 Good afternoon, everyone. My name is Wanda Malota, Assistant Professor of Psychology here at Exo College. I will be your chairperson for today. So the Department of Psychology welcomes each and every one of you here. We are so thankful to have you all with us to observe World Alzheimer's Day together. We are especially thankful to our resource person, Dr. Ashima Haobijan for so gracefully accepting our invite. So the team for this year's World Alzheimer's Day is no dementia, no Alzheimer's. And so we are also excited to hear and know more about this disease from an expert. So I would also like to thank all our students and our staff who are present here today. I welcome everyone. So I will read out to these program proceedings. Welcome address will be given by G Melody Sharma, Assistant Professor, Department of Psychology. And then we will have guest speaker note, Dr. Ashima Haobijan, MBDS, MD Psychiatry, Senior Resident, Department of Psychiatry, RIMS, Infile Management. Then we will have our guest speaker note. And then we will have board of thanks for the opportunity to be here, Assistant Professor, Department of Psychology. Now I give the time to Melody Sharma. Very good afternoon everyone. I'm Melody Sharma, Assistant Professor, Department of Psychology. And on behalf of our Department of Psychology at So College, I would like to welcome everyone present here for the session on World Alzheimer's Day. On the team, no dementia, no Alzheimer's. The knowledge about Alzheimer's can provide us the confidence. Sir, we have a headphone number. The competition is about how to live and plan. We have a headphone number. On this occasion of World Alzheimer's Day, we have a headphone number. We have here with us our guest speaker, Dr. Ashima Haobijan. And she is presently a Senior Resident at RIMS, Infile Management. And she has completed her MD from Institute of Human Behavioral and Allied Sciences, Delhi. And her MBDS from Lady Harding's College, Delhi. On this auspicious occasion, I want ma'am to show light on us on this particular disorder. And I would like to hand over the session to ma'am now. Thank you ma'am. Hi everyone. Can you hear me? Yes ma'am, your order is on. Okay. But that's on everyone. It's a great pleasure and an opportunity for me to be presenting you in the studio with me. Yes ma'am. Hi doctor. Actually, your voice is, we cannot hear your voice. Can you hear me now? Okay. So, I was saying that it's a great opportunity for me here presenting to you about this important topic of Alzheimer's and dementia. And medicine slides, but since I'm not able to load it for some reason, I'll just present like this. I hope everyone is okay with that. Yes ma'am. We are. Okay, can I start? Yes ma'am. Yes ma'am. I'll just make a brief presentation and all of you can ask me anything that you have questions about. So, starting with, before talking, before going to talk about Alzheimer's, we have to talk about dementia first. Because Alzheimer's fall into the big spectrum that dementia is. So, how do we define dementia? Dementia is basically losing your cognitive abilities or there is a decline in your previously attained cognitive function in a clear consciousness. So, for example, why do these two words basically, the cognitive decline and clear consciousness? Why these two are important? Firstly, you know, cognitive decline is there many, many things. Like for example, in IDD, it's their intellectual disability. So, how is it different from dementia? Is it, it is different in a way that in case of patients who had IDD, they have not really attained a functional state of, you know, cognitive, optimal cognitive functioning as per their age. But in case of patients with dementia, they have already attained that function, but they have declined due to the illness. Now a clear consciousness is important. In spite of the memory loss, in spite of the cognitive decline and sometimes the disorientation that the patients of dementia go through, consciousness is never lost. Consciousness is the basically how we react to the external stimuli. So, even if they seem like cognitively they are declining and they are not functioning to the optimum level, they will still have the response to the external environment until the last stage. So, dementia is defined like that. So, there are different kind of dementias. So, broadly we can first classify dementia into two classes. First is the reversible dementia. When we talk of dementia, I don't mean many of us know dementia can be reversed also. And there are the classes that most of us know about, which is the irreversible dementia. And what is reversible dementia? Basically, this here is the course which is called dementia. Now, in case of reversible dementia, usually the causes are like infection in the brain. Like you might have heard of meningitis, you might have heard of encephalitis. Now, meningitis and encephalitis, they can be due to bacterial infection, they can be due to viral infection. HIV also needs this condition. So, if you correct these conditions, then dementia can be reversed. Reversible dementia is also found in nutritional deficiencies, especially of B-drug deficiency and folic acid deficiency. Also in hyper and hypothyroid board. And in case of tumors, in case of brain