WHAT SHOULD THE ELDERLY AND THEIR CARERS KNOW ABOUT DEMENTIA

WAD and WAM

World Alzheimer's Day (WAD), which takes place every September 21, has just passed. It is a global effort to raise awareness and challenge the stigma around Alzheimer's disease and other dementias. World Alzheimer's Month (WAM) is the international campaign from Alzheimer's Disease International since 2012 that takes place every September to extend this awareness program beyond World Alzheimer's Day. WAM also support people affected by the disease and address the discrimination that still exists around dementia. This year’s World Alzheimer Report 2024 explores attitudes toward dementia, examining how the condition is perceived and understood by society and the stigma that still surrounds the condition, underpinned by a global survey of more than 40,000 individuals across 166 countries and territories, and 24 expert essays.

This blog follows one of the awareness programs conducted for Senior Citizens by National Institute of Social Defence (NISD), Ministry of Social Justice and Empowerment, Government of India on 21st September, 2024 in New Delhi.

What is dementia and Alzheimer’s disease?

Dementia including Alzheimer’s disease is a disorder of cognition. Cognition is a composite word for mental processes and various skills which happen in our brain like memory, communication, understanding, perception, attention, thinking, judgment, decision making and which together allow us to function as healthy individuals.

Dementia generally occurs in old age due to damage and death of brain cells and those -afflicted face any one or more of the problems of memory, communication, understanding, perception, attention, thinking, judgment, decision making, orientation and so much so that sooner or later, they are dependent on others for their day-to-day activities. Consequently, these people may become stigmatized and face negative attitudes from persons around them. Occurring in 5% among those aged 70, the disease doubles its proportion every 5 years to reach a prevalence of almost 40% among those aged 90. The disease is slowly progressive, irreversible, and has no cure and results in death. Commonest form is Dementia of Alzheimer type (DAT) commonly known as Alzheimer’s disease. Globally, more than 55 million people worldwide live with Alzheimer's and are expected to increase to 82 and 152 million in 2030 and 2050 respectively. In India, there are currently more than 5 million people with dementia (PwD) and are projected to rise to 7.5 million in 2030 and 15 million in 2050.

Who gets it?

Older age, female gender, family history of dementia, genetics and ethnicity are non-modifiable risk factors and we can do nothing about them. But there are supposed to be at least 14 modifiable factors which can place the person at risk for developing irreversible dementias. These are Intellectual inactivity (and low educational level), social isolation, depression, air pollution and 10 medical conditions (diabetes, high blood pressure, obesity, sedentarism, head injury, impaired hearing, impaired vision, tobacco, alcohol and bad cholesterol i.e. low-density cholesterol or LDL). Only a very small proportion of dementia cases have their origin in certain treatable medical conditions and unlike the vast majority, these are termed as reversible or the treatable dementias.

How to recognize it?

None would like to see the picture of full blown dementia but it is easy to recognize based on reverse alphabet CBA signs where C means cognitive decline (e.g. forgetfulness, misplacing objects, difficulty in recollecting phone numbers, recognizing persons, objects and places, confused about time and date and problems of thinking, judgment, and decision making), B means behavior problems (e.g. repetitive speaking, frustration, agitation, depression, shouting, sleep reversal, and wandering or losing one’s way) while A means that Activities of Daily Living (e.g. personal hygiene, bathing, dressing, eating, toileting etc.) get restricted and need help from carer. Above picture reflects dementia’s relentless progression but it is too late then.

But dementia is a slow creeper over months or even years and can be largely tackled if caught early. However, affected person or his family members will not even know when the disease has begun invading. This is because like early dementia, many if not all naturally or normally ageing persons also develop some cognitive decline like forgetfulness, slower processing speed, decreased attention and difficulty finding words. Family members may therefore fail to recognize early dementia which is characterized by somewhat similar overlapping features like losing things more often, forgetting appointments and even going to social events, lacking attention and difficulty concentrating and more trouble finding words and names compared to people of their age. Close watch is needed if such features aggravate or even persist for some duration say 6 months or so and then medical attention should be sought. There is no point waiting further. Some hints may be helpful. On misplacing an object, normally ageing person will know what object he has misplaced and will try to search for it. Dementia person on the other hand will not even remember what object he had misplaced and may not even remember he had forgotten something. Secondly, difficulty in communicating or asking some question repeatedly is seen in a dementia person but not otherwise. Thirdly, the elderly without dementia may at times not remember a street if visiting there after a long time but will not lose his way or wander while a dementia person is vulnerable to losing his way and may sometimes even forget his way to his own bedroom or bathroom.

Recognizing a friend meeting after long time but not remembering his name is not unusual among elderly but in dementia, ability to even recognize his close friend, relative or his loved  one may be compromised. Moreover, unlike an elderly person who may have difficulty in recollecting the day or date on a given day, a dementia person may have difficulty in even knowing if it is morning, noon, evening or night. Further, a dementia person may perform some socially unacceptable act but normal elderly will not. Finally, a normally ageing person does all his activities of daily living by himself unless he is too weak or physically disabled but the elderly with dementia despite having strength, faces cognitive difficulty in doing activities of daily living at a later stage of disease.

How to prevent it? Nip it in the bud or halt its progress

Medications to treat late-stage dementia are either not adequately effective or very costly and unavailable. Targeting the modifiable risk factors already mentioned above is a good strategy both to prevent dementia in the first place or to retard its progression once the disease has already occurred. Principles of healthy ageing apply both to dementia as well as most of the modifiable risk factors. The principles are too well known to merit further description and include “eat proper, exercise well, sleep full, bust stress, abstain from tobacco and alcohol, practice yoga and undergo annual health checkup”. Two more principles, intellectual (cognitive) stimulation and social enrichment are additionally useful for dementia and for depression and social isolation as well. Use it or lose it-an adage to keep the mind active is an expression to keep the dementia away through cognitive stimulation i.e. brain challenging activities. Some of these activities are alphabetically summarized below.

A ccomplish new tasks like reading, learning musical instruments, assembling gadgets.

B efriending and playing with grandchildren.

C hess, carom, cards, memory games playing and other indoor games and Cooking.

D Dominant and non-dominant hand use like knitting particularly useful for older women.

E xplore internet-online shopping, phone recharge, pay bills, submit tax returns, phone Apps   

F un with puzzles and crosswords.

G ardening including planning a garden.

H obbying, volunteering, reminiscences, socializing behaviors-A mixed mental/social stimul.

I mbibing a new language.

Note: Some of the above tasks may be tough for senior citizens but the stress involved in the task may result in satisfaction once the task is accomplished and this can enhance stress resilience in them-Epel ES. Toxic stress, hormetic stress, and the rate of aging. Ageing Res Rev. 2020 Nov; 63:101167

Google Baba also says in King Bruce and Spider story that repeated efforts pay the dividend.

Blog written by Dr. Vinod Kumar

             Disclaimer: Statements and observations contained in this paper are for only informational purposes. Author takes no responsibility for their practical applicability to matters of health, wellness, or well-being etc.