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Dr. Dr. Jitendra Prasad Yadav • Consultant Neurologist & Cognitive Specialist • NMC 8029
Progressive memory loss, confusion, or difficulty with daily tasks? You may have Alzheimer's disease — the most common form of dementia. Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS), provides Alzheimer diagnosis, cognitive testing (MoCA/MMSE), dementia medications, and caregiver support at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu.
Nepal Medical Council Reg. No. 8029 • 15+ years National Trauma Center, NAMS • Part of Clinics Tree Healthcare Network
What is Alzheimer's Disease?
Alzheimer's disease is the leading cause of dementia, characterized by memory loss, cognitive impairment, and functional decline due to brain changes.
Alzheimer's disease accounts for 60-70% of dementia cases worldwide. It is a neurodegenerative disease caused by accumulation of abnormal proteins in the brain: amyloid-beta plaques (between neurons) and tau protein tangles (inside neurons). These changes cause neuronal death, beginning in the hippocampus (memory center) and spreading to cortical areas responsible for language, reasoning, and social behavior.
Progression: Alzheimer's is gradual and irreversible. Symptoms worsen over years, from mild forgetfulness to complete dependence on caregivers. Average survival from diagnosis is 4-8 years, though some live 20+ years depending on age at onset and health status.
Early-stage (Mild):
Middle-stage (Moderate):
Late-stage (Severe):
No single test confirms Alzheimer's. Diagnosis requires comprehensive evaluation:
1. History: Detailed timeline of cognitive decline from patient and knowledgeable informant (family member). Key: progressive memory loss, functional impairment, absence of sudden onset (stroke) or fluctuations (delirium, Lewy body dementia).
2. Cognitive testing:
3. Neurological examination: Focal signs (weakness, sensory loss, visual field defects) suggest vascular or structural cause. Parkinsonism (tremor, rigidity) suggests Lewy body or Parkinson dementia. Normal exam typical in early Alzheimer's; later stages show primitive reflexes (grasp, snout).
4. Brain imaging (MRI or CT):
5. Blood tests: Rule out reversible causes (5-10% of dementia cases):
6. Biomarkers (limited availability in Nepal):
Diagnosis: Probable Alzheimer's disease based on clinical criteria (NIA-AA, DSM-5) — progressive cognitive decline, memory impairment prominent early, functional impairment, absence of alternative explanation, imaging consistent. Definitive diagnosis requires autopsy.
| Dementia Type | Key Features |
|---|---|
| Alzheimer's | Gradual onset, early memory loss, progressive, hippocampal atrophy |
| Vascular | Stepwise decline, strokes, focal signs, vascular risk factors, white matter disease |
| Lewy Body | Fluctuating cognition, visual hallucinations, parkinsonism, REM sleep behavior disorder |
| Frontotemporal | Younger onset (<65), behavioral disinhibition, language problems, memory preserved early |
| Mixed | Alzheimer + vascular features — common in elderly |
Symptomatic medications:
Managing behavioral and psychological symptoms:
Alzheimer caregiving is physically and emotionally demanding. Strategies:
Average survival 4-8 years from diagnosis, but highly variable (range 2-20 years). Younger age at onset often means longer survival. Death usually results from complications: aspiration pneumonia, urinary tract infections, sepsis, immobility-related complications.
No cure exists. Treatment goals: maximize function and quality of life, manage symptoms, support caregivers. Early diagnosis allows planning while patient can participate in decisions.
While no guaranteed prevention, lifestyle modifications reduce Alzheimer's risk:
Seek memory assessment if: consistent forgetfulness affecting daily function (missing appointments, forgetting recent conversations, asking same questions repeatedly), difficulty with familiar tasks (cooking, managing finances), getting lost in familiar places, word-finding difficulty, poor judgment (falling for scams, safety concerns), personality changes (apathy, suspiciousness), withdrawal from activities. Early evaluation allows diagnosis of treatable causes, early Alzheimer treatment, and planning.
Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS), provides:
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Kathmandu Neurology Clinic & Cognitive Center
Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600, Nepal
Phone: 974-7736624 • +977 9747978200
Sun-Sat 9AM-7PM • By Appointment • Near Narayanhiti Palace Museum • 27.7172, 85.3240
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Bring to Appointment
Bring a family member who knows you well, list of current medications, any prior cognitive testing results, and specific examples of memory or thinking difficulties you've noticed.
