More awareness needed on dementia disease to ensure early diagnosis and better management
Better health services and education have seen an increase in life expectancy in Kenya. Compared to half a century ago, a growing number of people are now living for over 60 years, or more. A World Health Organization (WHO) report of 2015 estimates life expectancy in Kenya at 63 years, up from 51 years at the start of the 21st century.
Even as we strive to work harder so that we can enjoy a relaxed, long retirement, it is difficult to visualise unexpected life where you are not capable of recognising your loved ones, are not aware of your surroundings and cannot do basic things like dress and feed yourself without assistance.
Dr Sylvia Mbugua, a Neurologist at Aga Khan University Hospital, Nairobi helps shed some light on Dementia, the degenerative brain disease that robs people of their sunset years.
Is Dementia a disease, or simply the process of ageing?
Dementia is a neurological disease characterised by deterioration in memory, thinking, behaviour and the ability to make decisions and perform everyday activities. Although dementia mainly affects older people, it is not a normal part of ageing. “Early onset dementia” is rare but can occur.
Dementia is a chronic and degenerative condition, affecting the ability of a person to process thought. The impairment in cognitive function is commonly accompanied by deterioration in emotional control, social behaviour, or motivation.
Is Dementia and Alzheimer’s disease one and the same?
Alzheimer’s disease is the most common form of dementia in people who are over 65 years and contributes to about 60 to 70 per cent of dementia cases. Dementia can also result from a variety of conditions including chronic alcoholism, stroke, Wilson’s disease, herpes virus and HIV infections, thyroid disease and vitamin deficiency.
What are the risk factors?
Although age is the strongest known risk factor for dementia, some people will develop dementia, while others live to a ripe old age with their mind as sharp as a 20 year old. Several things affect your risk of developing dementia – age, genetic factors, certain health factors and your lifestyle. If you have a family history of dementia, you stand a higher risk of developing dementia with time.
High blood pressure, obesity, high cholesterol and diabetes are also risk factors for dementia. Many studies have shown that people with one of these conditions during their midlife are about twice as likely to develop dementia later in life. If you have more than one of these conditions, your risk is even higher. Smoking and alcohol also put you at risk.
What can one do to reduce the risk?
There is nothing you can do about ageing, or your genes, but you can do something about your health. Keeping your weight within the appropriate bracket, managing blood pressure, cholesterol and blood sugar at healthy levels are important for your brain. Avoid head injury, smoking and depression.
Regularly exercise as well as challenging your brain through cognitive mental and social activities is associated with a lower risk of dementia. A healthy diet, low in red meat and high in Omega 3 fatty acids, coconut and olive oil, lots of fruit and vegetables, nuts, whole grains, legumes and vitamin E is recommended.
How do you diagnose dementia?
Unfortunately, there is no one test to determine if someone has dementia. Doctors diagnose Alzheimer’s and other types of dementia based on a careful medical history, a physical examination, MRI scans and the characteristic changes in thinking, day-to-day function and behavior associated with each type. Laboratory tests and MRI imaging are also done to exclude other causes of dementia which could be treatable especially in younger patients.
What are the symptoms?
The early stage of dementia is often overlooked because the onset is gradual and can go on for several years. Although the early signs vary, common symptoms include progressive forgetfulness, losing track of time and inability to recognise familiar places.
As dementia progresses to the middle stage, the signs and symptoms become clearer and more restricting. These include becoming forgetful of recent events and people’s names, getting lost at home, having increasing difficulty with communication, needing help with personal care, experiencing behaviour changes, including wandering and repeated questioning.
The late stage of dementia is one of near total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious.
Is the condition treatable?
In the case of most progressive dementias, including Alzheimer’s disease, there is no cure and no treatment that stops its progression. But, there are drug treatments that may temporarily slow down its progression. Once the neurologist has made a diagnosis, he will advise on medication that can help the patient. Dementia resulting from infective, thyroid problems and vitamin deficiency can be reversed.
Caregivers and Society
Dementia is one of the major causes of disability and dependency among older people worldwide. It is overwhelming not only for the people who have it, but also for their carergivers and families. The complete change in loved ones from people with strong personalities to dependents, unable to comprehend anything around them and attend to their activities of daily living, takes a big toll on caregivers and families and it is very important to educate and counsel them.
There is often a lack of awareness and understanding of dementia in Kenya, resulting in stigmatisation and barriers to diagnosis and care. Often we hear communities branding old people as witches and ostracizing them from their homes because “they are behaving strangely”. People with dementia need care, love and understanding, the same care we accord children.
By: Dr Sylvia Mbugua, a Neurologist at Aga Khan University Hospital, Nairobi