Memory Disorders

The classic example of a memory disorder is Alzheimer's disease described by the German Pathologist Allois Alzheimer in 1909. This disorder has serious social, psychological and financial implications in the patient's family and the national economy. It is estimated that caring for Alzheimer's disease patients in the United States in the year 2030 will costs US$30,00,00,00,000.

However, similar diseases have been described in the ancient Indian medical science of Ayurveda as long ago as 800 BC. Ayurvedic physicians described a condition which they called "Smriti Bhransh" which translates to "loss of memory". But the exact description of the condition they have noted is not precise enough for us to determine whether they are talking about Alzheimer's disease. Nevertheless it is important to realize that conditions similar to Alzheimer's disease were known long before 1909 when it was first described in the Western literature.

A term used in the Indian language to describe cognitive impairment in order ages translates literally as "turned 60." This term is used to describe patients who begin to exhibit signs and symptoms of cognitive decline, no matter what their age. Thus an 80 year old patient who shows signs of dementia is said to have "turned 60." This phrase has been part of the language for centuries, indicating that our ancestors considered cognitive impairment to be a part of aging, not a disease.

Although Alzheimer's disease is a disorder that occurs worldwide, the approach to caring for and treating patients with this disease varies among different cultures. In India, much of the functional and cognitive impairment resulting from Alzheimer's disease are tolerated by family members and friends because of the fatalistic approach to decline in old age. In general, Indians view deterioration of old age as inevitable and not something requiring medical treatment. This attitude prevails not only among older patients, but also their family members, community, and even physicians. In a culture such as this, managing the signs and symptoms of Alzheimer's disease necessitates an approach different from that used in countries such as the United States or in Europe.

In Indian communities, there are few expectations form elderly persons. They are not expected to achieve any particular level of activity and draw no attention if they choose to sit under a tree all day. Thus even though a person may be demented, they are not disabled functionally.

Family members assess memory in terms of long-term memory rather than recent memory. They may describe their grandmother's memory as being excellent because she can remember many things from her childhood and early adulthood. However, if she is unable to remember what she did yesterday, family members consider this a normal part of aging. This attitude, combined with comorbidity, illiteracy, and a fatalistic approach to aging, explains why elderly persons with cognitive impairment are rarely taken to a physician. Even if they are evaluated by a physician, not many physicians have the expertise to assess cognitive decline particularly in early stages.

There are well developed specialized care facilities for Alzheimer's disease patients in Western countries. Although these provide excellent physical care, they are not the ideal solution as the cost implications are huge and separation of patients and families creates psychological problems for both.