Page Information
Alzheimer's disease is the most common cause of dementia (60-70% of cases), characterized by progressive memory loss, cognitive decline, and functional impairment. Pathology: accumulation of amyloid-beta plaques and tau protein tangles in the brain causes neuronal death, particularly in hippocampus (memory) and cortex (thinking, language). Typical progression: early-stage (mild forgetfulness, word-finding difficulty), middle-stage (significant memory loss, confusion, ADL impairment, behavioral changes), late-stage (severe cognitive impairment, loss of speech, total ADL dependence, swallowing difficulty). Average survival 4-8 years from diagnosis, but varies widely.
Clinical diagnosis based on history (progressive memory loss, functional decline), cognitive testing (MoCA, MMSE), neurological exam, and exclusion of reversible causes. MRI or CT brain shows atrophy (hippocampal, medial temporal lobe) and excludes structural lesions (tumor, stroke, hydrocephalus). Blood tests rule out thyroid disease, vitamin B12 deficiency, syphilis. Biomarkers (CSF amyloid-beta/tau, amyloid PET, tau PET) are research tools, limited clinical availability in Nepal. Definitive diagnosis requires brain autopsy, but clinical diagnosis accuracy is 85-90% with careful evaluation.
Memory loss affecting daily function (forgetting recent conversations, appointments, asking same questions repeatedly), difficulty with familiar tasks (cooking, managing finances, driving), word-finding difficulty, misplacing items (putting things in odd places — keys in refrigerator), poor judgment (falling for scams, inappropriate dressing), withdrawal from social activities, mood changes (apathy, depression, anxiety). Distinguish from normal aging: occasional forgetfulness is normal; consistent, worsening memory loss affecting function is not.
Alzheimer's: gradual onset, early prominent memory loss, progressive course. Vascular dementia: stepwise decline tied to strokes, focal neurological signs, vascular risk factors, prominent executive dysfunction. Lewy body dementia: visual hallucinations, parkinsonism (tremor, rigidity), fluctuating cognition, REM sleep behavior disorder. Frontotemporal dementia: younger onset (<65), early behavioral changes (disinhibition, apathy) or language problems, memory relatively preserved early. Mixed dementia (Alzheimer's + vascular) is common, especially in elderly.
Symptomatic treatments (do not cure or stop progression, but may slow decline): Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) for mild-to-moderate Alzheimer's — improve cognition, ADLs, behavior by increasing acetylcholine (neurotransmitter depleted in Alzheimer's). Side effects: nausea, diarrhea, bradycardia. Memantine (NMDA receptor antagonist) for moderate-to-severe Alzheimer's — slows decline, can be combined with cholinesterase inhibitors. New disease-modifying therapies (aducanumab, lecanemab — anti-amyloid antibodies) reduce amyloid plaques but availability in Nepal is non-existent due to cost (USD $26,000+/year) and limited evidence of functional benefit. Treat comorbidities: depression (SSRIs), sleep disturbance, agitation (non-drug approaches first, low-dose antipsychotics only if severe).
No guaranteed prevention, but risk reduction strategies: cardiovascular health (control blood pressure, diabetes, cholesterol — 'what's good for the heart is good for the brain'), regular physical exercise (150 min/week aerobic), Mediterranean diet (vegetables, fish, olive oil, nuts), cognitive engagement (reading, puzzles, learning new skills), social activity, quality sleep, hearing aid use if hearing loss (untreated hearing loss increases dementia risk), avoid head injuries, limit alcohol, don't smoke. Education and cognitive reserve (lifelong learning) delay symptom onset.
Alzheimer caregiving is demanding — behavioral changes (agitation, wandering, sundowning), total ADL assistance, safety concerns. Support strategies: education on disease progression and management, respite care (temporary alternative care to give caregiver breaks), support groups (sharing experiences, coping strategies), home modifications (safety — remove tripping hazards, locks on doors/stoves, labels/reminders), legal/financial planning (power of attorney, advance directives while patient has capacity). In Nepal, caregiver resources are limited; family networks are primary support. Dr. Jitendra provides caregiver education and can connect families to available resources.
Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600 — Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS). Services: comprehensive cognitive evaluation (history, MoCA/MMSE testing, neurological exam), MRI/CT coordination, reversible dementia cause screening (thyroid, B12, syphilis), Alzheimer diagnosis, cholinesterase inhibitor prescription (donepezil, rivastigmine), memantine for moderate-severe disease, comorbidity management (depression, sleep, agitation), caregiver education and support, long-term monitoring. Book via /book-appointment or call 974-7736624, Sun-Sat 9AM-7PM by appointment. Bring family member who knows patient well, medication list, prior cognitive testing if available.
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