WeeklySA_AdminSmoke: Factors that increase the risk of the disease includ smoking and excessive alcohol consumption
By Monk Nkomo
Dementia – a term for several diseases that affected memory and the ability to perform daily activities- was currently the seventh leading cause of death with ten million new cases reported worldwide every year, according to the World Health Organization. (WHO).
In its latest report on the disease, the WHO revealed that a total 57 million people worldwide suffered from dementia in 2021, over sixty percent of whom lived in low and middle-income countries.
Dementia, the report added, cost economies globally, a total 1,3 trillion dollars and approximately 50 percent of these costs were attributable to care provided by informal carers including family members and close friends who provided an average five hours of care and supervision per day.
The WHO said Dementia resulted from a variety of diseases and injuries that affected the brain. Alzheimer disease was the most common form of dementia and may contribute to 60–70% of cases.
‘’Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older people globally. Women are disproportionately affected by dementia, both directly and indirectly. Women experience higher disability-adjusted life years and mortality due to dementia, but also provide 70% of care hours for people living with dementia.
The illness got worse over time and it mainly affected older people but not all people would suffer from it as they aged.
Factors that increased the risk of developing dementia included age (more common in those aged 65 or older); high blood pressure; diabetes; being overweight or obese; smoking ; drinking too much alcohol; being physically inactive ; being socially isolated and depression.
According to the WHO, Dementia was a syndrome that could be caused by a number of diseases which over time destroyed nerve cells and damaged the brain, typically leading to deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from the usual consequences of biological ageing.
While consciousness was not affected, the impairment in cognitive function was commonly accompanied and occasionally preceded by changes in mood, emotional control, behaviour or motivation.
‘’Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and society at large. There is often a lack of awareness and understanding of dementia, resulting in stigmatization and barriers to diagnosis and care’’.
The WHO report also highlighted that changes in mood and behaviour sometimes happened even before memory problems occurred. Symptoms got worse over time. Eventually, most people with dementia would need others to help with daily activities.
Early signs and symptoms of the disease:
• forgetting things or recent events.
• losing or misplacing things.
• getting lost when walking or driving.
• being confused, even in familiar places.
• losing track of time.
• difficulties solving problems or making decisions.
• problems following conversations or trouble finding words.
• difficulties performing familiar tasks.
• misjudging distances to objects visually.
Common changes in mood and behaviour included feeling anxious, sad or angry about memory loss, personality changes, inappropriate behaviour, withdrawal from work or social activities and being less interested in other people’s emotions.
Dementia affected each person in a different way, depending upon the underlying causes, other health conditions and the person’s cognitive functioning before becoming ill.
‘’Most symptoms become worse over time, while others might disappear or only occur in the later stages of dementia. As the disease progresses, the need for help with personal care increases. People with dementia may not be able to recognize family members or friends, develop difficulties moving around, lose control over their bladder and bowls, have trouble eating and drinking and experience behaviour changes such as aggression that are distressing to the person with dementia as well as those around them’’.
The WHO said Dementia was caused by many different diseases or injuries that directly and indirectly damaged the brain. Alzheimer disease was the most common form and may contribute to 60–70% of cases. Other forms included vascular dementia, dementia with Lewy bodies (abnormal deposits of protein inside nerve cells), and a group of diseases that contributed to frontotemporal dementia (degeneration of the frontal lobe of the brain).
The disease may also develop after a stroke or in the context of certain infections such as HIV, as a result of harmful use of alcohol, repetitive physical injuries to the brain (known as chronic traumatic encephalopathy) or nutritional deficiencies. The boundaries between different forms of dementia are indistinct and mixed forms often co-existed.
According to the WHO, there is no cure for dementia, but a lot can be done to support both people living with the illness and those who cared for them. People with dementia can take steps to maintain their quality of life and promote their well-being by being physically active, taking part in activities and social interactions that stimulated the brain and maintained daily functions.
In addition, some medications could help manage dementia symptoms. These included Cholinesterase inhibitors like donepezil which were used to treat Alzheimer disease; NMDA receptor antagonists like memantine were used for severe Alzheimer disease and vascular dementia. Medicines to control blood pressure and cholesterol could prevent additional damage brain due to vascular dementia. Selective serotonin reuptake inhibitors (SSRIs) could help with severe symptoms of depression in people living with dementia if lifestyle and social changes did not work, but these should not be the first option.
If people living with dementia were at risk of hurting themselves or others, medicines like haloperidol and risperidone could help, but these should never be used as the first treatment.
For those diagnosed with dementia, there were things that could help manage symptoms. These included the following :
* Stay physically active.
* Eat healthily.
* Stop smoking and drinking alcohol.
* Get regular check-ups with your doctor.
* Write down everyday tasks and appointments to help you remember important things.
* Keep up your hobbies and do things that you enjoy.
* Try new ways to keep your mind active.
* Spend time with friends and family and engage in community life.
* Plan ahead of time. Over time, it may be harder to make important decisions for yourself or your finances.
* Identify people you trust to support you in making decisions and help you communicate your choices.
* Create an advance plan to tell people what your choices and preferences are for care and support.
* Bring your ID with your address and emergency contacts when leaving the house.
* Reach out to family and friends for help.
* Talk to people you know about how they can help you.
* Join a local support group.
The WHO report noted that it was important to recognize that providing care and support for a person living with dementia could be challenging, impacting the carer’s own health and well-being. As someone supporting a person living with dementia, reach out to family members, friends and professionals for help. Take regular breaks and look after yourself. Try stress management techniques such as mindfulness-based exercises and seek professional help and guidance if needed.
Although age was the strongest known risk factor for dementia, it was not an inevitable consequence of biological ageing. Further, dementia does not exclusively affect older people – young onset dementia (defined as the onset of symptoms before the age of 65 years) accounted for up to 9nine percent of cases.
Studies showed that people could reduce their risk of cognitive decline and dementia by being physically active, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet and maintaining healthy blood pressure, cholesterol and blood sugar levels. Additional risk factors included depression, social isolation, low educational attainment, cognitive inactivity and air pollution.
‘’Unfortunately, people living with dementia are frequently denied the basic rights and freedoms available to others.
In many countries, physical and chemical restraints are used extensively in care homes for older people and in acute-care settings, even when regulations are in place to uphold the rights of people to freedom and choice. An appropriate and supportive legislative environment based on internationally-accepted human rights standards is required to ensure the highest quality of care for people with dementia and their carers’’.
The WHO recognized dementia as a public health priority. In May 2017, the World Health Assembly endorsed the Global action plan on the public health response to dementia 2017-2025. The Plan provided a comprehensive blueprint for action – for policy-makers, international, regional and national partners and WHO in the following areas: addressing dementia as a public health priority; increasing awareness of dementia and creating a dementia-inclusive society; reducing the risk of dementia; diagnosis, treatment and care; information systems for dementia; support for dementia carers; research and innovation.
