disease as
Identified by the participants.
Conclusion
Albeit prevention or remedy to this disease has yet not been found,
it is possible to ease certain symptoms or to prolong the loss of
certain vital functions of brain. For this it is necessary that an early
diagnosis is made however delays may occur due to inadequate
knowledge of the characteristics of the disease among clinicians.
There is a lot of ambiguity in the knowledge and practices
regarding this disease which necessitates that protocols are devised
at institutional levels and use of medical conferences and journals
are incorporated to increase the familiarity among the doctors.
References:
Lahjibi-Paulet, H., A. Dauffy Alain, et al. "Attitudes toward Alzheimer's disease: a qualitative study of
the role played by social representation on a convenient sample of French general practitioners."
Aging Clin Exp Res 24(4): 384-90.
One million Pakistanis suffer from Alzheimer’s, dementia - See more at:
http://ppinewsagency.com/72902/one-million-pakistanis-suffer-from-alzheimersdementia/#sthash.Ly0Q498H.dpuf
http://emedicine.medscape.com/article/1134817-overview.
Schiffczyk, C., B. Romero, et al. "Appraising the need for care in Alzheimer's disease." BMC
Psychiatry 13: 73.
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