Uttam Maharjan

Dementia is a disorder associated with damage to brain cells. The brain has many parts, each part carrying out specific activities like thinking, movement and judgment. The hypothalamus is the cerebral part that is concerned with thinking and memory. This is the reason the first sign of dementia could be memory loss (amnesia). This part is sensitive to cell damage. When the hypothalamus is affected, cortex shrinkage occurs, giving rise to memory loss. A person suffering from dementia can remember old things but he or she cannot remember recent things.

Most of the changes to brain cells are permanent and the damage due to such changes worsens over time. However, some problems related to thinking and memory caused by conditions like depression, drug side effects, excess alcoholism, thyroid problems and vitamin deficiencies can be improved through treatments. There are over 100 diseases that can cause dementia. However, the major contributors are Alzheimer’s, vascular dementia and dementia with Lewy bodies. As people age, they run the risk of developing dementia. The elderly, especially those 65 or above, are prone to dementia. Aging and hereditary factors are the main causes of dementia. Also those suffering from high blood pressure, diabetes, cholesterolaemia, stroke and obesity are more prone to dementia.

Mood change
People in their 40s or 50s, or those under 65, can also develop dementia. Such dementia is termed younger onset dementia. But the odds of those under 65 developing dementia are low vis-à-vis those 65 or above. A person suffering from dementia shows a mood change; sometimes he is irritable and at other times he is pleased with himself. He suffers from disorientation; he cannot determine direction. He has difficulty learning new things owing to amnesia. He has also speech difficulty; he cannot speak distinctly or he speaks incoherently. His eye sight may be gradually lost. He has to depend on others for even daily activities. He becomes a victim of social isolation. The signs of dementia show up slowly. If not treated in time, the condition will get worse, defying treatment. So it would be prudent to watch out for the early symptom of dementia – forgetfulness, for example.

The elderly usually suffer from dementia. One of the best ways for preventing dementia is exercise. Both physical and mental exercises are good for the health. Besides walking or jogging, listening to music, reading the news, writing, playing games like chess or engaging in other activities is good for brain health. As dementia is related to aging, nutritious food – greens, fruit like avocados and cherries, flax seeds and the like- should form the diet of the elderly. The elderly should be motivated all the way. They should be patiently listened to. An environment for anxiety-free life should be created for them. Care should be taken to ensure that depression does not develop in them. They should not experience insomnia. Sleep is one of the important factors for keeping them healthy.

The elderly want love. They should be loved and admired. Those suffering from dementia may forget things or talk incoherently. In our society, there is a tendency to see such abnormal changes in the elderly affected by dementia in a negative light. The elderly may show senility or dotage because of old age. And they may behave like children and may have to be taken care of as if they were children. That is why senility is also called second childhood.

There are several types of dementia. Dementia itself is not a disease; it is a syndrome. Alzheimer’s is the most common form of dementia. Alzheimer’s accounts for 60 to 80 per cent of dementia. Most people consider Alzheimer’s dementia itself. Alzheimer’s patients show symptoms like memory loss, difficulty planning and difficulty doing everyday work. The symptoms of the disorder are mild at first but go on getting worse over time. The most prominent symptoms of the disorder are disorientation, difficulty speaking or writing, losing things and being unable to find them out, poor judgment, mood swings and personality changes.

Vascular dementia
Another type of dementia is vascular dementia. It is caused by stroke. The symptoms of vascular dementia depend on the part of the brain affected by stroke. The first symptoms of this form of dementia are poor judgment and problems with planning, organising and making decisions. Other problems may include memory loss, difficulty speaking and writing, problems with recognising sights and sounds, disorientation, mood and personality changes and problems with walking.

There are also other types of dementia like dementia with Lewy bodies (in which deposits of a protein called Lewy bodies are formed in the cortex), Parkinson’s dementia and fronto-temporal dementia. A person may suffer from a combination of two forms of dementia. Called mixed dementia, a combination of Alzheimer’s and vascular dementia is the most common mixed dementia. Treatment of dementia depends on the stages and types of dementia. There is no cure for progressive dementia, including Alzheimer’s. However, one treatment – aducanumab therapy – is promising. Under the treatment, the amyloid is removed from the brain, which helps reduce decline in cognitive (thinking) and functional activities caused by Alzheimer’s.

The drug against dementia was developed in 2003 AD. Such drugs are acetylcholinesterase inhibitors, memantine, antipsychotic drugs and the like. There are other therapies that prevent the symptoms of dementia from getting exacerbated. It may be noted that non-drug therapies – palliative care methods – can also mitigate the symptoms of certain forms of dementia. Dementia is a serious problem. Cases of dementia are also increasing in Nepal. In 2019, the World Health Organisation declared Alzheimer’s the seventh cause of death. So we should take precaution to ward off dementia.

(Former banker, Maharjan has been regularly writing on contemporary issues for this daily since 2000. uttam.maharjan1964@gmail.com)