Lifelong habits and healthy lifestyle, key to dementia prevention
• 2.29 To 21.60 Percent Of Nigerians Don’t Have Access To Treatment
Dementia is a condition that occurs when part of the brain responsible for learning, memory, decision-making, and language is affected by infections or diseases and is severe enough to reduce a person’s ability to perform everyday activities.
Health experts explain that the disorder may be reversible, when caused by adverse effects of drug or alcohol abuse, thyroid problems, vitamin deficiencies or depression. Depression is by far the most common of the potentially reversible causes. Irreversible dementia is caused by degenerative brain disorders, such as Alzheimer’s disease.
They said by reducing the risk factors for vascular disease, for instance diabetes, high blood pressure, obesity, smoking, physical inactivity and depression could also prevent dementia.Similarly, a healthy lifestyle is said to reduce the risk of dementia. With regular physical exercise, maintaining a healthy weight, not smoking or drinking alcohol, a person can greatly reduce the risk. A healthy balanced diet, which is low in saturated fat, salt, sugar with plenty of fish, fresh fruits and vegetables also reduces the risk of dementia.
A Consultant Physician/Neurologist at Lagos State University Teaching Hospital, Ikeja, Lagos, Dr. Olajumoke Oshinaike, said dementia mainly affects elderly people usually over the age of 65 and the likelihood of developing dementia increases significantly with age. She explained that about five per cent to eight per cent of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. It is estimated that as many as half of people aged 85 and above suffer from dementia.
In a very small number of people, certain types of dementia are inherited as a single gene that directly causes the disease. People with one of these genes will usually get dementia before the age of 65.Oshinaike said Alzheimer’s disease account for 60 to 80 per cent cases of irreversible dementias, while vascular dementia, which occurs after a stroke, is the second most common type.
Others include the frontotemporal and lewy body types. It is also common for people to have mixed dementia, a combination of two or more types of dementia. For instance, some people have both Alzheimer’s disease and vascular dementia. Irreversible dementias are progressive, meaning symptoms start out slowly and gradually get worse over time.
She said: “Signs and symptoms of dementia occur, when the brain cells neurons stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss. The specific symptoms that someone with dementia experiences depends on the parts of the brain that are damaged and the disease that is causing the dementia.
“Generally, they may have memory difficulties of keeping track of personal effects, remembering recent conversations and recalling events that happened recently, the names of family members and friends or even paying bills.“They may have difficulties making decisions, solving problems or carrying out a sequence of tasks such as cooking a meal; difficulties following a conversation or finding the right word for something; problems judging distances (such as on stairs).
“They may lose track of the day or date, become confused about where they are, sometimes unable to find their way back home. As the disease progresses, more of the brain is damaged, and such mood changes as frustration, irritability, apathy, social withdrawal and anxiety set in.“With some types of dementia, the person may see things that are not really there (visual hallucinations) or strongly believe things that are not true (delusions). At this stage, the person will need more support to carry out everyday tasks.”Oshinaike said management of dementia depends on the cause.
“It is important to evaluate dementia symptoms comprehensively, so as not to miss the treatable/reversible ones,” she said. “The irreversible types of dementia cannot be cured, but there are ways to manage the symptoms. Memory-enhancing drugs that slow the breakdown of brain chemical involved in memory and judgment, such as cholinesterase inhibitors, for instance donepezil, rivastigmine, and galantamine along with memantine, a medication that acts on another neurotransmitter system have all been shown to have some benefit in improving memory function in some patients. However, none of these drugs appear to stop the progression of the disease.
“There is a range of non-drug treatments that can help someone to live well with dementia. Taking therapies, such as counseling, can help them come to terms with their diagnosis or discuss their feelings, especially if depressed or anxious. There are also therapies to keep the mind active and retain skills.
“Activities such as music, singing or art may be of help. Basically, people with dementia should stay active physically, mentally and socially. Being mentally and socially active into later life may help lower a person’s risk of dementia. Doing puzzles, reading or learning a new skill is ways of staying mentally active, whilst visiting friends or going to a place of worship are ways of being socially active.
