By 2050, 11.44 million people in India are expected to be living with dementia, which is up from 3.84 million in 2019, says the Global Burden of Disease study, published in the Lancet Public Health. It will primarily be due to population growth and population aging coupled with factors like smoking, obesity, high blood sugar, and lack of education of the subject. Side effects of medicines, vitamin deficiencies and thyroid hormone imbalance are other causes while Covid-19 has just added to the woes. The HEALTH PIONEER reports.

Some lapse in memory over time in an elderly person is expected. However, forgetfulness becomes problematic if you find your loved ones struggling to remember recent events or conversations, constantly asking the same questions, repeating themselves or forgetting how to perform tasks they’ve been doing consistently, such as going to the toilet or making tea. High chances are that they might have dementia.

Dementia is an umbrella term used for impaired ability to remember, think, or make decisions that interfere with everyday activities. Alzheimer’s disease—a progressive neurologic disorder that causes the brain to shrink and brain cells to die — is the most common type of dementia.

It is common in people over 65 years but is also seen sometimes in younger people in their 50s. Medical experts say that there is a tendency to ignore early signs of dementia and most patients are brought for medical help when their disease is in advanced stages in India.

The World Health Organization reports on dementia rings an alarm bell. “Today there are around 55 million people worldwide living with dementia, with over 60% living in low and middle-income countries. As the proportion of older adults increases, this number is expected to rise to 78 million in 2030 and 139 million in 2050! Dementia also happens to be the 7th leading cause of death amongst all diseases,” it says.

“India’s burden would be much higher than what the Global Burden of Disease data shows,” Prof (Dr) Rajinder K Dhamija, Director of the Institute of Human Behaviour and Allied Sciences in New Delhi said, adding that the Government need to work on the national policies and programmes specifically targeting epilepsy, neuro infections, dementia and neuro-degenerative diseases.

As per 2020 Lancet Commission, nearly 40% of dementia cases could be prevented or delayed if exposure to 12 known risk factors were eliminated — low education, high blood pressure, hearing impairment, smoking, midlife obesity, depression, physical inactivity, diabetes, social isolation, excessive alcohol consumption, head injury, and air pollution.

Dr Suvarna Alladi, Professor of Neurology, National Institute of Mental Health and Neurosciences, Bangalore stressed on early treatment. “Dementia is common brain disease among older people with loss of memory being a major problem which might lead to agitation, suspicion and other distressing behavioural problems. Thus, it is very important to consult a doctor in the early stages of the disease, so that the best can be done for persons with dementia,” Dr Alladi was speaking at an ASSOCHAM event recently. 

Type 2 diabetes, heart disease or stroke have double the risk of developing dementia, as per a  study from Karolinska Institutet in Sweden published in the journal Alzheimer’s & Dementia. Yet another study published in the Journal of Science and Medicine in Sport has found that better performance on physical tests is related to better cognition later in life and may protect against dementia in later years.

The researchers found that children with the highest levels of cardio-respiratory and muscular fitness and lower average waist-to-hip ratio had higher midlife scores in tests of processing speed and attention, as well as in global cognitive function.

For caregiver too, living with PwD is full of challenges---confusing, frustrating, and heartbreaking as they require round the clock care and attention to get through their day. It becomes more challenging if they have other co-morbidities.

Tips to consider early on and as the disease progresses:

Try to keep a routine, such as bathing, dressing, and eating at the same time each day.

Help the person write down to-do lists, appointments, and events in a notebook or calendar.

Plan activities that the person enjoys and try to do them at the same time each day.

Consider a system or reminders for helping those who must take medications regularly.

When dressing or bathing, allow the person to do as much as possible.

Buy loose-fitting, comfortable, easy-to-use clothing.

Use a sturdy shower chair to support a person who is unsteady and to prevent falls. You can buy shower chairs at drug stores and medical supply stores.

Be gentle and respectful. Tell the person what you are going to do, step by step while you help them bathe or get dressed.

Serve meals in a consistent, familiar place and give the person enough time to eat.

To help make communication easier for PwD, you can:

Reassure the person. Speak calmly. Listen to his or her concerns and frustrations. Try to show that you understand if the person is angry or fearful.

Allow the person to keep as much control in his or her life as possible.

Respect the person’s personal space.

Build quiet times into the day, along with activities.

 Keep well-loved objects and photographs around the house to help the person feel more secure.

Remind the person who you are if he or she doesn’t remember, but try not to say, “Don’t you remember?”

Try distracting the person with an activity, such as a familiar book or photo album, if you are having trouble communicating with words.

Remove hazards and add safety features around the home. Try these tips:

If you have stairs, make sure there is at least one handrail. Put carpet or safety grip strips on stairs, or mark the edges of steps with brightly colored tape so they are more visible.

Insert safety plugs into unused electrical outlets and consider safety latches on cabinet doors.

Clear away unused items and remove small rugs, electrical cords, and other items the person may trip over.

Make sure all rooms and outdoor areas the person visits have good lighting.

Remove/lock up cleaning and household products, such as paint thinner and matches.

Tips for a Healthy and Active Lifestyle for PwD

Consider different activities the person can do to stay active, such as household chores and cooking, exercise, and gardening. Match the activity to what the person can do.

Help get an activity started or join in to make the activity more fun.

Add music to exercises or activities if it helps motivate the person.

Be realistic about how much activity can be done at one time. Several short “mini-workouts” may be best.

Take a walk together each day.

Buy a variety of healthy foods, but consider food that is easy to prepare.

Give the person choices about what to eat.

Dos and Don’ts with PwD

Developing effective ways to meaningfully engage the elderly using puzzles, simple kitchen activities, music, classic movies, reminiscence activities, or colourful activities via arts and crafts is important.

Don’t argue or correct them, understand their sense of reality and live in it with them.

Seek professional help when required so that you don’t burn out.

Go healthy

Seven healthy habits can help in lowering cases related to dementia among people with the highest hereditary risk, research by American Institute of Neurology has said. These are: eating better, being active, not smoking, losing weight, controlling cholesterol, reducing blood sugar and maintaining healthy blood pressure.The findings have been published in the journal ‘Neurology’.

Dementia develops slowly over decades, first manifesting as gradual cognitive decline that only shows up in cognitive tests. It then degenerates into cognitive impairment in which the individual notices their failing memory but can still look after themselves, and finally into full-blown dementia