The rise in the number of cases of dementia and Alzheimer’s globally and in Sri Lanka has raised concerns among health officials already burdened by other equally serious health issues.
One of the biggest drawbacks to delaying the onset of Alzheimer’s disease is the delay in taking a person with likely symptoms to be examined by a qualified health professional.
The Sunday Observer spoke to the President of the Alzheimer’s Association of Sri Lanka Prof. Shehan Williams to get more insights into this condition once considered a disease of the elderly but is now being diagnosed even in younger patients.
According to Dr. Williams, more focus must be devoted to improving brain power and a better understanding of the disease which calls for empathy and compassion and creating Dementia friendly environments in our neighborhoods.
Excerpts
Prof. Shehan Williams
Create Dementia friendly communities to persons with Dementia and Alzheimer’s to ensure them quality care they deserve
–Lanka Alzheimer’s Foundation
Q: The theme chosen for this year’s World Alzheimer’s Day I which is observed on September 21 is “Time to Act on Dementia, Time to Act on Alzheimers’ Does this mean that Alzheimer’s disease and Dementia are both the same thing?
A. Dementia is the overarching term used for a person developing progressive problems with memory, thinking and ability to speak and conduct day to day activities as they age. The commonest reason for someone developing this problem is Alzheimer’s disease. There are however numerous other conditions that can cause dementia.
Q: What is its significance to people living with Alzheimer’s disease?
A. The theme for this year focuses on the fact that there is under recognition of the problem of Dementia and Alzheimers despite it being a global non communicable disease that is and will impact the lives of millions of people world wide. An estimated more than 50 million people suffer from this condition globally currently, and the need for global and local action is imperative to support people with this condition.
Q: In what way does it affect Sri Lankan people with Alzheimer’s disease?
A. Sri Lanka is no exception and an estimated 400,000 people suffer from dementia, a majority with Alzheimers. Like the rest of the world, very few of us understand the condition and the challenges that persons with dementia and the caregivers face day to day, with limited support services.
Q: Have you seen an upward curve in recent years? What are the main causes for this disturbing trend? Is it due to our rising ageing population?
A. Yes, age is the biggest risk factor and Sri Lanka’s population is ageing. By 2030 around 20 percent of Sri Lanka’s population will be over the age of 60 years. With a bigger ageing population the likelihood of a greater number of persons with dementia is inevitable.
Q: In what way is it linked to the theme for this year? Pl explain what is meant by Attitudes to Dementia.
A. Our attitude to the condition has to change drastically. Many of us consider dementia to be a form of madness. We look down on persons with dementia and even the families with persons with dementia. We do not realise that it is a condition that can affect any of us as we age.
We have to understand that it is a disease process similar to any other medical condition. The person with the disease cannot help forgetting or behaving in a certain way we perceive as crazy. Many of us blame the person with the condition for forgetting and not making an effort.
Some of us go to the extent of saying that it is due to them not having enough merit or because they have sinned in their lives. We need to understand that this is a brain disease.
Q: So is there a way to slow down this unhealthy trend?
A. There are many things we can do to prevent or delay the onset of this condition. Maintaining a healthy lifestyle from a young age is key to delaying the onset of dementia. We need to keep ourselves physically and mentally active from a young age. Similarly we need to eat healthy, maintain optimal body weight, rest adequately and focus on optimising our brain health. We do not realise that the brain is our ultimate operational centre.
We need to keep it ship-shape so that we can live a good life.
We need to manage conditions that affect blood flow to the brain like high blood pressure, diabetes and high cholesterol. We need to stop smoking, -the most harmful for brain health. Current evidence shows that even alcohol in moderation can be harmful to the brain.
Q: Will early diagnosis help?
A. Persons with early stages of dementia can live a near normal life for many years. Therefore, early diagnosis will help to identify treatable causes of dementia, especially hormonal and vitamin deficiencies. Similarly, there are certain medications that delay the progression. And more importantly, lifestyle modifications can be made to improve the wellbeing of the person and also plan for the future.
Q: It was reported that most people living with dementia and Alzheimer’s have not received a formal diagnosis, and that even in developing countries only 20 -50 percent of dementia cases have been diagnosed . A study in India, our closest neighbour, has also revealed the shocking revaluation that there are around 90 percent undiagnosed cases. Your comments?