injuries, and in case of metabolic abnormalities. Now, what is metabolic abnormalities? It is like, for example, diabetes, hypertension. In those cases, the dementia might be reversed if we collect the cause. Now, what are irreversible ones? Your Alzheimer's is an irreversible dementia. You can actually cure it. You might control it, but you are not able to cure it. So, when we are dealing with a case of memory loss, first, it's very important to find out what might be the cause behind the dementia. So, we have to... Firstly, there is a thing called major cognitive decline. I don't know if any of you know about it. In case of major cognitive decline, decline is such that it doesn't affect the functionality of the person. So, when you get a patient of forgetfulness, you should not first jump to dementia or Alzheimer's. You have to first see if it is major cognitive decline or it is dementia. And if you are sure that it's dementia, you have to first rule out if it is irreversible or it is an irreversible one. How to rule out? There will be an array of investigation. Firstly, of course, a very detailed history. What is the onset? Usually the irreversible ones will have an onset after infection or after you have had a chronic illness like diabetes or hypertension or if you had a brain injury. So, you have to take a very detailed elaborate history for this. After that, you have to take the laboratory examination. You have to get the LFTs and KFTs and all those brain-invading done. And we are sure that this is dementia and which is irreversible. Then we have to come to the classification of which type of irreversible dementia it is. Now, since we are talking about Alzheimer's today, so how do we reach the diagnosis of Alzheimer's? Now, if we talk about a definitive diagnosis, a definitive diagnosis can be only done after brain violence, which is obviously not possible when the person is leaving. We have to do a diagnosis based on ruling out other diagnosis. If you have a case of dementia which is falling into a category which is of progressive decline, irreversibility, the age of onset is usually more than 65, and then all the other causes of dementia are ruled out, then you can vary with moderate confidence, you can say it is the case of Alzheimer's. As many of us know, Alzheimer's was coined by the scientist. Allo is Alzheimer's. Now, how is Alzheimer's different from other dementia? Firstly, the onset, we have two types of Alzheimer's. One is early onset Alzheimer's and second is late onset Alzheimer's. Early onset ones are in the age category which is less than 65. It can start from the 40s, very rarely from earlier than that, and the late onset ones are in people who are more than 65. So, this is early in the late onset Alzheimer's. Now, what are the science and symptoms of Alzheimer's? So, basically, before the science and symptoms, we can talk about the prevalence of Alzheimer's. In all the dementia's that we have, Alzheimer's has around 60 to 70% prevalence. So, majority of the dementia cases, it is of Alzheimer's. As we all know, it is a progressive and deteriorating illness. The science and symptoms usually, the first thing we notice of course is the memory. Presenting symptoms usually how they present to the doctors to us is because of memory loss. Initially, the memory loss is of very recent memory. We will say complaints like the patient is misplacing things. They will say that he has forgotten that he has had a particular conversation before. He has forgotten to take food and he has forgotten certain conversations. He will keep repeating these statements. Eventually, this might deteriorate further into your long-term memory, even eventually leading to other peripheral memories. So, they will have in the later stages, you will have an inability to find words. They are not able to express thoughts. They are unable to take a deeper conversation. Later on, there might be a seizing of the speech. So, the first thing is the memory. Then, moving on to the memory, we have an effect on the thinking and reasoning also. So, things that were easier for us before or easier for them before, like simple things like paying bills, managing finances, dealing in numbers, and then difficulty in concentrating. So, daily tasks become a big thing for them. They are not able to do it. Then also, we have a decline in making judgment and decisions. So, normal things like what to wear, like what to wear appropriately for a social setting or for a weather. So, the person is not able to take these decisions, most of the decisions. So, there is also a major effect in the day to day living, like simple things like cooking, dressing, batting, you know, even brushing in the morning, those things are not able to do it. Then there are changes in personality and behavior also. Major changes that we can see is that kind of empathy that the person goes through. So, when a person was emotionally very expressive or who was very, you know, in tune with the family, you will start noticing that they are not very empathetic or sympathetic towards their family members. They are not taking part in the day to day conversation or the planning of family. So, they become kind of empathetic. Along with this, there is a case of irritability also. They might have sudden