Dr. Costis Pruskas, Chief Clinical Officer of Blocks Group, is answering the most important questions related to symptoms, onset, and treatment of the disease in following interview

On September 21st we celebrate World Alzheimer’s Day. To find out more about the disease, we spoke with Dr. Costis Pruskas, Chief Clinical Officer of Blocks Group – the largest operator for long-term care for the elderly in Southeast Europe. The company has operating center in Bulgaria (Blocks Health and Social Care) and Greece (Aktios) where Dr. Costis Pruskas introduces a special and unique model of care for people with dementia, which his colleagues in Bulgaria are successfully working on. Dr. Pruskas is a Psychologist with a Master’s Degree (MSc) in Psychological Assessment in Organizations and a doctorate (PhD) in Gerontology. He is also the Scientific Director of the Dementia Day Centre of Frontizo NGO in Patras and the External Supervisor of the three Dementia Day Centers of the Athens Alzheimer Association.
In the following lines, Dr. Costis Pruskas answers the most important questions related to symptoms, onset, and treatment of the disease. If you have questions or need a consultation with a specialist for your loved one, you can contact Blocks Health and Social Care at the listed contacts.

September 21st is “World Alzheimer’s Day”. Could you explain to us what the disease is?
Alzheimer’s is a neurodegenerative disease which progressively affects memory, and cognitive function, causes psychological and emotional changes and results in functional decline. In the course of the disease, family carers are also seriously affected in a social, economic, emotional, and physical level.

What are the first symptoms to watch out for?
In most cases, the first symptoms of Alzheimer’s consist of memory deficits especially regarding recent events, conversations, or activities. Usually, a decline to a lower level of functioning is observed. An example could be forgetting a recipe, a conversation with someone the day before or a difficulty retrieving his/her parked car. However, we should note that the first symptoms are not always observable since most people are unable to tell the difference between normal cognitive aging and cognitive impairment.

 

What can we do to avoid the disease and is it possible to avoid it at all?
Even though the scientific community still does not know the exact reasons behind the development of Alzheimer’s, we have managed to detect a plethora of risk factors, mainly life-style related. As a result, we can safely say that there is no way to completely avoid the disease but there are certainly ways to reduce the chances and delay its onset.

How fast can the disease progress?
There is no way to accurately define the disease’s progression rate since it varies from one person to another. We know for sure that Alzheimer’s patients progressively worsen over time but while some people live 4-8 years after the diagnosis, there are cases where the individual lived 20 years or more after being diagnosed with Alzheimer’s. It seems that cognitive empowerment, social activities and physical exercise slow down the progression. On the other hand, untreated medical conditions such as hypertension and diabetes are linked with a faster progression rate.

In what percentage of the cases does dementia develop?
Dementia is an umbrella term that includes Alzheimer’s Disease. It’s impossible to say that an individual suffers from Alzheimer’s without having dementia since memory loss and cognitive impairment are included in the diagnostic criteria for Alzheimer’s.

How common is Alzheimer’s disease?
It is estimated that approximately 25 million people worldwide suffer from Alzheimer’s disease. Evidence have shown that an approximate 6-7 out of 10 people with dementia are diagnosed with Alzheimer’s disease, making it the most prevailing cause of dementia. The prevalence of dementia according to age is the following: 3% of people aged 65-74, 17% of people aged 75-84, around 30% of people aged 85-94 and over 40% for people over the age of 95.

At what age do the first symptoms appear?
Once again, the age onset varies depending on the person, but Alzheimer’s diagnosis begins at the age of 65 becoming more common on older people. Nonetheless, it is important to notice that we are now aware of the preclinical Alzheimer’s existence. However, it can only be detected through genetic tests and biomarkers’ measurement since the cognitive symptoms are not apparent at this stage.