A. It is not surprising at all. Many of us consider dementia and Alzheimer’s to be a normal part of ageing. We do not recognise the symptoms and realise it is dementia until it is very late in the progression of the disease.
Q: If someone is suspected of having symptoms of dementia what are the symptoms his/her caregivers should look out for?
A. The commonest symptom that is easily identified is forgetfulness.Invariably it is the short term or recent memory that is affected first. The person is able to remember events from their past quite well. However, they may forget messages given to them, misplace things and not be able to find them, repeat the same question over and over and even get muddled about recent happenings. These are early warning signs and if they persist it is worthwhile checking out their memory through a memory test or discussing it with their doctor.
Q: How is it diagnosed? Does the person have to be hospitalized? For how long?
A. The diagnosis will have to be made by a doctor. There are many treatable causes as mentioned above which may have to be looked for. There is no reason for a person to be hospitalised unless there is some drastic change that requires immediate attention. Most persons can be investigated without admission to hospital.
Q: Who makes the final evaluation? Any general practitioner or a specialist?
A. Any doctor should be competent to make an initial diagnosis of dementia. However, it may be best to get a specialist opinion from a neurologist, psychiatrist or geriatrician.
Q: What are the tests you usually carry out on a patient with symptoms of dementia?
A. There are many tests that a doctor may request depending on the presentation. This may include blood tests, brain scans and even genetic testing. A memory test is also useful, where the person is given a set of questions and tasks which enable the doctors to identify the degree of impairment.
Q: Age wise who are those most at risk to Dementia?
A. Some forms of dementia can affect people even in their 40s and 50s. However, we are most vulnerable as we age. Up to 30 percent of people will be affected after the age of 80.
Q: Gender wise are males or females more prone to the disease? Why?
A. Alzheimer’s disease in particular affects more females than males. No one is quite sure why although there are many theories especially related to menopausal changes. However, vascular dementia and alcoholic dementia are more prevalent in males.
Q: What about strokes ? And Parkinson’s disease (PD)? I read that PD was a leading cause for dementia?
A. Vascular dementia is interrelated with strokes. It is due to minor strokes called lacunar infarcts and other changes that occur in the brain when the blood supply to the brain is compromised. Major strokes depending on the areas of damage in the brain will also lead to dementia.
Parkinson’s disease is another cause of dementia. Studies show that it accounts for around 5 percent of all dementias. Nearly a quarter of people with Parkinson’s disease run the risk of developing dementia.
Q: Practising yoga, engaging in mild exercise and reading, playing scrabble and other games that stimulate the mind and attention are said to go a long way in improving the mental health of people with Alzheimer’s and Dementia. Do you agree?
A. Yes, we need to keep our brains active at all times. We need to exercise it regularly and each one of us has to keep persisting with any activity we are comfortable with to keep our brain stimulated. If we don’t use it, we lose it !
Q: We already have laws that protect people with disabilities in our constitution. What we need is to implement them in a manner that encourages tolerance and empathy. As President of the Lanka Alzheimer’s Foundation tell us what the recent inputs your society has made towards achieving this goal?
A. Our Foundation advocates for people with dementia and their caregivers. We want communities to recognise that this is a real problem that affects us as we age. We cannot close our eyes and pretend that it does not exist as dementia is prevalent all around us in all strata of society.
Dementia is no respecter of persons! We campaign for ‘Dementia friendly communities’. The health services alone cannot manage this issue. There is no cure for Alzheimer’s. Communities will have to support persons with dementia and help them lead active and meaningful lives as long as they can without isolating them. They need to be cared for with dignity and receive the care they deserve. Families and communities have to join hands to help persons with dementia.
Q: I understand that you conduct informal programs and discussions on many issues that can change attitudes. Do you work with young people so that they have more empathy towards older people?
A. We target young and old in our awareness efforts. Many young people including school children and university undergraduates visit our activity centre in Maradana where they interact with persons with dementia and get involved in their care.
We improve their awareness of the condition and some even volunteer for periods of time at our activity centre.
Q: Is there a hotline that a person who needs help can reach easily ?
A. The Lanka Alzheimer’s Foundation hotline is available : 0112667080