mood changes. They might become suddenly agitated for any particular reason. Aside from these small, these behavioral changes, there is around 20 to 30% of psychotic symptoms in these patients also. So, they might present a hallucination. They might present with visual, both visual and cognitive hallucinations. And there is also a very high prevalence of delusions in these patients, especially of the paranoid type. So, they become very suspicious towards their family members. They might not trust them in little things like taking food from them or taking advice from them. So, these are the behavioral changes. So, these changes won't come together at first. They won't be there in the first time when you diagnose the patient themselves. So, it is a case of depending on the severity. For example, in initial stage, there is mild severity. So, when I am telling you about the severity, I will tell you also about the course here. So, initially in the initial phase, the severity is mild. So, in the initial stage, the mild stage, there will be only loss in certain things like day-to-day tasks, like those things like forgetting things that we are misplacing these basically. And then it lasts usually a period of around 2 to 10 years. So, this gap is very much. Some people might have only 2 years in this stage. And some people in this stage may last even 10 years. In the second stage, which is the moderate stage, you may start losing certain other activities like day-to-day tasks, performance of day-to-day tasks. Like I said, taking bath, cooking, which are the usual things for them. So, again, this stage might last 2 to 3 years or it might last 10 years also. The last stage, which is the severe stage where a person starts losing most of all his cognitive abilities. They need assistance for almost everything in their life. So, many of them can become bad people and lose their motor abilities and lose their speech ability. So, this stage is particularly shorter compared to the other stages. So, it lasts maybe 3 to 4 years. So, this is where the end promises of Alzheimer's lies. Now, there are certain things in Alzheimer's which are preserved. You would think a person is losing motor abilities, he might lose speech. Certain preserved skills, very interestingly, some skills like singing, some skills like breathing, some skills like dancing, you know, arts and crafts, they are very much intact to a very later stage. So, these are called preserved skills. Then, there are certain phenomena which are associated with dementia. I don't know if you have heard about this, but there is one thing called very interesting thing or very sad thing also called the catastrophic reaction. So, in this case, a person, usually the patient with dementia, one very big difference between a patient with dementia and one other patient from say, depression or major cognitive decline is, patient with dementia or Alzheimer's, they never acknowledge that their cognitive function is declining. They will try to deny it, they will try to, you know, even distract when we are talking about these things. For example, this patient when they come to us, I will ask aunt Ki or aunt La, you having difficulty in memory, they will say, no, I don't have a problem, my family or my son has a problem, I don't think so. Okay, they will say like this. So, there is a thing of catastrophic reaction where suddenly one fine day or one fine moment, they suddenly realize that their cognitive abilities are declining, you know, they are not able to remember certain things, they are not able to do certain tasks, it was easy for them and they have this certain panic like reaction. It might present with simple panic attack, but it might be more, it may, they might have some agitation, they might become behaviorally very disruptive, they might, sudden people will start banging on the wall, you know, they will start shouting, because they don't know how to deal and, you know, they are not able to understand what's going on with them. So, this is called the catastrophic reaction. There's another thing called a Sundamus effect. This is very particularly mentioned by the family members. They will say that my father or my mom was okay in the morning, they were very fine, and suddenly the evening in the night, they are suddenly deteriorated. So, it is called the Sundamus effect. All the symptoms of dementia or Alzheimer's, they start deteriorating within the evening time. So, along with the deterioration, the cognitive effect, there is also a sudden deterioration in the behavioral aspect. So, why does it occur? Usually, during these late hours, there is a decline in the external stimulus that the person received. There is a decline in the light stimulus, there is decline in the auditory stimulus that the person received. And because of this deficiency, this is the belief that the Sundamus effect occurs. So, Sundamus effect is also more in case of patient who are taking sedatives or they are taking antipsychotic. So, they might also have complained so full of this orientation of Atexia also. The third phenomena is, it's not actually a phenomena, but this is a behavior that we see very much in the patient of dementia. That is of denial. They will always deny. But anything wrong is going with them. Like I