By Dr Hiruni Abeysinghe and Dr. Kaveendra Pathirage
Every year, there are nearly 10 million new cases of dementia.The World Health Organization (WHO) states that more than 55 million people have dementia worldwide, over 60% of whom live in low-and middle-income countries. Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older people globally.
What is dementia?
Dementia is the term given when a person develops a decline in memory and intellect severe enough to interfere with their daily functioning. It may even result in the change of the sufferer’s personality.
A scientific overview on the types of dementia:
Dementia is caused by many different diseases or injuries that directly and indirectly damage the brain.
- Alzheimer disease is the most common form and may contribute to 60–70% of cases. Alzheimer’s dementia is prevalent among those over 60 years and the rate of disease doubles every 5 years. Memory is lost for recent events first. Language is usually affected early on, with difficulty in finding words or naming objects and impairments in the ability to construct fluent and informative sentences. Visuospatial skills may be affected, with difficulties in tasks such as copying pictures or learning the way round unfamiliar environments. Depression is frequent and fluctuations in mood and confusion are common, especially at night.
Other forms include vascular dementia, dementia with Lewy bodies and frontotemporal dementia.
- Vascular dementia results from neuronal damage due to diminished blood supply to the brain.
- In dementia with Lewy bodies (abnormal deposits of protein inside nerve cells), patients experience visual hallucinations where you see objects or images which do not actually exist. These present together with features of Parkinsons disease and a history of recurrent falls.
- Frontotemporal dementia (degeneration of the frontal lobe of the brain) is a condition with prominent behavioural changes and difficulties in speech.
Dementia may also develop after a stroke or in the context of certain infections such as HIV; as a result of harmful use of alcohol; repetitive physical injuries to the brain or nutritional deficiencies. The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
- Signs and symptoms of Dementia consist of forgetting things or recent events,losing or misplacing things, getting lost when walking or driving, being confused even in familiar places, losing track of time, difficulties solving problems or making decisions, problems following conversations or trouble finding words and difficulties performing familiar tasks.
Changes in mood and behaviour like feeling anxious, sad, or angry about memory loss, personality changes, inappropriate behaviour, withdrawal from work or social activities and being less interested in other people’s emotions are seen.
Dementia affects each person in a different way, depending upon the underlying causes, other health conditions and the person’s cognitive functioning before becoming ill.
Screening
The most important part of dementia care is to get diagnosed early and obtain professional advice on the management plan. Standard screening tests such as Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are available at government hospitals and screening centers.
Treatment
Every person with dementia is unique and the approach to care should be individualised. There is no cure for dementia, but a lot can be done to support both people living with the illness and those who care for them.
The basic principles of care include understanding the disease pattern and the struggles or difficulty the person with dementia is facing, providing a supportive environment, maximising their ability and minimising their loss due to cognitive decline.
For those diagnosed with dementia, the following measures can help:
- Educating family members about dementia; how to provide care, and to be empathetic
- Environmental modifications such as writing down everyday tasks, labelling objects, having a large calendar and clock in the vicinity, placing directions to frequently used locations within the house and ensuring good lighting while minimising risks
- Keeping the brain active by engaging in art and music, solving puzzles, involving in games
- Eating healthy and being physically active
- Social interactions, spending time with family and friends and community activities
- Going for regular checkups with the doctor and making sure that the medical conditions are well managed.
In addition, medications like Donepezil and Memantine may be prescribed by doctors to improve the symptoms and delay the progression of the disease.
Risk factors and prevention
Although age is the strongest risk factor for dementia, it is not an inevitable consequence of biological ageing. Studies show that people can reduce their risk of cognitive decline and dementia by being physically active, not smoking, avoiding alcohol, controlling their weight, eating a healthy diet and maintaining healthy blood pressure, cholesterol and blood sugar levels.
(The writers who are graduates of the Faculty of Medicine, University of Kelaniya, are currently interning at the Lanka Alzheimer’s Foundation)
Originally published in the Sunday Times on Sunday, September 03, 2023
