While most people look forward to reaching old age, seeing it as a reward for a long, well lived life, that time of life also comes with a lot of problems, especially health related ones. These range from reduced physical strength to more serious health challenges such as diabetes, high blood pressure and even dementia. While the latter is one of those ailments that exists in our communities, there is however, very little awareness or information about it.
Health experts believe that dementia is one of the biggest public health challenges facing the world in the 21st century and more awareness about the disease is needed to tackle it.
The 2013 bulletin of the World Health Organization for instance, estimates that 35.6 million people are currently living with dementia worldwide and that the number will double every 20 years. Developing countries like Nigeria account for 57.7% of this number.
“For a disease that has no known cure, the level of awareness is still very low and a lot needs to be done about it,” opined Dr Popoola Oluwafemi, a medical practitioner. Speaking further, he stated. “Dementia can safely be described as a disease of old age though it should be noted that it could be seen sometimes in the younger population like in early onset Alzheimer. In dementia, there is a history of chronic, steady decline in short and long term memory and is associated with difficulties in carrying out daily activities, maintaining relationships or even work.
It is important to note that dementia is a generic term for a broad category of diseases that cause decline in a person’s usual mental functioning.”
“Studies on the prevalence of dementia in Nigeria are actually limited and this is due in no small part to what is called the ‘iceberg phenomenon’. In Nigeria as in other developing countries, the cases that are seen and documented in the hospitals are only a tip of the iceberg because many of the sufferers of these disease don’t seek medical help. The low awareness of the populace about mental illnesses also contribute to the low statistics available.”
Popoola noted that various epidemiological studies carried out in Nigeria have revealed a prevalence rate ranging from 2.29% to 21.60% of the population. “Major risk factors identified in these studies include old age, female gender, cardiovascular disease and illiteracy among others,” he added.
Also describing what dementia means, Dr Femi Agberotimi, Clinical Psychologist, Psychiatry Dept, Ladoke Akintola University Teaching Hospital, (LAUTECH), Ogbomosho, Oyo state, stated: “It occurs as progressive deterioration of intellect, behavior and personality as a consequence of diffuse disease of the brain hemispheres, maximally affecting the cerebral cortex and hippocampus. For dementia to be diagnosed memory must be impaired, followed by a deterioration from previous function in at least three of the following functions: language, visuospatial skill, executive abilities and emotion.”
On the symptoms of dementia, he said: “Loss of memory for recent events is the earliest feature of dementia. Subsequent symptoms include abnormal behavior, loss of intellect, mood changes, and difficulty coping with ordinary routines. Insight may be retained initially, but is then usually lost. Ultimately, there is loss of self-care, wandering, incontinence, and often paranoia.
“Dementia has to be distinguished from delirium which is an acute disturbance of cerebral function with impaired conscious level, hallucinations and autonomic overactivity as a consequence of toxic, metabolic or infective conditions.”
A growing Third world concern
Due to the low awareness about the ailment, the prevalence rate of dementia in the country are not readily available. “Certain factors like dearth of data on the disease, and unavailability and poor nursing home arrangement where they exist make prevalence study of dementia difficult in Nigeria,” said Agberotimi. Experts, however, point out that the condition is one that is set to increase in many developing countries including Nigeria in the future. For instance, a study carried out in 2008 titled: “Alzheimer’s disease and vascular dementia in developing countries: prevalence, management and risk factors by a group of doctors namely Raj Kalaria, F.R.C Path, Gladys Maestre and Piero Antuono noted that, “Older people with dementia exist in nearly every country in the world. Dementia rates are predicted to increase at an alarming rate in the least developed and developing regions of the world despite mortality resulting from malnutrition, poverty, war and infectious diseases.”
The study stated that WHO projections suggest that by 2025, about three quarters of the estimated 1.2 billion people aged sixty years and older will reside in developing countries.”Thus, by 2040, if growth in the older population continues and there are no changes in mortality or burden reduction by preventive measures, 71 percent of 81.1 million dementia cases will be in the developing world,” the study noted.
On the risk factors for the disease, Agberotimi said: “Age is a primary risk factor for dementia. Studies of the United States population show that about 3% of the population between the ages of 65-74 suffer from dementia, about 18.7% of people aged 75-84 have dementia, while the number is expected at about 47% of people over 85 years old.
Other factors that have been associated with the cause of dementia of the Alzheimer’s disease type include: female gender, head injury, cerebrovascular disease, low education level, rural residence, blood cholesterol, and low blood levels of folic acid.”
He further explained that there was a difference between dementia and Alzheimer stating:
“Dementia and Alzheimer are not two separate disorders, rather Alzheimer’s disease is a type of dementia.
“There are many different types of dementia and many different causes. Alzheimer’s Disease (AD) is the most common form of dementia. Overall, Alzheimer’s disease accounts for just over half of all dementia (55% – 60%) which is significantly more than any other form. AD is a neurodegenerative disease which causes impaired cognitive functioning. People with AD have difficulty recalling information after a short period of delay. New information may be learned, but won’t be remembered after a period of even a few hours. And because it is a progressive disease with one of the earliest symptoms being memory loss, diagnosis is difficult. There is currently no known cure for AD.
Signs to look out for
Experts state that the condition comes with certain signs that are easily discernible. Common symptoms of dementia include forgetting names and objects, not recognizing family and friends, forgetting one’s own phone number or address, difficulty finding a familiar place, noticeable language and intellectual decline, forgetting to eat or maintain one’s hygiene, poor judgment, inability to follow simple instructions, progressive sense of distrust and unusual agitation and irritability.
“Symptoms of dementia may be subtle at the initial stage and patients might even try to hide or downplay them,” said Popoola. Continuing, he added: “But as the condition progresses, the symptoms tend to become more pronounced. There is affectation of ability to think, speech and language difficulty, memory difficulty and problems with organization. Sufferers of this disease might also be seen getting lost, repeating things over and over as they can’t remember saying them before, and they might also develop social withdrawal and personality changes.
Dementia is a slow and progressive disease and by the time these symptoms are noticeable, the disease is already advanced. In Alzheimer’s disease, the most prominent early symptom is memory difficulty which affects short term memory first, and then long term.
By the time the disease is in its late stages, the sufferers become entirely dependent on care givers, they may become incontinent and might not recognize even familiar people anymore.”
On the treatment for the disease, Agberotimi had this to say: “No medication can cure dementia yet. But symptoms can be managed, especially if early diagnosis is made. The earlier a correct diagnosis can be made, the greater the gain in managing symptoms through pharmaceuticals. Trained clinicians with proper imaging techniques can diagnose AD correctly nearly 90% of the time. Magnetic Resonance Imaging can measure the size of various structures in the brain.”
Also speaking, Popoola said:”Dementia is a disease that has no cure. There are also no proven modalities for preventing dementia, especially Alzheimer’s disease. However, recent epidemiological studies suggest that healthy lifestyles can reduce the risk of developing the disease. It has also been documented that physical activity, exercise and general body fitness might be protective.
“Cholinesterase inhibitors are used to compensate for the depletion of acetylcholine in the cerebral cortex seen in patients with Alzheimer’s disease but the benefit is small. Other medications used are antidepressants, anti psychotics and anti anxiety drugs which are used to manage the secondary symptoms.
Of utmost importance is 24 hour supervision especially for advanced cases. This might necessitate committing such patients to long term care facilities and educating the care givers on how best to cater for these patients.”
To reduce dementia risks, experts advise the elderly to be physically active, follow a healthy diet, look after the heart and indulge in activities that will challenge the brain among others.