earlier explained to you, they will deny there is a cognitive decline. They will deny there is a decline, there is a problem, even for them, they will say things are completely fine. Which is kind of a differentiating feature from more memory decline in other cases. Like even in patients of let's say depression or psychosis, they will also say that they have a memory decline. But this problem will be acknowledged by them and will be very problematic to them. But in case of dementia patient, they don't acknowledge it and it is not actually a problem for them. So, this is the denial that we talk about. I'm sure many people want to know what are the risk factors of Alzheimer's. So, the first thing of course is age. But then as we all know, everyone of age has dementia Alzheimer's. So, first thing of course is age. Beyond the age of 65, there is a progressive increase in incidence of dementia. After age, there is a major genetic role here. So, around 30 to 40% of people who have Alzheimer's have family history of parents or family members who have had Alzheimer's or who have had dementia. The third thing is basically chronic illnesses. For example, people who have uncontrolled diabetes or who have uncontrolled hypertension, they have more chances of having dementia. Then there is another very interesting thing where females have more chances of Alzheimer's or dementia than males. Now, why is it so? It is not actually, let's say proof. One hypothesis is that females live longer than males. So, the incidence or prevalence is more than them. And second is the hormonal factors. After menopause, females have significant decline in hormonal levels. So, this is also one reason that has been hepatocytes. It's one of the reasons that females have more incidence of prevalence compared to males. Another thing is head trauma. So, people who have had a history of head trauma, who have had a history of strokes, who have had history of, you know, like I said, infections. I mean, anxieties and all, they have more chances of developing dementia. One other very significant thing is your lifestyle. So, in lifestyle, your lipid profile. If there is your cholesterol levels are very high, this is also very important in this sector. Your uncontrolled sugar levels, your hypertension, air pollution, then smoking. Apart from smoking in the substances, we have alcohol. So, people who have had taken chronic alcohol, then they also have the higher chances of Alzheimer's. Then we also hypothesize the lack of intellectual stimulation is also one respect of Alzheimer's. So, we can see it in lower or middle income people. The incidence of prevalence of Alzheimer's is more compared to the higher income group. So, these are the few risk factors that we know of in Alzheimer's. Also, the education levels. So, in people who have higher education levels, the chances are low compared to the people with lower education level, though it is not very significant as one would imagine. Now, coming to the treatment. So, in treatment, we have your pharmacological treatment and your non-pharmacological treatment. So, talking about pharmacological, we don't really aim for cure in dementia and it is just no cure as such. But all the drugs available are mostly to be given during the mild and the motor stage. At the severe stage, drugs actually do not have much of a role and it is not going to cause any improvement. Rather, it might deteriorate the case because it might lead to side effects instead of giving any useful effect. So, drugs that we have as some drugs called burnables, then there is one called mementoine. Basically, targets the cholinergic system of the brain. Apart from this, you have to symptomatically treat the patient. For example, if they have anxiety, if they have depression, if they have psychosis, you have to treat accordingly. If they have aggression, you have to treat accordingly. They might have insomnia also. They might have appetite problems. So, symptomatically treatment has to be done in this case. So, earlier you treat the case better is the prognosis, even though you might not cure the disease, but you might cause a decrease in the rate for how to process for some time. So, this is mainly the aim for the pharmacological treatment. The drugs that are given for dementia doesn't really have any significant or major side effect. But compared, like in some patients, they might complain of nausea, they might complain of some gastritis irritation. But it is not major, and most people get used to the side effects within one to two weeks. In the non-pharmacological, I'm sure you know more about this than me, but we have to divide this into two ways. The non-pharmacological method for the patients and non-pharmacological methods for the caregivers. Now, one important major factor here is psycho-educating the patient about illness. Obviously, when someone comes with severe dementia, we can't obviously psycho-educate them. They will not be in a state to understand what's going on with them. But people with mild to moderate, we can attempt to psycho-educate them, tell them honestly what's going on with them. So, be there when they're dealing with, they're accepting or dealing with the diagnosis. Another very important thing is to encourage the preserved skills. One