Dementia: Are you becoming increasingly forgetful?

Many older people have a slight loss of memory that does not affect their daily lives. But memory loss that gets worse may mean dementia, a progressive disorder that affects how the brain works and in particular the ability to remember, think and reason, reports SADE OGUNTOLA.

It’s normal for one’s memory to be affected by age, stress, tiredness, or certain illnesses and medications. In fact, memory loss may be annoying if it happens occasionally and affecting one’s daily life.

But if you are worried about memory loss or if a loved one has memory loss that is getting worse, it may be important for medical experts to rule out dementia or other cognitive problems.

Forgetfulness and memory problems don’t automatically point to dementia, a general term for a decline in mental ability severe enough to interfere with daily life, which is caused by damage to or changes in the brain.

“When the forgetfulness is intense to the extent that the person forgets such things as his children’s name, misses his way home or this begins to affect his language  functions, it may be suggestive of dementia,” said Dr Rufus Akinyemi, a senior research fellow, Neuroscience and Ageing research unit, Institute of Advanced Medical Research and Training, College of Medicine, Ibadan.

Generally, body functions undergo age-associated decline, including brain’s cognitive functions. Anybody can be forgetful, for instance, if he has something on his mind.

Symptoms of dementia

Difficulty with calculations, difficulty handling finances, or buying goods and failing to collect or give wrong change, may be signs that a person may be demented.

Dr Akinyemi added “those close to the individual, like the spouse, would tell you when they started noticing the gradual deterioration in the person’s memory functions.”

Subtle short-term memory changes can be an early symptom of dementia. An older person may be able to remember events that took place years ago, but not what they had for breakfast. They might forget where they left an item, struggle to remember why they entered a particular room, or forget what they were supposed to do on any given day.

A change in mood is also common with dementia. Dr Akinyemi, a consultant neurologist, stated “Depression can mimic dementia and the two conditions could coexist together. The individual may also be unable to concentrate, have a bad mood, lose interest in hobbies or activities and may often become confused. There could also be a shift in personality, from being shy to outgoing.”

Difficulty recognising people and places, finding right words or following story lines sometimes may be classic early symptom of dementia.

Just as finding and using the right words becomes difficult, people with dementia sometimes forget the meanings of words they hear or struggle to follow along with conversations or television programmes.

Dementia not due to ageing

Dementia is not a consequence of growing old, although the risk of having the brain problem increases with age. “There are people who are 100 years old and older that are senile, their memory function is still okay for their age,” he added.

According to Professor Sola Ogunnniyi, a consultant neurologist, UCH, Ibadan, Oyo State, dementia is caused by a variety of diseases and injuries that affect the brain, such as Alzheimer’s disease, Parkinson’s disease, HIV, Huntington’s disease and stroke.

Also, Professor Ogunniyi added that chronic alcoholism, diet rich in cholesterol and hypertension can also predispose to developing dementia.

Much as Alzheimer’s disease, is the leading cause of dementia, he added “in parts of the world where people drink a lot of alcohol such as Russia, we have a lot of cases of dementia linked to intake of alcohol. Also, some disorders that cause dementia can run in families.”

Stroke is the second most common cause of dementia. Dementia caused by stroke is called vascular dementia.

Rates of dementia

Worldwide, World Health Organisation (WHO) says that around 47 million people have dementia, with nearly 60 per cent living in low and middle-income countries. Every year, there are 9.9 million new cases.

WHO also estimates that between five and eight per 100 people in the general population aged 60 and over will have dementia at a given time.

Professor Ogunniyi declared that studies done in Lalupon and Idikan, both communities in Oyo State, found about three per cent of those above the age of 65 have dementia in these communities.

The burden of dementia, however, is higher as people grow older.

He added, “By the time you are reaching 85, the prevalence would be about 15 per cent, that is three out of every 20 persons.”

Although a study in Jos puts the prevalence of dementia at about six per cent, he said a bigger geographical study involving South Western Nigeria came up with a 10 per cent prevalence rate for dementia.

Dementia in Nigeria

From the study carried out both in Lalupon and Idikan, Professor Ogunniyi said, “in Nigeria, we found dementia more in people who are old. So, age is a risk factor.

“In our study in Idikan, it is the female gender that is at risk and we attributed that to their longevity. But in the study at Lalupon, dementia was more in men than women. Of course, the women in studied population at Lalupon were younger. So in terms of gender, nothing is clear cut.

“Some studies have shown that low education increases the risk of dementia, but we think that education will be counterbalance by native intelligence in our environment. And so maybe that is why educational status was not shown to be a major factor in our study.

“Dementia had also been linked with severe injury to the head, say from road traffic accidents and falls. But in our study we do not have any data to link dementia to head injury.

“We think that diet may be important; we think that hypertension and cholesterol are things that can predispose to stroke and hence increase one’s risk of dementia.”

Treatment and care

There is no treatment currently available to cure dementia or to alter its progressive course. Numerous new treatments are being investigated in various stages of clinical trials. Much can be, however, offered to support and improve the lives of people with dementia and their carers and families.

Can you prevent dementia?

Social isolation and cognitive inactivity are required to keep stimulating the brain in preventing dementia. “That is why card games and being socially active by going for religious programmes and communal activities, which prevent inactivity, is helpful in elderly,” Professor Ogunniyi added.

Also eating nutritious foods and in the right amount as well as avoiding things that will damage the blood vessels or things that are deleterious to health, he added can help prevent dementia.

Treating brain diseases early and adherence to medications for hypertension, he said is also important.

Professor Ogunniyi, however, assured that with treatment and support, many people with dementia are able to lead active, fulfilled lives.

In addition, Dr Akinyemi suggested physical exercises, intake of fruits and vegetables and avoidance of junk foods as some lifestyle changes to adopt to prevent or delay onset of dementia.