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This year’s theme for World Health Day (7 April) is ageing and health, i.e., “Good health adds life to years." Ageing is associated with very specific health concerns such as dementia, a medical condition of the brain that primarily affects people over the age of 65. It is characterized by a progressive loss of mental faculties and the World Dementia Report (WDR 2010) estimates that 3.7 million people are currently affected with dementia in India.

Dementia is a major concern as we age. Early diagnosis can go a long way in bringing relief

Pettarusp Wadia, consultant neurologist, Jaslok Hospital and Research Center, Mumbai, recounts the case of one of his patients. In his 70s, the man drove off from home one day without telling anyone where he was going. He reached a railway station but had no idea where he was. Fortunately, a neighbour recognized him and took him home; his family had been frantically searching for him for over 6 hours. The patient still didn’t think he needed medical help. The family, however, consulted Dr Wadia, who eventually diagnosed Alzheimer’s-related dementia. Dementia is the loss of brain function that occurs because of different illnesses. In Alzheimer’s, this loss of brain function occurs over a period of time, affecting a person’s ability to think, their memory and their behaviour.

The symptoms

Dementia is generally an irreversible, long-term illness. It eventually results in a complete loss of what we associate with normal brain function, including short-term memory, the capacity to learn, our ability to speak and comprehend language and our ability to judge situations. According to Dr Chandra, the incidence of the disease increases with age so that 5% of people over the age of 65, 10% over the age of 70, and 40% over the age of 80, have dementia. The good news is that though the disease is relentless in its course, the symptoms can be managed. “The earlier the diagnosis of dementia, the better it is for the patient because the symptoms are easier to control then and the patient has enough time to plan and manage his or her affairs," says Dr Chandra.

Dementia is typically diagnosed when someone is no longer able to manage routine tasks (see The 10 signs). Long-term memory is rarely affected in people with dementia, and they can remember events from decades ago with absolute clarity. Dr Wadia says dementia patients often approach doctors after something dramatic happens to them and the family can no longer attribute their behaviour to age-related forgetfulness. The diagnosis, says Dr Chandra, is confirmed by a neuropsychological evaluation followed by a series of tests to determine the type of dementia. The three common forms of dementia include Alzheimer’s disease-related dementia, vascular dementia and infective dementia.

Dementia is mostly irreversible but sometimes, if it is caused by nutritional deficiency like a deficiency in vitamin B-12, the patient can be cured if given supplements. A head injury or hypothyroidism can also cause dementia—the first can be treated with surgery, and the latter with thyroid hormone therapy, says Dr Chandra. Dementia of the irreversible type is far more common, however—and in India, the more common forms are Alzheimer’s disease and vascular dementia.

Dementia can be accompanied by depression and anxiety—these conditions can be treated effectively. Patients can also be trained to manage their illness better by using memory-aid devices like notebooks and day planners; they can refer to the notebook for information so that there is less anxiety about day-to-day tasks. Making to-do lists, keeping a schedule, writing a diary can all be of help.

The caregivers of people with dementia also need support since they may suffer from fatigue, sleeplessness, anxiety and depression. Shamsah Sonawalla, associate director, psychiatry research and consultant psychiatrist, Jaslok Hospital and Research Center, Mumbai, says one-third of caregivers of dementia patients have symptoms of depression.

When it comes to prevention of Alzheimer’s disease, Philip Scheltens, professor, neurology, and director of the alzheimer centre at the VU University Medical Center, Amsterdam, says you should eat and live healthy, do some exercise and keep your brain active with the things that you enjoy doing. As Dr Wadia succinctly put it, “If you don’t use it, you lose it."

The 10 Signs

Look out for these symptoms in older family members and seek medical intervention

1. Memory loss

A typical sign is to forget recently learnt information. Forgetting important dates and events can be a part of this. Sometimes forgetting names but remembering them later is NOT dementia.

2. Challenges in working with numbers

Some people experience changes in their ability to work with numbers. Making mistakes in balancing a chequebook once in a while is NOT dementia.

3. Withdrawal from work and social activity

A person with dementia may start to remove themselves from work, social activities and sports. Feeling weary of social obligations sometimes is NOT dementia.

4. Confusion with time or place

People with dementia can lose track of dates and the passage of time. Getting confused about the day of the week once in a while is NOT dementia.

5. Trouble understanding visual images

People with dementia may not recognize their own reflection. Difficulty in seeing at night due to cataract is NOT dementia.

6. Problems with language

People with dementia may have trouble following or joining conversation. Sometimes having trouble finding the right word is NOT dementia.

7. Misplacing things with an inability to retrace steps

A person with dementia may put things in unusual places. Misplacing things once in a while is NOT dementia.

8. Difficulty in completing familiar tasks

People with dementia can have trouble driving to a familiar location. Needing help with using the settings on a microwave once in a while is NOT dementia.

9. Decreased judgement

People with dementia may experience changes in judgement or decision making. Making a bad decision once in a while is NOT dementia.

10. Changes in personality

People with dementia can become confused, depressed, suspicious, fearful and anxious. Being irritable when a routine is disrupted is NOT dementia.

—Alzheimer’s Association, ‘Know the 10 Signs’ publication.

Advice for family members

• Educate yourself about dementia and its management

• Accept what you cannot change, have realistic expectations, stay positive

• Learn to say “no" to excessive external demands, e.g. from family, relatives, employer, etc.

• Take care of yourself—get enough sleep, maintain some sort of an exercise routine, stay in touch with friends

• Take short breaks from caregiving when possible to prevent burnout: Get help from family, relatives, home help, etc.

• Ensure emotional support for yourself—from family, friends, or a counsellor if required

• Recognize symptoms and signs of stress, anxiety or depression in yourself and seek help early to manage them.

—Dr Shamsah Sonawalla, Mumbai.

Sujata Kelkar Shetty, PhD, writes on public health issues and is a research scientist trained at the National Institutes of Health in Bethesda, US.

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