might have problems in memory, one might have problems in cognitive, but as I mentioned before, there are certain things which are preserved. You have to enhance it. Let's say someone has a singing is intake, or the interest in music is intake, they still love to draw. Then we can encourage them. We can also encourage them to participate with the family members to induce activities. Then you have to schedule their activities of the day. So, they have a small structure in the day. You can schedule the activities along with the family members, along with the patient and try to adhere to it as far as possible. Then we can suggest some methods that you can preserve the memory, like taking notes, setting reminders, alarms. Aside from this, you have to treat the other mental health issues that might be present with them. And of course, there's the healthy lifestyle choices like you have to cut down in any substance use if it is there. Regular physical exercises, meditation, all this will help to a large extent. Coming to the non-pharmacological method or the counseling of the care givers. Now, care givers, many times, this is a very practical thing that we have seen. So, many times, they suffer from guilt. Obviously, when you are dealing with a case of Alzheimer's, people get very irritated. They get very helpless, like, what to do? You can't do this, no cure. There's nothing there they can do. The severe seizures, the person is completely dependent on you. So, in these cases, many times they are doing the all they can do, but still so many things are left, they are not able to do it. So, they suffer from guilt, which might lead also to mental head deterioration in these people. So, you have to take precaution or you have to take extra care that they are not suffering from these things. So, in order to allow for the psychoeducation to the patient himself, you have to psychoeducate the family members. Also, be very honest and be very honest as well as empathetic about taking about this case, about this diagnosis to them. You don't have to say that you have this diagnosis, there is no cure or it is hopeless. You have to tell them about the plan, what is the illness, what all can be done and what is the stage. So, this is one thing you have to deal with them and basically tell them what to expect as you go on. So, they can prepare and plan what all they can do eventually. So, this is the pharmacological and non-pharmacological methods which we can somehow improve the life of a patient with Alzheimer's. Now, how to prevent Alzheimer's? Now, this is the thing that has been many times asked to us in the techniques like how to prevent Alzheimer's. There is no sure shot way of preventing Alzheimer's actually, it's all random. So, if in case let's say you have a family history then obviously you can somehow think maybe your risk is higher. So, in this case you have to meet a very disciplined life style. So, all those risk factors I mentioned like taking substances, uncontrolled diabetes, having more lifestyle choices like not so nutritious things, keeping yourself mentally stimulated and then taking care of your mental health obviously, taking care of your early signs of any decline like forgetfulness, all those things you have to keep that in mind. Apart from the general things like having a good support system, regular exercises, these are the things which might help in preventing Alzheimer's but then there is no sure shot way unfortunately where we can say if you do this you won't get Alzheimer's. So, this is how prevention work here. I think I have covered most of it. So, yeah, I think we can ask these things that I can clear your doubts about I think. Okay Doctor, thank you so much for running us through the disease in so much detail. I think the anecdotes that you shared and also the very practical tips on how to increase our protective factors have been very insightful for me and I think we have all come out more and more knowledgeable after your talk. So, now we will take questions from the audience. So, if anybody has any questions, please feel free to unmute yourself and ask your questions or you can also type down your questions so that I can read it out for you. Okay, there is a question for you Doctor, is Alzheimer's genetic? Yeah, like I already mentioned it is genetic in the sense that people who have had family members or Alzheimer's, they have increased chance of around 40 to 60% in them of having Alzheimer's compared to the other population who don't have a genetic problem. So, you can say yeah, it is genetic. Feel free to unmute yourself and ask your questions also. There is another question for you Doctor, is it possible for an Alzheimer's patient to restore their memory at certain cases times? If yes, is it a common or rare case? Restore memory at certain cases of time? Well, there is no such phenomena as such where they are automatically or suddenly dramatically restored memory. But yes, the Alzheimer's memory decline is kind of fluctuating day to day basis, time to time basis, but they won't completely regain their earlier functioning. So, the memory decline may be worse in some time of the day or some days of the week or it might be better in some days of the week or some time of the day, but it's not going