Dr Rajeev Anand
The world’s population is ageing. Improvements in health care in the past century have contributed to people living longer and healthier lives. However, this has also resulted in an increase in the number of people with non-communicable diseases, including dementia. Current estimates indicate 35.6 million people worldwide are living with dementia. This number will double by 2030 and may be with turn triple by 2050. Dementia doesn’t just affect individuals. It also affects and changes the lives of family members. Dementia is a costly condition in its social, economic, and health dimensions. Nearly 60 percent of the burden of dementia is concentrated in low- and middle-income countries and this is likely to increase in coming years.
According to World Health Organization Human brain is most complex structure of our body which is responsible for each and every activity happening automatically such as beating of heart, breathing and all other activities performed consciously.
To perform all these functions brain has 100 billion neurons and their 300 trillion connections almost like a master computer with so many different programs. These connections are communicating with each other through electrical and chemical signals. It is this unique ability of brain which makes us human by our ability to walk, talk, think, reason, feel and remember and behave the way we do. Dementia literally means “loss of the ability to think.”
Dementia deprives us from all those attributes that make us human: our capacity for love, for planning and reasoning, for making and recalling memories. And it happens due to loss or malfunction of neurons. Thus dementia is gradual irreversible decline of brain function which slowly interferes with a persons’ ability to carry out tasks of normal daily living.
It is important to talk about dementia as it has tremendous physical, mental, social and economical impact on the individual, family and community at large. Our life expectancy continues to inch upward and with this the burden of dementia is also rising. Therefore dementia is described as a “global disaster waiting to happen”. Above 65 about 5-8% have dementia and figure doubles every five year.
It is very important to diagnose dementia early as accurate diagnosis is the key to its management. There are more than 50 types of dementias. However it is even more important to diagnose and treat other diseases which may present with abnormalities of brain function and are treatable. Diagnosis is based upon History, Examination, blood investigation and brain scan.
Key to diagnosis
* Memory must be impaired to make the diagnosis of dementia.
* Loss of memory for recent events is the earlist feature of dementia.
* Subsequent symptoms include abnormal behavior, loss of intellect, mood changes, and difficulty coping with ordinary routes.
* Insight may be retained initially, but is then usually lost.
* Ultimately, there is loss of self-care, wandering, incontinence, and often paranoia.
* Dementia has to be distinguished from delirium which is an acute disturbance of cerebral function with impaired conscious level, hallucinations and autonomic overactivity as a consequence of toxic, metabolic or infective conditions.
* Depression can mimic the initial phases of dementia and it is termed ‘pseudodementia’ (which is amenable to antidepressant medication).
DRUGS
As on date there is no care for dementia. Therefore it is important to decrease the impact of disease by reducing the aggravating factors. As it is also the care giver who suffers, his training and treatment also requires consideration.
Despite research drugs help only modestly in few patients only to help memory and cognition. To control the behavioral symptoms anti psychotics may be required. Vitamin and mineral supplements are also prescribed.
WAYS TO REDUCE RISK
No matter what your age or stage of life is you have power to change many variables that influence your brain health. Following habits incorporated early may help to live longer with better brains:
* Mental Exercise: – Build physical and mental activities into everyday-Exercise halts dementia gene from being expressed and keeps your brain healthy. Moderate exercise may be single most effective way to prevent dementia.
* Eat healthy: Whole grains, fruits and vegetables, nuts and unsaturated fats. Also research has found turmeric and coconut oil to be protective and may even help new brain cell growth.(we see less dementia)
* Maintain healthy weight and body shape
* Don’t smoke: Always treat your chronic diseases like high blood pressure, high blood sugar, and abnormal lipids with your doctor’s help
* Challenge your mind – Putting off retirement cuts chances of dementia. “USE IT OR LOOSE IT “Keeping the brain mentally challenged is one way to prevent dementia. Speaking more than one language also seems to help.
* Build a strong social network – Have a positive mindset and purpose to live -Negative mindset and lack of purpose increases risk of dementia.
(The author is Director Neurology Department BLK Superspeciality Hospital New Delhi)
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