“If you or a loved one is experiencing memory difficulties or other changes in thinking skills, consult a Neurologist to determine the cause. Professional evaluation may detect a treatable condition. And even if symptoms suggest irreversible dementia, early diagnosis allows for maximum benefit from available treatments.”A Senior Registrar at Federal Neuro-Psychiatric Hospital (FNPH), Yaba, Lagos, Dr. Olusegun Akinwotu said a number of epidemiological studies undertaken in Nigeria revealed a prevalence rate range of 2.29 per cent to 21.60 per cent of the population do not have access to treatments. Due to lack of adequate awareness of the illness, this may just be a tip of the iceberg.
He stated that the risk factors for dementia in addition to age include, female sex, family history of dementia, Down’s Syndrome, mild cognitive impairment, heavy alcohol consumption, high blood pressure, poorly controlled diabetes, previous head injury and low body max index (BMI).Akinwotu noted factors that have been found to be protective against the development of dementia are higher level of education, non-steroidal anti-inflammatory drugs and Vitamin E, among others.
He said: “The causes of dementia include neuro-degenerative diseases, Alzheimer’s disease, vascular dementia, frontotemporal dementia, Parkinson’s disease, Huntington disease, Lewy body disease, intracranial tumours, head trauma, cerebrovascular accidents, normal pressure hydrocephalus, infections neuro-syphillis, HIV associated dementia, tuberculosis, endocrine hypothyroidism, Cushing’s disease, Addison’s disease, toxins, prolonged heavy alcohol misuse, heavy metal poisoning, vitamin deficiency B12, thiamine, niacin, metabolic electrolyte imbalance, low glucose level and uremia, among others.”
Akinwotu explained that dementia presents with memory loss, difficulty in handling complex tasks, difficulty communicating, difficulty with coordination and motor function, confusion, disorientation, personality changes, diminished self-care, inhibition, silliness, anxiety, depression, paranoid, delusions, hallucinations, agitation, Sundowner syndrome, where confusion increases as evening approaches.
Consultant Psychiatrist/Lecturer at Lagos State University Teaching Hospital/Lagos State University College of Medicine Dr. Olayinka, Atilola said anyone can have dementia and the most consistent risk factors in the literature are old age and genetics. However, certain medical conditions and lifestyles have shown association with dementia and these include, poor cognitive stimulation occasioned by low levels of education, sedentary lifestyle and poor social network, among others. “It is important to ensure continuous brain stimulation through lifelong reading to avoid the condition. Other measures include regular and physical exercise, regular productive social engagement, prompt and proper treatment of diabetes, hypertension, and maintaining a healthy weight.”
Atilola said: “If you observe a consistent memory issues, such as forgetfulness, misplacing items, mixing up information, difficulties with recognition of familiar faces, and general deterioration in quality of behaviours in yourself or someone, talk to a doctor about your concerns. Though most medical doctors are familiar with dementia symptoms, but you may also wish to ask that you or somebody be assessed for dementia, if you have any of the concerns above. Doctors can conduct further tests such as blood tests and brain imaging to further establish dementia or to rule out other causes of dementia-like symptoms.”He noted that the best place for dementia treatment is in the hospital, as most doctors are familiar with symptoms of dementia and may be able to treat it.
“However, there are some specialist doctors with more advanced training and skill in the management of dementia. These specialists include Neurologists, Geriatricians, and Psychiatrists. You may request to see any of these specialists in any hospital. You may be so referred if your hospital does not have such manpower. Most Teaching/Specialists hospitals in Nigeria have a dementia unit”.
“People should adopt a lifestyle that is protective from dementia. Ensure that any form of sustained memory problem is promptly and properly evaluated. Seek appropriate treatment for dementia, and remember that most people with dementia may not be able to remember exactly what to do about their condition. So, be your brother’s keeper.”
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