to go back to the earlier stage if you will discuss that. Are the drugs used to treat Alzheimer's effectively? Okay, that's what I was saying. It is effective in the way that you can slow down the process, but it is not cured. If you administer the drug earlier in the earlier stages when the Alzheimer's have not deteriorated and severe cognitive decline, there might be a chance of little bit improvement in the cognitive functioning which might last a very long time. For let's say five, six years, there might be an improvement in the cognitive decline even though it won't be completely cured. So, the drugs are useful in that sense, but it is not going to cure the Alzheimer's. So, it's not going to root out Alzheimer's. The deterioration will be there, but the speed will decrease basically with the drugs. What is the best place for care at home or in the nursing facility? That depends on the stage of the illness. For mild cases, then you don't need, mild to moderate, you don't need to be at the person admitted. But in certain cases, there is a comorbidity of psychiatric diagnosis, especially severe depression or psychosis. In those cases, the family members are not able to handle the patient. So, we might admit the person for symptomatic treatment for the psychiatric home morbidity, but I don't think there is any use in admitting a person with severe Alzheimer's because it is not going to cure it as such. It is better to teach the family members how to handle the patient, what are the things that is going to occur, what are the declines that is going to occur and then guide them in staying, letting the patient stay at the home instead with proper supportive care. So, admission is usually when there is a behavioral problem, complimenting the area. Does Alzheimer's affect how long an individual lives? We say that once you are diagnosed with Alzheimer's, I won't say you are diagnosed, but once a person gets Alzheimer's, the life expectancy can be from 3 years to 10 years. It is a very large range, but it is how it is. Some people might live for 3-4 years and some people might live for 10 years, so the expectancy is said to be 3-10 years. It depends on the stage or so. Let's say you are diagnosed with severe stage, then the life expectancy is very low. It is maybe 4-5 years, but if you are diagnosed with earlier stages, then we can see 5-10 years is the range here. Is there a professional course or center for Alzheimer's? Course or center for Alzheimer's? Only for Alzheimer's, but there is a super speciality in psychiatry about psychiatric psychiatry, which will deal with dementia and Alzheimer's specifically along with other ailments that occurs in psychiatric population, but there is no specific different or one course about Alzheimer's. What is the success rate of being Alzheimer's with drugs? Success rate of what? Curing Alzheimer's with drugs. Like I said, drugs do not cure Alzheimer's, so the success rate is let's say 0. It's only going to halve the process, it's not going to cure Alzheimer's. So the treatment is only to help control the symptoms for some time, but the brain deterioration is going to take place even though the rate or the process might be slowed down. So it is not cured. Is there a way to prevent Alzheimer's? Prevent Alzheimer's, yes. Like I said, you have to maintain a healthy lifestyle. You have to stay away from drugs, you have to stay away from alcohol, you have to stay away from smoking, you have to keep your blood levels very, the sugar levels well maintained, the cholesterol levels well maintained, your BP well maintained, you have to maintain a healthy lifestyle, you have to have regular physical activities, you have to have mental stimulation, and you have to have low pollution, I don't know how you're going to do it, but yes, there is one of the things that they have mentioned there. So there is some of the things that will prevent you from, and of course, have a nutritional guide where you can prevent deficiencies, get yourself regularly checked, but there is no sure sort of way of preventing Alzheimer's like I previously mentioned. But if you have a genetic loading, then you have to take extra precaution, and you have to take extra precaution in maintaining all this healthy lifestyle choices, but still then, again, there is no sure sort of way that I can say, can you do this and you will prevent Alzheimer's, yeah. Ma'am, is Alzheimer's disease hereditary? Hereditary, in a sense, yeah. People who have had family members who have Alzheimer's have increased rates compared to the people who don't have family members in the tune of around 60%. So yeah, you can see that there is a genetic component or hereditary component here in Alzheimer's. Alzheimer's disease is a uniquely human order. Does animals get Alzheimer's? Okay, I have not specifically read about this, but no, as far as I know, there has been no case of Alzheimer's in animals, because firstly, it would be very difficult to assess the animals. How will you assess the memory decline? How will you assess the patient that animal is not able to brush anymore? So there is no principle of Alzheimer's in animals other than humans as of now. If anyone has any more questions, you can ask. I would like to thank Nime Nyo. Ma'am, I have a question. So