Prof. Dr. Shyam P Lohani
The aging population is increasing worldwide. A decrease in fertility, an increase in life expectancy and better healthcare facilities are some of the reasons for this. With the number of aged people rising, the need for optimum geriatric care is being realised throughout the world. There has been considerable coverage of geriatric services in the developed world. However, low and middle-income countries are lagging in providing care to senior citizens. One of the prominent health issues of the aged people is cognitive health, and dementia is the most critical medical condition.
Growing trend
An estimated 50 million people worldwide have dementia. About 60 per cent of them are living in low and middle-income countries. The number of people with dementia is estimated to triple by 2050. The new cases of dementia are increasing by 10 million every year. The syndrome of dementia is caused by various underlying diseases with specific signs and symptoms involving neuropathology. Alzheimer’s disease is the most common cause of dementia and accounted for 60-70 per cent of cases (WHO, 2019). The prevalence of Alzheimer’s disease increases with the increase in age.
Dementia affects people’s ability to think, memorise, and other social behaviours. The deterioration of cognitive function will lead to severe disability which interferes with the daily life of an individual. The dementia is caused by damage to the nerve cells and their connections in the brain. Depending on the area of the brain that is affected by the damage, different individuals show different symptoms. There are reversible and progressive types of dementia. The reversible type is often treated with the treatment of underlying causes such as drug-induced, alcohol-induced, and associated with diabetes, nutritional deficiencies, dehydration, infection, poisoning, anoxia, and immune disorders.
The progressive dementia is caused by Alzheimer’s disease, vascular dementia, lewy body dementia, frontotemporal dementia, and mixed dementia and they are not reversible. Huntington’s disease, traumatic brain injury and Parkinson’s disease may also cause progressive dementia. There are several risk factors for dementia. The risk factors such as age and family history cannot be changed. The risk of dementia sharply increases after the age of 65 and a familial history of the disease increases the risk of having the condition. People with down syndrome develop early-onset dementia.
There are modifiable risk factors such as diet and exercise, cardiovascular risks, diabetes, depression, heavy alcohol use, smoking, sleep apnea, and nutritional deficiencies. The lack of exercise and an unhealthy diet are linked to the development of dementia. Studies are supporting the fact that insufficient physical activity increases the risk of dementia. People who eat a diet rich in fresh produce, whole grains, nuts, and seeds have less prevalence of dementia. The cardiovascular risk factors that include high blood pressure, high cholesterol, atherosclerosis, and obesity are linked to an increased incidence of dementia. Although few studies have shown the protective effect of moderate alcohol consumption, however, heavy alcohol consumption has a higher risk of developing dementia. Late-life depression might indicate the development of dementia. People who smoke have a higher incidence of dementia and similar the case with people with sleep apnea. Vitamin and nutritional deficiencies may put the individual at risk of developing dementia. Lack of vitamins such as vitamin D, Vitamin B 6, Vitamin B 12, and folate may increase the risk of dementia.
There are several complications of dementia. It may lead to poor nutrition, pneumonia, inability to perform self-care, increase risk of personal safety, and ultimately coma and death.
The rapid pace of increase in demographic aging and age-related dementia in low and middle-income countries will pose tremendous challenges to public health in the region. The cost associated with direct medical and social care of dementia is enormous. It has been estimated that in 2015, the global cost of dementia was 818 billion US$ which is equivalent to 1.1 per cent of GDP of high-income countries to 0.4 per cent GDP of low and middle-income countries (WHO, 2019). There is no cure for progressive dementia. The management of the condition is often symptomatic and supportive. Supportive care can be provided to improve physical health, cognitive activity, and well-being. The nutritional deficiencies and pneumonia in people with dementia can be avoided with optimum care.
Risk factors
People should be made aware of numerous modifiable risk factors. There have been studies supporting the fact that people can reduce the risk of dementia by adopting various healthy lifestyle approaches. A healthy lifestyle includes moderate exercise and a healthy diet including fresh produce, fresh vegetables, and fruits, seeds and nuts, quitting smoking, avoiding harmful alcohol consumption, controlling weight, maintaining normal blood pressure, cholesterol and blood sugar. Early management of diseases that may lead to dementia is equally important.
The first step in the development of care facilities for dementia is to have data on the prevalence of the condition in the country. Till date, the dementia care in the developing countries is largely home based unlike in many developed countries. The health care professionals should be encouraged to conduct research studies on dementia. Health needs of people with dementia are often complex and hospitals and care homes need health professionals for care, social and psychological support. It is high time for the government to plan for upcoming health issues of old age people including dementia.
(Prof. Lohani is the Founder and Academic Director of Nobel College and can be reached at lohanis@gmail.com)
(from The Rising Nepal)