What treatment do you use?
Numerous studies prove the effectiveness of non-pharmaceutical intervention plans. As a result, Aktios and Blocks offer a wide variety of non-pharmaceutical intervention plans including Art Therapy, Creative Occupation, Cognitive Empowerment, Music Therapy / singing groups, Reality Orientation through newspaper reading & group discussion while finally, we are constantly trying to familiarize our patients with new technologies (e.g., online videocalls with their loved ones).
As of now, there is no certified medical intervention plan for Alzheimer’s. The scientific community is currently working on developing new medical interventions to delay its progress and improve some of the disease’s symptoms such as delirium, anxiety, sleeping problems and delusions. However, as we mentioned before, there are already some ways to delay the disease’s onset and prevent it as much as possible.

Tell us more about the methods you use in the treatment of your patients?
Aktios and Blocks use a dynamic model of operation which consists of 6 elements: Facilities & Hospitality, Residents, Families, Community, Daily Operation & Protocols and finally, Human Resources. We provide a wide range of services for different levels of cognitive function as well as many different activities and treatments since our model emphasizes in mobilization and activation, not in passive care.
Our Provision of Care is based on two pillars. First is our Nursing sector and second is our Psychosocial sector working together to ensure the provision of excellent services to all parties involved. Our units consist of special spaces full of colours, light and music. The dynamically changing decoration, along with paintings, lighting, crafts, and photographs highlight the life of our residents and help them orientate in time and place. Our intention is to have the atmosphere and energy of a kindergarten, being a place full of life and health rather than a conventional elderly care unit.

When do people need to seek specialized help?
Anyone with a family history of dementia/Alzheimer’s and middle-aged individuals that notice changes in their cognitive function should visit their doctor to detect the disease as soon as possible. Prevention is the key in most medical conditions and that is the case in Alzheimer’s as well. In addition, family carers need to seek help since numerous studies have shown that caregivers suffer from a plethora of negative feelings such as grief for their loved one or entrapment in the caregiver’s role, losing every other active role and sense of identity. The pain of the family is not only due to the memory loss, but mainly due to the changes in personality and behavior of the person with dementia. These changes mark the ending of a relationship and the beginning of a new one.

What advice would you give to anyone who is anxious or hesitant to seek help for a loved one with Alzheimer’s disease?
I would personally suggest beginning with learning more about the disease itself. It is true that their loved one is suffering from the disease and the most impactful way to help them is to seek specialized help as soon as possible. Specialized help will not only help the individual with dementia but will also help the caregiver learn how to cope with this new situation. It is normal to get anxious or be afraid of the condition but sometimes all we need is to embrace reality and do what is best for our loved ones.

What team of specialists cares for Alzheimer’s patients in your hospital?
Our team consists of specialized Internists, Geriatricians, Internists, Neurologists, Pneumonologists, Psychologists, Gerontologists, Neuropsychologists, Physiotherapists, Nurses, Occupational Therapists and Social Workers.

Are there any exercises or activities that people can do to prevent the disease from occurring?
Research evidence have shown that there are plenty of ways to slow down the brain atrophy and cognitive decline caused by the disease, but completely preventing the disease from occurring seems doubtful to say the least. Some of the activities that help Alzheimer’s patients include regular exercise, having medical conditions regulated such as hypertension & diabetes, healthy diet rich on fibers and low on saturated fats, avoiding smoking & substance consumption (alcohol, drugs etc.), having healthy sleeping patterns and finally, maintaining lifelong social and mental engagement.

What activities help with already advanced Alzheimer’s and how much can the condition be improved?
Every activity that stimulates the brain can certainly help but it is hard to define how much it helps. In detail, proper nutrition and activities that include movement (e.g., exercise, painting) can help the individual maintain his/her motor skills and delay muscle atrophy. Furthermore, both auditory and visual stimulation are ways to help. As a result, talking to advanced Alzheimer’s patients or having them listen to music stimulates their brain, having a positive impact on their condition.

Research claims that music improves the condition of people with dementia. What do you think? Do you apply music therapy?
Yes, music is found to be a very effective tool in the battle against dementia and we also use music as a therapeutical “tool” every day. Music does not only stimulate the auditory cortex and the brain but also provides the patients with pleasant feelings of joy and euphoria. Last but certainly not least, we are trying to play music matching our patient’s age and cultural backgrounds. As a result, there have been cases where people unable to function properly, have recalled lyrics of songs or melodies and I find that amazing.

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