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Case Study
Case I The lady was the mother of five children living in a middle class family. The early symptoms noticed were forgetfulness and keeping the things in unknown and uncommon places. At the age of about 73 years, she was found to do such uncommon behavior that the members of the family had to consult the physician. Loss of memory with forgetfulness became a regular phenomenon. The patient had chronic gastritis for which she had to use anti acid drugs. Gradually the burden of the family rolled on to the daughters – in – law and they became busy with the day to day work in addition to looking after the mother – in – law.
During the early stage the patient was very calm and quiet and used to make fun with her uncommon behavior. Family members realized that she had some peculiar disease without knowing the details of its outcome.
Apart from nervous treatment the patient was taken to the psychiatrist for counseling. Gradually the disease spread and the nervous disorder became acute. The patient was found to remain in isolation and almost kept silence. The grand children also could not receive any response when they went close to her.
The patient had to be nursed and assisted in her day to day work and the inmates of the family had to keep constant vigilance lest she went out of the house. Some other queer behavior was also noticed which was very uncommon on the part of a devotee who regularly worshiped her deities. She often made hide and seek with the family members by placing her combs, vermillion and other articles under the seat of the deities. Apart from this she often did her toilets in the corner of the rooms and also hid the wastes in the shelves of the kitchen and under the mattress in the bedroom - Scissors, blades and knives was kept out of her reach despite her attempt to keep the articles under her possession. The illness continued for about 11 years and the patient died at her residence at the age of about 83 years.
Case II This case is relatively a recent one. The patient and her husband lived in a flat in a multistoried building in south Kolkata. The couple had no issue. The husband was a retired professor and had many illnesses. Prior to her illness the patients used to assist her husband in his academic activities. She was a pious lady and had many distinguished characteristics. She was a good singer and an accomplished lady to mix with the neighbors and friends of her husband were delighted to talk with her. She took active participation in performing Durga Puja of their society. She extended her helping hand towards her relatives in their distress. Excepting some minor problems of acidity she had little complain with regard to her health. She was, however, extremely concerned and deeply worried with her husband's health.
The first symptom of Alzheimer's disease noticed was her peculiar behavior with regard to keeping her keys. She often forgot where she kept the keys. Gradually she had disbelief over her husband too whenever she was asked to keep the keys of the cupboards and the almirahs to him. By locking the bolts of the door unmindfully she used to have extreme difficulty to open it due to her short height. She had, however, no other physical problem, excepting forgetfulness. Gradually she had acute nervous tensions and difficulty to walk straight and in regular pace. Her movements were restricted within the flat as she was gradually losing her normal senses. Difficulties in recognizing persons and to converse with them were increasing – she had to struggle within herself for recollection of facts and persons.
The onset of the illness was noticed at the age of about 77 years. Her body became diminutive, and also as she could not herself wear saris, she had to wear short gowns reaching down to the knees. At the beginning she became numb in front of her neighbors and gradually failed to communicate with them. Usually she sat stooping her head with closed eyes and sometimes murmured herself often causing irritation of the husband. Her voice too was very feeble and not intelligible. Occasionally she tried to improve her handwriting which was topsy-turvy and the words were small. Special attendants were engaged for 24 hours to look after her. Daily supply of meal through home delivery system was arranged. Notwithstanding such arrangement, she often tried to move out of the flat.
Her husband and relatives took her to nearby Nursing Home for nervous and psychiatric treatment but she vehemently showed her reluctance to stay there. Medical attention and nursing at home and helping her for day to work by attendants were arranged by the husband. During the last stage of her life she was frightened with her husband and feared that he will leave her and marry at the age of over 80 years.
Finally, after about 6 years of sufferings the patient died due to cardiac attack. Half an hour before her death she could regain her normal sense and sought permission from her husband to leave him forever. This was reported by the husband in a very pensive mood.
Case III Unlike the previous cases, the patient of our third sample is unmarried and surviving. She is now about 76 years of age and is staying with her sisters in their relatively small family. She had a surgery in tonsils at her early age and is short of hearing since then.
History of the patient reveals that she was brought up in her maternal uncle's house at Kolkata when her parents were still in erstwhile East Bengal, now Bangladesh . At a very early age after completing her school education she joined the Central Govt. Service at Kolkata and worked there till her retirement. The patient was very soft spoken and a responsible person. She became the anchor of the family at the time of her father's last days. Since then she looked after her sisters, reared them up with her meager income. She remained unmarried.
Although in her young age the patient had financial stringencies yet she was determined to overcome the crisis. She was instrumental to reconstruct the two storied building demolishing the mud house built by her father; her sisters too extended their helping hand in achieving the task. One interesting event draws attention to the visitors who went during her lunch or dinner. Everyday she is surrounded by about a dozen kittens and she called them by name (which was also given by her) and offered them part of her meal. Too much affection often causes affliction.
Early symptoms of Alzheimer's disease were noticed at about 70 years of age of the patient. Some unnatural behavior evoked the interest of the sisters to scrutinize the daily activities of the patient. During the initial stage of illness the patient was found to forget her days to go to Bank for collection of pension. She felt ashamed and thanked her sisters for reminding her about the date. Gradually the symptoms of Alzheimerism manifested in her disposition and she often forgot the names of her relatives. But she could not overcome the mistake and rectify it through her own effort. With the progress of the disease the kittens gradually left her either by death or moving to other places. Though she did not reveal her agonies yet she used to brood and tried to rebuild the empire, slowly and steadily the brunt of the disease spread over her pathological process and today her sufferings are acute. She cannot identify her near relatives due to sharp decline in memory. Her footsteps are short and she is now dependent on her sisters for her dressing and other daily activities. One of her sisters who is a Doctor living in London used to visit her and advise regularly for follow up treatment. In chart II we have shown the details of ALzheimerism as revealed in our three samples.
Observation
Alzheimer's disease has been described as the “silent epidemic” of the last century. It is also important cause of morbidity and mortality. Eradication of the disease is almost difficult in as much as the cause of the disease is quite unknown. Prolonged research is carried out by the scientists for combating the disease. This disease could occur mostly to male ageing population though we have considered the females in our samples too. It is curious to note that all the classical features of the disease are manifested in our patients. Excepting the last illustration the death of the patients occurred within a period of 10 years. Nursing and care to the patients were being carried out at home. Regular administration of medicine was made to prevent health breakdown.
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