Let's talk about dementia

Dr. Mathew Abraham
Senior Consultant, Neurologist
Aster Medcity, Kochi

Dementia is the loss of multiple domains of brain function, which reach a stage that it significantly affects professional and activities of daily living. The chances of developing dementia increase with age, especially after 60. With life expectancy on the increase, more and more patients are going to get dementia.

This is therefore becoming a huge social and medical problem, especially in the developing countries, with a largely young population at present. It is estimated that by 2030, 80% of the world’s dementia patients would be in India and China. Sadly we do not, as yet, have the physical, medical and social infrastructure to look after this affected population.

Only about 8% of all patients with dementia have a reversible cause. These would include Vitamin deficiencies like Vitamin B12 (more likely to be seen in pure vegetarians), Hormone deficiencies like hypothyroidism, and Organ failures like hepatic or renal dysfunction or overuse of drugs or toxins. A small group among these suffer from Pseudo dementia which is a dementia- mimic brought on by anxiety and depression. All they need is reassurance, anti-anxiety and anti-depressant drugs for full recovery.

It is of paramount important that all patients are first screened for treatable dementias, as any delay in this diagnosis makes an eminently treatable disease beyond redemption.

I had a patient who was an Ayurvedic physician who had lost his mental faculties to the extent that he was urinating in public. Detailed investigations revealed that he had a significant B12 deficiency which was appropriately corrected. He could resume his consultation practice within two months of treatment, which only highlights the importance of identifying and treating such reversible dementias early.

After the group has been treatable dementias have been screened for and treated, we have a small group of partially treatable dementias, which are mainly due to multiple strokes. Hypertension, diabetes, smoking and high cholesterol are risk factors for the progression of this vascular dementia. Life style modifications, control of diabetes and using aspirin helps prevent a progression of this disease and even reverse some of the symptoms, making it a partially treatable dementia.

We are still left with a large percentage of patients who fall in the category of irreversible dementias like Alzheimer’s disease, Fronto temporal dementia, Dementia with Lewy bodies or mixed dementias. Although gigantic strides have been made in the understanding of the pathophysiology, progression and genetics of these diseases, we still have not yet found treatments that will reverse or cure these conditions. Depending upon the specific circuits that are affected, these present with derangements of memory, organizational and executive ability, behaviour, speech and language or inability to identify and use tools in daily living (Apraxia). Over a period of time, the symptoms overlap as the pathology progresses from one area to another, eventually leaving the patient in a pitiful, helpless, incontinent and bedridden state.

The caregivers of these patients are the ones who bear the brunt of looking after these patients. The quality of their care can only be improved by educating them about the diseases and their progression, as well as supporting them psychologically and socially. Looking after such progressively dementing patients is a 24 x 7 job and sadly, a thankless one. This is where support groups like the Alzheimer’s Society help in educating and enhancing the spirit and morale of the caregivers. Such NGO’s have done a tremendous job in improving the public awareness of dementia, thus helping relatives to bring such patients early in the disease so that pharmaceutical and social interventions can be done early. These help to improve the quality of life of both the patients and the caregivers in this tragically progressive downhill course.

An enormous amount of research is going on in multiple fields in many institutions the world over, trying to find out the cause and possible cure for these as yet untreatable diseases. There is every chance that some serendipitous discovery in medicine or in some other obscure field may open the floodgates to new discoveries that will help make these diseases totally curable.

We can only hope and pray that this goal will be reached on our own lifetime.