By Kasmiah Mustapha

EIGHT years ago, the symptoms emerged slowly. She kept forgetting to turn off the tap and the stove. She set out to the market to buy groceries but came back empty handed. She was easily agitated and blamed others for her forgetfulness.

Kwan Saw Hah knew there was something wrong with her mother. She had read about these symptoms in newspaper articles and realised that her mother - Ho Geok Eng - was showing signs of early stages of Alzheimer's.

As time passed, Ho's symptoms became more obvious. She kept forgetting things, and asked the same questions numerous times. She would leave the house and wander around the neighbourhood.

There was a time when Kwan caught her mother with a knife in her hand, trying to get into the neighbour's garden to cut some leaves in the middle of the night. Ho, 85, would also try to open the gate and front door at night, wanting to go to the market.

"I could hardly sleep at night because my mother would walk in the dark when she was restless. I was worried that she would fall and hurt herself or try to leave the house.

"At that time, I had no one to turn to. My siblings refused to discuss our mother's condition nor provide any care. As I was not getting any help, I had to resign from my job," she said.

Kwan, a single parent, who also has a child with special needs, was overwhelmed as she had to take care of her mother as well.

She then joined an Alzheimer's disease caregivers support group to understand the condition better and what could be done to help her mother.

"I cannot leave her alone in the house because she will get out and wander around. I will take her to the centre in the morning and take her home in the evening. At least at the centre, there will be people to take care of her and she will be safe."

For the past eight years, Ho's condition remains mild. When she was first diagnosed, she was on medication to help slow down the progression of the disease. But after six months, Kwan decided to discontinue it as she could still control her mother's behaviour. The treatment - at a private hospital - cost RM700 per month.

"For now her condition is still mild. There are brief moments when she would forget us and repeat the same questions. To keep her occupied, I taught her to play solitaire. At least that would keep her in the house and not wander about."

University Malaya Medical Centre consultant geriatrician, Professor Dr Philip Poi says that Alzheimer's disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills. It is the most common case of dementia in elderly people and the risk of developing it increases with age.

The symptoms usually will appear after the age of 60 although for the first few years, people may not notice the person is suffering from memory loss. And most of the time, they will disregard the symptoms, as they believe that being forgetful is part of growing old.

"Many Malaysians think that dementia is normal and is part of ageing. It is not. Losing your memory and thinking skills when you grow older is not normal. It is normal if you cannot remember where you put your keys. But it is not normal if you do not know that what's in your hands are keys."

Alzheimer's disease affects 18 million people worldwide with one in 10 individuals over the age of 65 suffering from the condition. In Malaysia, approximately 60,000 people have the disease. The number is expected to double by 2020.

Once considered as a rare disorder, Alzheimer's disease is now a major health problem as the number of sufferers are expected to increase with the growth in ageing population. Unfortunately, the disease not only affects the patient but their families as they need to constantly care for the patient.

"It can cause a lot of stress to the caregivers because it is not easy to handle the patients. When their condition worsens, they will lose control of their bowel and bladder movement. They would wander around and get lost. Some even display aggressive behaviour that could harm themselves and others," said Poi.

He says memory loss is the first sign of Alzheimer's but as the disease progresses further, the patient will display behavioural disorders.

"No one knows what causes Alzheimer's but we do know a lot about what happens in the brain once the disease takes hold," he said at the launching of Exelon Patch, the first and only skin patch for the treatment of mild to moderately severe Alzheimer's.

Applied once-daily to the back, chest or upper arm of patients, the patch delivers the medication into the bloodstream over 24 hours. Research found that the patch can reduce side effects compared to the oral formulation and provide easier access to optimal therapeutic doses.

Poi says the progression of the disease is not the same for every individual. Some can last between 10 and 20 years before it gets worse while others may deteriorate faster over a shorter time period.

While there is no cure for Alzheimer's disease, treatment is important to slow down the progression of the illness.

"Steps can be taken to reduce the risk of Alzheimer's, including lowering cholesterol and homocysteine levels, controlling blood sugar levels and hypertension, exercising regularly and engaging in social and intellectually stimulating activities."