DEMENTIA : A BRAIN ILLNESS !

Dementia is a clinical syndrome caused by a range of diseases or injuries to the brain. Worldwide, 47.5 million people have dementia, and up to 135.5 million could by 2050. According to a 2020 report, there are around five million people in India living with dementia.

Clinical presentation The most common cause of dementia is Alzheimer's disease, which is implicated in up to 70% of dementia diagnoses. Early symptoms include absent-mindedness, difficulty recalling names and words, difficulty retaining new information, disorientation in unfamiliar surroundings, and reduced social engagement. Atypical symptoms include impairment in recognizing visually presented objects despite a normal visual field, acuity and color vision. Some might also experience word-finding difficulties.

As the disease progresses, there is a marked memory loss and loss of other cognitive skills, including reduced vocabulary and less complex speech patterns. This may be accompanied by mood swings, apathy, a decline in social skills, and the emergence of psychotic phenomena. Advanced disease is characterized by monosyllabic speech, psychotic symptoms, behavioral disturbance, loss of bladder and bowel control, and reduced mobility.

Preventing dementia

The WHO has identified preventing Alzheimer's disease to be key to fighting the world's dementia epidemic. Economic analyses have found that delaying the onset of the disease by even one year could reduce its prevalence by 11%.

Studies, in 1996 and 2009, have demonstrated a strong relationship between midlife hypertension and dementia in later life. Current smokers have a 50% higher risk of developing dementia relative to those who have never smoked. Smoking cessation is known to reduce the risk to the level of never-smokers. Regular exercise helps.

offset cardiovascular health risks and improves cerebral perfusion, synaptic function, and stimulates the growth of new brain cells in the hippocampus.

There is also a robust link between depression in late life and the incidence of sporadic dementia. Having depression almost doubles the risk of developing dementia. So, treating depression in persons with established cognitive impairment is vital. Higher educational and occupational attainments have consistently been implicated as protection against developing dementia later in life. This is probably a result of the longer period of learning, which stimulates the development of larger and/or more complex neural networks.

How to treat dementia

Dementia care has four pillars. The first two include managing the important aspects of the disease, with a goal to reverse their effects or to delay its progression in the brain as well as managing the cognitive, neuropsychiatric, and functional symptoms. The other two pillars involve providing systematic, evidence-based supportive care to patients and to carers.

Non-pharmacological interventions for the first line of therapy except in emergencies. But over time, medicines often become integral to the care regime. Cognitive symptoms associated with dementia are treated with cholinesterase inhibitors. They have modest and temporary effects in 10-15% of persons with dementia and their effects last 6-12 months. They don't stop or reverse the degenerative process.

Dementia has some behavioral and psychological symptoms that precipitate a loss of independence, more responsibilities for careers, and early placement in nursing care. They require non-pharmacological interventions. Neuropsychiatric symptoms of dementia respond modestly to aromatherapy, physical therapy, and music therapy, among others.

Despite large gains that may accrue no controlling risk factors, we will still need disease-modifying therapies to reduce the global burden of dementia.

We will also need a cultural transition - moving from dementia to a framework of brain health will destigmatize cognitive decline, empower people to take more responsibility towards prevention, and encourage society to adopt inclusive solutions to maintain functional independence.