“DOCTOR my grandmother has become forgetful nowadays. She forgets where her room is. Sometimes she forgets name of her close relatives and also blames us for misplacing her belongings.”
This scenario is becoming more common in families with elderly relatives.
With the advances in medical sciences the average life expectancy is increasing all over the world but has not been without some health consequences.
The term “dementia” is generally used to describe the loss of memory and cognitive function of the brain. However there are different types of dementias and the two most common are Alzheimer’s disease and Vascular dementia.
According to one report the number of dementia cases will increase in the Asia Pacific region from 13.7 million people in 2005 to 64.6 million by 2050.
Thus the number of new cases of dementia in Asia Pacific region is projected to increase from 4.3 million new cases per year in 2005 to 19.7 million new cases by 2050.
World Health Organisation data has suggested that the disease burden of dementia exceeds that of malaria, tetanus, breast cancer, drug abuse or war and is projected to increase by over 76 per cent over the next quarter century. Fiji is not an exception to the above facts.
I have been working in mental health facilities in Labasa and Suva and have noticed a rise in the number of dementia cases although there is no current statistical records available.
Dementia is characterised by gradual loss of memory function associated with a decline in:
* Ability to speak coherently or understand spoken or written language
* Ability to identify or recognise familiar objects and loss of capacity to name simple objects like pen, table, telephone, name of close relatives
* Ability to perform daily routine activities like bathing, changing clothes, washing
* Ability to carry out complex tasks like marketing, driving, and shopping
These changes are gradual and not all the symptoms are present at same time. (A symptom in medical terminology refers to subjective sensations, possibly indicative of a disease process, which the sufferer feels or expresses, such as feeling confused, pain, forgetfulness, etc).
Initially the person has some memory loss which usually becomes evident when he or she frequently misplaces items and blames another for hiding or stealing them.
It is often attributed to old age and not given much attention, but later the memory loss gradually worsens and disrupts daily activities.
It becomes increasingly difficult to complete familiar tasks at home, and confusion with time and place ensues. The person starts having problems with words in speaking or writing and there may be changes in mood and personality. The individual withdraws from work and social activities.
The progress of dementia and Alzheimer’s disease from mild to severe form is variable for each individual. As the disease progresses, the individual becomes more dependent on others for their activities of daily living such as eating, bathing, dressing and personal care. Those in the final stages of the disease fail to recognise very close family members and lose their ability to communicate. They may also experience hallucinations and are aggressive at times. They need constant supervision and are vulnerable to infections.
Facts about dementia
Although this is a disease of old age, not all elderly suffer from this dreadful disease. Dementia is not a normal part of aging. It is usually caused by a variety of brain illnesses that affect memory and cognitive functions.
As mentioned earlier, there were about 35.6 million people living with dementia worldwide in 2010 and the number is increasing by one new case diagnosed every four seconds around the globe.
This disease has huge economic impact estimated to be US$ 604 billion (F$1136 billion) per year.
Caring for a dementia patient is very stressful and exhausting for family members. It is a huge physical, emotional and economical burden on a family and always requires support from health and social systems.
Risk factors for Alzheimer’s and other dementias
Cardiovascular disease risk
factors — The health of the brain is closely related to health of heart and blood vessels. Healthy heart and healthy blood vessels are essential to maintain adequate supply of oxygen and nutrients to brain needed to function normally.
Therefore the factors that increase the risk of cardiovascular diseases are also associated with a higher risk of developing Alzheimer’s disease and other dementias particularly vascular dementia.
These are the well-known factors which are repeatedly been mentioned but mostly been underestimated by people. These factors include smoking, high cholesterol in mid life, obesity and hypertension (abnormally high blood pressure) in mid life.
Thus the combination of three or more of the following: poorly controlled hypertension and blood sugar level, obesity and abnormal blood cholesterol levels increases the risk of dementia.
As we all know non communicable diseases are a growing concern in our country and so the long term complication like dementia is added burden to that.
Thus to protect the brain one should protect the heart. Physical exercise and diet low in saturated fats and rich in vegetables may reduce Alzheimer’s and dementia risk.
Education: People with less years of education have a higher risk for dementia and Alzheimer’s. In other words, education reduces the risk of Alzheimer’s and dementia. The reason is not clear. However, studies have demonstrated that engaging regularly in mentally stimulating activities help reduce risk.
Social engagement: People who are more mentally and socially active have reduced risk of developing Alzheimer’s and other dementias.
Traumatic brain injury: Moderate to severe traumatic brain injury which means loss of consciousness or post traumatic amnesia (temporary loss of recent memory) that lasts more than 30 minutes and loss of consciousness or post traumatic amnesia lasts more than 24 hours respectively, are associated with increased risk of Alzheimer’s and other dementia.
Also those who experience repeated head trauma such as boxers are at higher risk of dementia. Other non modifiable factors include family history of Alzimer’s and dementia; individuals whose first degree relatives (parents, brother or sister) have this disease are at greater risk.
Treatment of dementia
This disease has no cure and pharmacological treatment has limited success. The supportive treatment therefore rests solely on an individual’s choice to deal with this disease, having their needs understood and good family and social support.
Early intervention may help to slow the progress of disease and improve the quality of life of an individual.
There are many challenges such as limited awareness about dementia, inadequate human and financial resources to meet care needs, inadequate training for caregivers and lack of support for family caregivers and attached stigma.
Dementia is not a natural part or complication of the ageing process. There are a number of factors including urbanisation, increasing trends towards nuclear families and increasing number of elderly people living alone which complicates the social and economical impact of dementia.
Many countries in Asia Pacific are not yet prepared to provide the quality health and care services for people with dementia but in coming years we all need to address the issue of caregiving for the increasing number of dementia cases.
Fact sources:
* Dementia in the Asia Pacific region: The epidemic is here report by Access Economics Pty Limited.
n Alzheimer’s Association, 2013 Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia, Volume 9, Issue 2.
* Dr Kiran Gaikwad is a doctor practising in Psychiatry at Saint Giles Hospital, Suva.