we have often heard of anterior-grade and retrograde in Russia. So what is particular Alzheimer's, which one would be more prevalent? And again, yeah. Initially, the anterior-grade is firstly affected. After that, basically, all the aspects of memory will be affected, depending on the stages. Firstly, you have the anterior-grade memory. After that, you have lost in the retrograde also and you have lost in the autobiographical memory also, eventually. So initially, it will be anterior-grade. So again, regarding hypertension as your pension, for people who are having chronic hypertension, they must be taking medications for quite a long period or quite some time. So for them, besides the lifestyle changes, what all preventive measures they can carry, because here I think especially in the North East, even in our family members, they are not much aware of what they have to do regarding disease. So we are not aware whether they have developed this disorder or not. So for that reason, what are the steps that we can take up as family members in order to protect the elderly ones in the house? Firstly, what I want to mention is just because your hypertension doesn't mean you'll have Alzheimer's, just that the risk is a little bit higher here. What we say about hypertension and Alzheimer's is that the BP level, the systolic BP, should be kept at the higher side of the normal range. It shouldn't be kept very low, but that is one thing that a doctor has to do. Obviously, you won't be able to do it. That is one thing. Secondly, apart from maintaining your BP, even if you're taking anti-hypertension for a long time, it is more important to maintain your BP than worry about taking these drugs, because these drugs are important. So the drugs are not going to cause your Alzheimer's, but the uncontrolled BP is going to cause Alzheimer's. So continue taking anti-hypertensive. Apart from that, obviously, how to control the hypertension will be a low social sodium diet. It doesn't mean to cut off the sodium completely. It just means low sodium, no sodium. What we get many a times in our clinic is that people, because they have heard if sodium causes increase in BP, they'll just completely cut off sodium from their diet. That is not going to help, and it is also going to be harmful. You have to have a low sodium diet. Decrease salt amount in your food. Don't take extra sodium. Don't take those fries and those chips and all those things. That is one thing. How to control BP will be other than the diet. There will be, of course, the physical exercises is very important. It doesn't mean you have to go to the gym. You have to take breaks exercises, like remuneration, taking wards, and hypertension. Get regularly checked yourself regularly. You know, every six months, especially if your parents are having hypertension, you should get their ECG done regularly every six months. You can get your blood levels done, check their cholesterol levels, because all these things are connected. Get their LFTs done, their KFTs done. So you can catch your metabolic changes if it has started to occur and correct it at the initial stage of itself. So this increase in blood levels is going to all affect your brain. So this is how you're going to prevent if any change in the Alzheimer's, like changes occurring in your brain or in your mind. So these are the things apart from teaching medicine that you can do. Thank you, Ma. Of course, keep them mentally stimulated. Make them read, make them well aware of what is happening around the world, music and all those things. Thank you so much. Any other questions? I'd like to thank Melody, as well as Nime Nyo, Lobino, Imli Benla, Tenjen Le, Tenjen Nyella, Houding Le and Machuni for your questions. I think your questions have all helped us also understand better. And also, Ma'am, for clarifying our doubts. So if anyone else has any questions, if no, then I give the time to Dr. Nuzini, I say. Good evening once again. That was indeed a very intensive and learning experience from you, Ma'am. We have all learned a lot. And in spite of a very short time given provided to you, you have explained to us very properly about our onset and how it progresses as well as you have touched a little bit on treatment, all the specific areas. So yeah, we have learned a lot from you, Ma'am. And thank you so much for accepting our invitation in spite of your busy schedule. We hope to have, you know, in the future to have more collaborations if the opportunity arises. Yeah. Thank you so much. I hope I have been able to convey some ideas to you and, you know, help you understand Alzheimer's a little more. Yes, Ma'am, indeed we have, yes. And I hope the students also have also joined. Yeah. Yeah. So with that, we have already come to this today's Awareness in Alzheimer's program. And I would like to thank, you know, all the students, the staff, and those guest who have joined us this evening from, you know, outside of college as well. You know, your presence made a difference for this program. And I hope, yeah, all of us will be living this program with God and creating more awareness about dementia and Alzheimer's. Yeah. Okay. Yeah. Thank you all. Yeah. And have a good evening. Thank you. Thank you, Ma'am, once again. Thank you. Thank you so much.