It mainly ails the elderly and regrettably even in the developed world it is “poorly recognized”. This is why we need to discuss dementia at length, reiterates Senior Consultant Neurologist Dr. Padma Gunaratne, pointing out that there are 50 million people struck down by this disease across the world. Why poorly recognized, she asks, answering [...]


Struck down by dementia

Senior Consultant Neurologist

It mainly ails the elderly and regrettably even in the developed world it is “poorly recognized”.

This is why we need to discuss dementia at length, reiterates Senior Consultant Neurologist Dr. Padma Gunaratne, pointing out that there are 50 million people struck down by this disease across the world.

Dr. Padma Gunaratne

Why poorly recognized, she asks, answering that many of the signs and symptoms of dementia are attributed to ageing and as such the diagnosis of dementia comes only after the disease is quite advanced.

In dementia what is most predominantly affected is memory. However, it is not just memory impairment but much more. It is not the ageing process – some age without dementia, others with dementia. Memory is a complex process and we don’t know how it works. Dementia affects the cortex of the brain, says Dr. Gunaratne.

The three parts of the brain affected by dementia in the initial stages are:

  • Hypothalamus
  • Thalamus
  • Amygdala

These three play an important role in memory, ‘encoding’, ‘storing’ and then ‘retrieving’ information, MediScene learns.
Usually, according to Dr. Gunaratne, the starting point of dementia is the hypothalamus, after which it gradually spreads all over the brain, owing to serious molecular changes, along with the tau proteins that have become defective.

“There is insidious onset, steady progression and then, of course, deterioration in cognitive and behavioural functions. This not only affects memory but also other domains, impacting on the person’s social and occupational life,” she says.

As dementia is a syndrome, there is a “collection” of signs and symptoms. Firstly, however, all aspects need to be checked out whether there are any other causes for the memory issues such as physical problems, alcoholism, nutrition issues, B12 deficiency, kidney or liver disease or poorly functioning thyroid resulting in hypothyroidism, says this Neurologist.

This is why it is critical to investigate and exclude other causes for memory loss before identifying primary or Alzheimer’s Disease as a certainty, she urges.
Dementia comes as:

  • Alzheimer’s Disease which affects about 70% of all dementia patients.
  • Vascular Dementia which affects about 25% of dementia patients.
  • Lewy Body Dementia which affects about 5% of dementia patients.

According to Dr. Gunaratne the contributory factors for dementia have still not been identified. Ten percent could be due to a genetic predisposition (hereditary) with environmental factors too contributing to the disease.
The usual risk factors are:

  • For Alzheimer’s Disease: Age – a non-modifiable risk factor with about 20% of people over the age of 80 being affected. If it occurs before the age of 60, it is pre-senile dementia.
  • For Vascular Dementia, which is linked to a person’s blood vessels, repeated ischaemic injuries could lead to loss of cognition. Here the risk factors would be hypertension, diabetes, smoking and heart disease and there would be “step-wise” rapid deterioration.

Of course, not eating a healthy diet, lack of exercise and obesity could pave the way for dementia, it is understood.
The initial symptoms are:

  • Forgetting names of people and objects.

This is followed by:

  • Loss of visuospatial ability which enables a person to perceive and interact with the visual world. Those affected by dementia would feel lost in familiar surroundings.
  • Language being affected.
  • The loss of judgement and reasoning.
  • Attention span becoming shorter.

As there is a disease spectrum in dementia, it can be grouped into ‘mild’, ‘moderate’ and ‘severe’.
Initially, it is episodic but gradually it becomes more apparent with the loss of memory for names and objects coming to the fore. Progressively, it affects the person in a bigger way, with an inability to perform his/her stuff alone and being unfamiliar (getting lost) with a very familiar environment, it is learnt.

Dr. Gunaratne says that the most difficult challenge for the family is that people with dementia have behavioural changes such as quarrelling with others, looking for something such as keys or money which they believe they have lost and which they have forgotten where they have kept and sometimes even accusing others of stealing them.

As it is the recent memory that is affected, the person’s day-to-day life is in trouble. There would also be personality changes, with less speaking but also much anxiety. Gradually, he/she would lose the ability to recognize family, such as children and even the spouse. There would be difficulty in reading, writing and doing calculations, MediScene learns.

Dementia patients also tend to develop behavioural and psychological issues such as anxiety, depression, ‘wander’ behaviour, hallucinations and delusions. They will lose orientation with regard to time and place, use offensive language and lose inhibitions, bringing embarrassment to family.

Citing an example, she says that the person may take a phone message but forget to pass it on. It would be good to maintain a diary, to help perform day-to-day activity.

“Take the case of a person who wants to bake a cake. Even though we don’t give much thought to it, it is a complex action as it entails planning, purchasing the ingredients, carrying out some preparatory tasks and then performing the actual baking,” she points out, adding that as the disease progresses wrong decisions and judgements could result in the person facing losses.

It is always better to keep persons with dementia in their familiar surroundings without moving them elsewhere, so that they can manage as long as it is possible to do some basic stuff. Unfamiliar surroundings will quicken the deterioration, it is understood.

In the advanced state they will not be able to recognize anyone or communicate becoming totally dependent on others for their daily living. They will find it difficult to swallow which could result in severe weight loss, while also being prone to infections. They will lose bladder and bowel control, sleep throughout the day, develop bedsores and ultimately become bed-bound, adds Dr. Gunaratne.

Take care of the carers
Dementia in a person may last from 4 to about 20 years, says Dr. Padma Gunaratne, looking closely at the difficult and tedious role played by the carer.
Carers need special training, she stresses, as well as counselling and sometimes even treatment for depression.

Urging that carers need “respite” and Sri Lanka with its rapidly ageing population should be giving serious thought to dementia, she says the country should consider how to deal with the multi-pronged aspects of this debilitating disease including those who are compelled to bear the responsibility of looking after these patients.

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