September 2018 is World Alzheimer’s Dementia Month.

September 2018 is World Alzheimer’s Dementia Month.

Dementia is impaired cognition sufficient to affect a person’s ability to perform activities of daily living. Cognition is simply thinking but can also be seen as the mental process of acquiring knowledge and understanding through thought, experience and the senses. 

People with dementia have variable combinations of memory and other cognitive difficulties, behavioural abnormalities and/or motor dysfunction. It is estimated that every 3 seconds, a person comes down with dementia worldwide. In countries with ageing population such as in the US, Japan and in Europe, dementia has assumed a public health concern due to the increasing incidence and prevalence as people live longer. By 2050, more than 70% of people with dementia are expected to be in the developing countries. Studies from Nigeria have found prevalence rates between 2 – 10.1% depending on the instruments used. 

Every 3 seconds, someone develops dementia in the world. Are you at risk?

Most of us can identify one or more of our aged relations with memory difficulties. Some of these are less serious cases of mild cognitive impairment (MCI) as they can still do their daily tasks. However there is a risk of this progressing with time to dementia. 

Dementia is commonly a neurodegenerative disease occurring usually from the 6^th decade of life. There are instances where young persons may suffer dementia. It produces a progressive decline of the mind, brain and body that are so profound in the sufferer that it has been termed ‘the second childhood’ as the individual behaves like a child before succumbing terminally.

Elderly persons with dementia often suffer a lot of rejection, stigma and discrimination by family, friends and the public due to the sometimes bizarre neuropsychiatric manifestations. There have been instances where locally in Nigeria, such hapless elderly individuals are mobbed and lynched as suspected witches and wizards. Of course, they are always unable to defend themselves or proffer reasonable answers to the queries thrown at them by the frenzied mob.

The dementia process typically starts decades before the clinical manifestation and this has enabled the development of genetic and other tests that can reasonably predict an individual’s risk and profile for dementia. You can tell if you will come down with dementia years before and take steps to prevent, delay or mitigate it.

The commonest type of dementia is called Alzheimer’s disease. Other types are vascular dementia (due to stroke), fronto-temporal dementia and dementia seen in Parkinson’s disease amongst many others. Some are more amenable to drug therapy than others. Alzheimer’s disease has the best response to specific medications especially when diagnosed early.

Dementia is best managed by a neurologist working in concert with other health professionals including psychiatrists, nurses and experts in rehabilitation, palliative care and hospice services.

A strong family history of dementia may be a cause for concern. Anyone with such is best advised to consult the neurologist.  There are steps than can positively impact on the risk profile. Use of NSAIDs, high cerebral cortical reserve (measured by educational attainment), coffee intake and antioxidants use are  putatively protective from dementia. 

A person diagnosed early with dementia needs professional care and guidance as there are issues to be anticipated and prepared for in the personal family and professional spheres of life such as finances, wills, end-of-life care etc. The time from dementia diagnosis to profound debility and death may range from as little as 2 years or less to more than 10 years. 

Ronald Reagan (1981-1989 as President), one of the most popular US Presidents of all time, had dementia in his later years and died of it. However, by hindsight, experts have concluded that the symptoms actually manifested during his presidency. Could some of his actions have been influenced by his illness? This situation may easily be replicated in some elderly individuals who are heads of state or occupying high public/private offices.

So as we raised awareness of dementia throughout this September, let us spare a thought for those living with dementia.

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