DEMENTIA : A SERIOUS GLOBAL HEALTH CONCERN

One in 14 people over the age of 65 is affected by dementia, and as the population ages, this number is likely to increase. Every four seconds, a new case of dementia is added somewhere in the world.The World Health Organisation, in its report ‘Dementia – a public health priority’, estimates that India had 3.7 million people with dementia in 2011 and the numbers are set to double in 20 years.There are nearly 35.6 million people living with dementia world wide. This number is expected to double by 2030 (65.7 million) and more than triple by 2050 (115.4 million). There are 7.7 million new cases of dementia each year. In developing countries like India and China where incidence of lifestyle diseases such as diabetes and hypertension is high, dementia cases could go up considerably because of vascular problems according to experts.

Dementia is a “serious loss of global cognitive ability in previously unimpaired person” (Wikipedia). Its early meaning was “madness” from the latin root ‘de’ means ‘without’ and ‘ment’ means ‘mind’. Dementia is not a single disease; it is a set of “signs and symptoms in which affected areas of cognition may be memory, attention, language and problem solving”. Dementia may be static or progressive. The symptoms may be reversible or irreversible.Dementia is not a disease caused by ageing, but ageing is a risk factor. Therefore,   more older people are seen among the dementia patients and as longevity increases their proportion will also increase. Senile Dementia of the Alzheimer’s Type (SDAT) or Alzheimer’s disease is the most common form of dementia. It is a progressive disorder and it has no cure as of now. The treatment available currently only alleviates some symptoms for a limited period, but does not deal with the underlying causes of the disease.Dementia is still not properly appreciated and hence dementia research remains highly under- funded.

Dementia is less ‘visible’ than many other illnesses because the majority of the people affected are over 65, and in many cases, says Dr Pat Kehoe of UK, there are few outward manifestations of the disease, especially in the early stages, which make it easier to ignore. Often ageing is cited as a common explanation for memory loss and behavioural changes. There is substantial evidence to suggest that Alzheimer’s disease starts to develop during middle age, so that by the time the symptoms show, perhaps as much as 20 years later ,‘several rooms are ablaze,’ to use Kehoe’s analogy of the dementia brain as a house on fire. As the disease progresses, the chemistry and structure of the brain change, leading to the death of brain cells. Dementia is caused by a multiplicity of factors including age, genetic inheritance, environment, lifestyle and overall general health.

 Dementia is a stressful experience for patients and their families, but specialists say that technology can make life easier and safer.Dr. E. S. Krishnamoorthy,Chennai – based neuro psychiatrist , observes: More and more people are moving into nuclear families. The elderly living alone will require constant support. In Europe, there are facilities that make the life of dementia patients simple.”  Most people in India have mobiles and, therefore such facilities can be cost-effective. India lacks national guidelines for the management of dementia. Consequently, facilities for diagnosis , treatment and rehabilitation are woefully inadequate. Early diagnosis or golden period intervention can help better management of dementia patients and lower the stress of the care givers. Care giving of dementia patients takes a heavy toll on the physical and mental health of the care givers, whose work schedule is 36-hour day.” We need professional care givers. If we don’t create the necessary human resources, hospitals will soon be burdened and the cost of treatment will go up, “ says Dr.Krishnamoorthy .

Loving care ensuring the patient’s dignity, and engaging them in activities like puzzles, games, memory-lane and story- telling are necessary in the management of dementia patients. Day care centres with adequate facilities near residential areas are extremely useful. A serious health issue like dementia which costs the national economy heavily is to be taken seriously.

September 21 is World Alzheimer’s Day.On this day let us pay tribute to Dr.Alzheimer for explaining the nature of this dreadful disorder.