Dementia: An unappreciated reality

You have probably heard of the term dementia and wondered what it really means. There exists a variety of symptoms some people (especially the older adults) exhibit, which might just be pointers to this. While empathy and assistance should be made available; rejection, social isolation and worst of all, denial of necessary care are sometimes meted out to them. Some places in the world have simply labeled the affected individuals as “witches” and “wizards” in need of “exorcism” and “deliverance”. 

The number of people living with dementia is increasing globally. According to World Health Organization, WHO, dementia is currently the seventh leading cause of death and a major cause of disability and dependency among older people worldwide. In Nigeria, the prevalence is 4.9% and the global burden is over 47 million people living with this condition (Adeloye et al.). As of September 2022, WHO reckoned “more than 55 million people currently live with dementia worldwide, and there are nearly 10 million new cases every year”2. 15% of Canadians older than 65years have dementia (Toronto Note, 2022) and a million United Kingdom residents are projected to have dementia by 2025 (Alzheimer’s’ Society of UK).

What is dementia?

Dementia is a medical term which describes a set of symptoms that over time can affect people’s ability to think properly, remember events, solve both basic and complex problems as well as language and behaviour. There are several types ranging from Alzheimer’s disease (the most common type), Vascular Dementia which results usually from stroke, Dementia with Lewy Body which is associated with abnormal thoughts, beliefs, and movement problems, as well as Frontotemporal type which predominantly causes significant changes in the way the affected people behave and speak. There exists other rarer types. This write-up focuses more on the commonest type: Alzhiemer’s disease.

What are the risk factors for dementia?

According to the World Health Organization fact sheets on dementia, this condition “results from a variety of diseases and injuries that primarily or secondarily affect the brain. Alzheimer’s disease is the most common form of dementia and may contribute to 60-70% of cases”2.

Risk factors for dementia include:

• Age: Not all old people develop dementia, however, most primary dementias are diagnosed at age greater than 65 years.
• Physical inactivity or sedentary lifestyle (not exercising regularly)
• Smoking
• Alcoholism
• Uncontrolled high blood pressure (which can cause stroke and vascular dementia)
• High blood fat
• High blood sugar (Diabetes mellitus)
• Low educational status
• Depression
• Social isolation
• Cognitive inactivity
• Air pollution

Controlling the above factors significantly reduces the risk of developing dementia. WHO opines that “people can reduce their risk of cognitive decline and dementia by being physically active, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels”2.

Common symptoms that may point to dementia

Although several symptoms occur with dementia, according to Alzheimer’s Society of United Kingdom, no one’s experience will be the same as anyone else’s.

“For most people, the first sign of Alzheimer’s is trouble with memory – in particular, difficulties recalling recent events and learning new information. This is because early on in Alzheimer’s the damage is usually to a part of the brain called the hippocampus. This has a big role in day-today memory. However, the person’s memory for events that happened a long time ago is not usually affected in the early stages” says Alzheimer’s Society of the United Kingdom.

When a person has dementia, especially Alzheimer’s, the person’s memory is usually affected first, and this begins to affect common daily activities. A patient with Alzheimer’s might:

• lose items (such as keys and glasses) around the house
• forget a friend’s name, or struggle to find the right word in a conversation
• forget about recent conversations or events
• get lost in a familiar place or on a familiar journey
• forget appointments or significant dates.

As well as memory difficulties, people with Alzheimer’s are also likely to have – or go on to develop – other problems. These include problems with thinking, reasoning, language, or perception such as:

• speech – they may repeat themselves or struggle to follow a conversation
• seeing things in three dimensions and judging distances (visuospatial skills) – going up or down stairs or parking the car might become much harder
• concentrating, planning, or organising – they may struggle with making decisions, solving problems, or carrying out a sequence of tasks (such as cooking a meal)
• orientation – they may become confused or lose track of the day or date.

As the condition progresses, some persons living with dementia may begin to experience psychological disorders such changes in personality and behavior, depression, anxiety, hallucinations, mood swings, agitation, and apathy – lack of interest or emotions. The presence of hallucinations might make them “see things”, “hear things”, “feel things”, “say things” which do not actually exist. Hence, the reason some people erroneously tag their loved ones (older adults, mothers, fathers, aunties, uncles, distant relatives, and elderly community people) who develop dementia and have progressed to these psychological symptoms as being “possessed”, “witches” or “evil”. Rather than assisting them in their illness, they abandon them and even cause harm. So many have probably being killed for this reason. Now we should know better!

What to do…

Unfortunately, many parts of the world believe dementia is not a common condition in their society leading to missed diagnoses. We need to know and act now so we can help protect those living with this condition. “Getting a diagnosis of dementia can give you a better understanding of the condition and what to expect. Timely diagnosis can help you make important decisions about treatment, support, and care. If you or someone close to you is experiencing changes such significant memory loss, confusion, or language difficulties, it’s a good idea to visit your General Practitioner (Doctor) for an assessment”3. 

Treatment

Although there’s no cure treatment for dementia as of now, there are both medical (drugs) and supportive treatment that can help the affected persons lessen their symptoms. Symptoms are generally progressive and depending on the type and severity, most people eventually succumb to the condition within 5 to 20 years.4 

Educating the society on the reality of dementia is essential to both its prevention and management. World Health Organization developed a “Global Action Plan for Dementia”5 which is a great resource for both health workers and the general populace, as well as for advocacy for people living with dementia.

Tell someone who can tell someone about dementia today. Let’s support the people living with this unappreciated reality.