Dementia

Old and forgetful

Your Health   DR GITA MATHAI

The recent elections threw up a spate of experienced "senior citizen" politicians, astute, informed and ready with verbal repartee. They are part of the 4.5 per cent of our population over the age of 65 years. They present a stark contrast to many other senior citizens who cannot remember what was said to them a few minutes ago, though the past is still very vivid and easily recollected. Questions get repeated over and over and answers are irrelevant. Words seem lost, forgotten or are inappropriate. These individuals no longer seem to follow a logical train of thought. Their personalities change for the worse and they become short-tempered and difficult to deal with. Such people may struggle with 21st century gadgets such as microwaves, mobile phones and remote controls, which seem to make their life more complicated. Keeping track of medication becomes a logistic nightmare. Falls with injury and fractures occur as balance and co-ordination become faulty. People fitting this description are loosely classified as suffering from dementia, a Latin word that means "deprived of mind". Dementia may be due to many causes. Alzheimer's disease is the commonest type of dementia and is the diagnosis in 50 per cent of the cases. Dementia occurs in the elderly as brain cells deteriorate with age. Chemical messengers in the brain, essential for its proper functioning, become depleted and chromosomes shorten. Many of these changes are inevitable and irreversible. Young people may develop symptoms similar to dementia, but in their case it usually occurs as a sequel to a brain infection (encephalitis or meningitis), brain trauma owing to an accident or a sport like boxing, bleeding in the brain (subdural haematoma), poisoning with lead or other heavy metals, or lack of sufficient thyroid hormone (hypothyroidism). The dementia is often cured if the underlying condition is treated successfully. Recently, some types of dementia have been found to have a genetic basis. Many members of an affected family carry certain gene mutations that are passed on through the generations. Scientists are now beginning to identify these defects. The risk of developing dementia increases if the lifestyle involves excessive alcohol consumption, smoking, a sustained elevated abnormal lipid profile, uncontrolled hypertension or diabetes. Heart or lung diseases, which compromise blood supply to the brain, also accelerate dementia. The diagnosis of dementia is based on medical history and an evaluation of orientation, general intellectual, academic and language skills, memory, reasoning and judgment. Scans (computed tomography or CT and magnetic resonance imaging or MRI) and electroencephalograms (EEGs) help to evaluate changes in the brain and clinch the diagnosis. Dementia can be treated with medications like donepezil, rivastigmine, galantamine hydrobromide and memantine. Specific symptoms and behavioural problems can be treated with sedatives and antidepressants. It is important to take the medicines exactly as prescribed in the correct dosage, which is often individualised. Many people take alternative medications such as vitamin E, omega 3 fatty acids, Coenzyme Q or extracts of ginkgo biloba (a Chinese herb). The dosage schedules are not established. There may be unwanted reactions with the regular medication. For a long time Indian physicians thought that dementia was a "Western" disease. They felt it did not occur in India as we had longer hours of sunlight exposure. And also because our diet contained turmeric which has the protective anti aging antioxidant curcumin. Actually earlier, life expectancy in India was only 45 years. This made cases appear few and far between. Now it has increased to 64. Still, only 4.8 per cent of our population is over the age of 65 years. This is in contrast to Western countries where 12 per cent of the population falls in this group. Today, realisation has dawned that across the globe 0.3-0.4 per cent of the elderly suffers from dementia. We in India are not equipped to deal with it. Caretakers are expensive and family members are left with the difficult responsibility. Geriatrics is an emerging speciality and still not very popular. Old age homes are a recent phenomenon. Insurance is often not available to cover the medical care of the elderly. Dementia occurs in a genetically predisposed individual living in a conducive environment. Age and genes cannot be changed but blood sugars, lipid levels and hypertension can be controlled. Stimulating the brain by doing puzzles, painting or learning a new skill compensates for some of the changes associated with dementia. The more frequent the activity, the more beneficial the effects. Physical activity such as walking an hour a day also helps delay dementia. Many young adults do not exercise regularly. Old age seems far away and they feel "this cannot happen to me". Nothing could be further from the truth. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in