Garth Rattray

Wavering memory has plagued me since my late 20s, so, I listened intently as our brilliant speaker, Dr. Albert Chen, family practitioner and gerontologist, explored Alzheimer's disease at an Association of General Practitioners of Jamaica seminar on 'Geriatrics Update' last year. He said, "Patients with memory problems spanning many years do not have Alzheimer's." At that point I turned to two nearby colleagues and proclaimed, "Thank God!" My amusing declaration of relief backfired when our speaker finished his statement by saying, "those patients are mentally retarded".

Mentally retarded or not, I know that - thanks to modern medicine - we Jamaicans are living longer and, since the greatest risk for developing Alzheimer's is advancing age, we are seeing and are going to see a proliferation of the disease. It is estimated that 30 per cent to 50 per cent of people living to 80 years of age will develop Alzheimer's disease. When German physician Dr. Alois Alzheimer first described this particular progressive neurological disease, it was in a 50-year-old woman! She died at 55-years-of-age. The (presumptive) diagnosis of 'Alzheimer's disease', was therefore, once reserved for people with (pre-senile) dementia between 45 and 65 years of age. Senile dementia (in people over 65) was erroneously seen as a normal part of the ageing process.

Inability to learn

Eventually, 'Alzheimer's disease' was attributable to anyone exhibiting a series of well-recognised problems with short-term memory, the inability to learn or retain new information, a loss of executive functions (the ability to plan and to carry out abstract thinking), marked personality and behavioural changes and finally, severe deterioration and death.

In this relentless disease, we find beta-amyloid deposition (senile plaques), phosphorylated tau deposition, neurofibrillary tangles, neuron degeneration, and synaptic loss. But, deteriorating patients take no comfort in the highfalutin science behind their problems with memory and mentation - all they want is medical help. Desperate family members care little about the pathology of Alzheimer's disease when a loved one is staring at them confused, forlorn and in need of constant care and attention. They, too, only want help. Some patients live for only four to five years after diagnosis, however, most live for 10 years, and a few live to between 18 and 20 years.

No cure

Alzheimer's has no cure but, three drugs, Exelon, Reminyl and Aricept are available in Jamaica for the treatment of the disease. They should be started early in order to slow the process of deterioration and/or temporarily effect slight improvements in mental function. Success is measured by postponement of memory loss, maintenance of activities of daily living and by delaying the personality/behavioural changes, helplessness and institutionalisation. All this makes drug therapy worthwhile; but, the cost is extremely prohibitive.

Currently, the National Health Fund (NHF) does not cover drugs for treating Alzheimer's disease. It covers 60-80 per cent of the cost of the drugs used in the 15 conditions that burden our health-care system. The NHF bases its operations on three pillars: short term (assistance with medications); institutional (radiographic equipment); and prevention (educational/informational health fairs, etc.). The fund gives universal coverage to all residents and, having assessed the full impact of its usage, plans to expand coverage to other medications under certain circumstances.

NHF CEO, Rae Barrett, explained that the NHF is funded by dedicated taxes on cigarettes and payroll deductions. Additional government funding is needed for the board and subcommittees to consider expansion to include Alzheimer's disease in their drug coverage. Our growing elderly population, their families and physicians desperately need help in combating this devastating affliction. I pray that the Ministry of Health will act soon.