What Is Alzheimer's Disease? The Real Story Behind Memory Loss — Dr. Anand Karnam

Alzheimer's disease is the most common cause of dementia, accounting for 60–70% of all dementia cases. It affects approximately 3.7 million people in India — a number expected to triple by 2050. Yet despite this scale, most families have profound misconceptions about what Alzheimer's is, how it progresses, and what can be done.

What Is Alzheimer's Disease?

Alzheimer's is a progressive neurodegenerative disease — meaning it destroys neurons (brain cells) steadily over years and decades. It is not a normal part of ageing. It is a disease, with a specific biological process: abnormal accumulation of two proteins in the brain — amyloid beta (forming plaques between neurons) and tau (forming tangles inside neurons). These protein deposits begin accumulating up to 20 years before the first memory symptom appears.

How Alzheimer's Progresses — Three Stages

Mild (Early) Alzheimer's

• Repeating questions or stories in the same conversation
• Forgetting recent conversations and events — while distant memories remain
• Misplacing items; accusing family of taking things
• Difficulty with complex tasks: managing finances, planning events
• Getting lost in unfamiliar places
• Personality changes: withdrawal, anxiety, occasional suspicion

At this stage, the person is still largely independent. Many live alone with support. This is the stage where medication can have the most impact.

Moderate (Middle) Alzheimer's

• Increasing memory loss — forgetting spouse's name, not recognising familiar faces
• Wandering — leaving the house and getting lost
• Sleep disturbances — reversed day/night cycle
• Hallucinations and delusions — believing someone is in the house; seeing deceased relatives
• Difficulty with personal care — dressing, bathing, toileting
• Significant behavioural changes: agitation, aggression, restlessness (especially in the evening — "sundowning")

Full-time caregiving or a memory care setting is typically needed at this stage.

Severe (Late) Alzheimer's

• Loss of all conversational language
• Inability to walk, sit up, or swallow
• Complete dependence for all personal care
• Vulnerability to pneumonia and pressure sores — the most common causes of death

Risk Factors — What You Can and Cannot Change

Non-modifiable: Age (the strongest risk factor), genetics (APOE ε4 gene — not a cause, but increases risk; one copy doubles risk, two copies increases it 10-fold), family history

Modifiable (35–40% of Alzheimer's cases attributable to these):

• Physical inactivity — exercise reduces risk most powerfully
• Hypertension in midlife — one of the most important modifiable risk factors in India
• Diabetes — doubles dementia risk
• Obesity
• Smoking — doubles risk
• Social isolation and loneliness
• Hearing loss (untreated) — strongly associated with cognitive decline
• Depression
• Low educational attainment (reduced cognitive reserve)

Alzheimer's Treatment — What Is Available Today

Approved medications:

• Donepezil, rivastigmine, galantamine (acetylcholinesterase inhibitors): Improve symptoms in mild-to-moderate Alzheimer's. Do not stop disease progression but improve cognitive function and daily living for 1–3 years
• Memantine: Used in moderate-to-severe Alzheimer's. Moderates symptoms of agitation and slows functional decline

Starting medication early — at the mild stage — provides the maximum benefit window.

Supporting the Family — Equally Important

Alzheimer's disease is as hard on the caregiver as on the patient. Caregiver burnout, depression, and health deterioration are common and serious. At Sri Anand CNC, Dr. Anand Karnam provides not only patient management but also practical guidance for families — managing behavioural symptoms, sleep disruption, wandering, and nutrition; and connecting families with caregiver support resources.

For Alzheimer's assessment, diagnosis, and ongoing management: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.