What is dementia
- Dementia is a term used to describe a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life.
- Dementia is a clinical syndrome caused by a range of diseases or injuries to the brain.
Extent of Dementia
- Worldwide, 47.5 million people have dementia.
- Given the dramatic growth of the population of older people, the number of people living with dementia worldwide is expected to double every 20 years, going up to 135.5 million by 2050.
- According to a 2020 report published by the Alzheimer’s and Related Disorders Society of India, there are around 5 million people in India living with dementia.
- The most common cause of dementia is Alzheimer’s disease.
- It is implicated in up to 70% of dementia diagnoses.
- Early symptoms include absent-mindedness, difficulty recalling names and words, difficulty retaining new information, disorientation in unfamiliar surroundings, and reduced social engagement.
- More atypical symptoms include impairment in recognising visually presented objects (visual agnosia) despite a normal visual field, acuity and colour vision. Some might also experience word-finding difficulties (anomic aphasia).
- As the disease progresses, there is marked memory loss and loss of other cognitive skills, including a reduced vocabulary and less complex speech patterns.
- This may be accompanied by mood swings, apathy, a decline in social skills, and the emergence of psychotic phenomena.
- Advanced disease is characterised by monosyllabic speech, psychotic symptoms, behavioural disturbance, loss of bladder and bowel control, and reduced mobility.
- Doctors diagnose dementia on clinical grounds using neuroimaging and neuropsychological tests.
- The first and foremost step is to obtain a comprehensive medical history of the individual from a reliable informant.
- A slowly progressive dementia over years with insidious onset may point to Alzheimer’s dementia.
- A dementia that progresses rapidly over months may point to dementia due to prion disease.
- Conducting a cognitive assessment is central to the evaluation of dementia
- Neuropsychological tests can help differentiate dementia from milder cognitive syndromes and/or from normal ageing.
- Further work-up using laboratory studies and brain-imaging will be required in most instances. These include a metabolic panel, liver test, blood counts, thyroid test, and vitamin B12 and folate tests.
- As of today, there is no genetic or biomarker test that can be used to diagnose dementia.
- The WHO has identified preventing Alzheimer’s disease to be a key element in the strategy to fight the world’s dementia epidemic. Economic analyses have found that delaying the onset of the disease by even one year could reduce its prevalence by 11%, while a delay of five years could halve it.
- Prevention programmes usually focus on lifestyle risk factors – such as sedentary behaviour, unhealthy diet, smoking, and excessive alcohol use – together with mental wellbeing and risk of cardiovascular diseases.
- Current smokers have a 50% higher risk of developing dementia relative to those who have never smoked
- Regular exercise helps offset cardiovascular, and in fact broader, health risks.
- In addition, there is a robust link between depression in late life and the incidence of sporadic dementia. Having depression increases the risk of developing dementia by nearly twofold.
- Higher educational and occupational attainments have consistently been implicated as protecting against developing dementia later in life. One recent study reported that those who attain higher education have a 40% lower risk.
- The first pillar of care is to manage the important aspects of the disease, with a goal to reversing their effects or to delay its progression in the brain.
- The second is to manage the cognitive, neuropsychiatric, and functional symptoms of the disease.
- The other two pillars involve providing systematic, evidence-based supportive care to patients and to carers.
- Except in emergency situations, non-pharmacological interventions form the first line of therapy. But over time, medicines often become necessary, even an integral part of symptom management.
- Cognitive symptoms associated with dementia are treated with drugs called cholinesterase inhibitors.
WHO’s Efforts against dementia
- Global Action Plan on the Public Health Response to Dementia 2017-2025
- Global Dementia Observatory
- GDO Knowledge Exchange Platform
- Guidelines on Risk Reduction of Cognitive Decline and Dementia
- WHO released mDementia handbook
- Mental Health Gap Action Programme
- WHO is also developing a Dementia Research Blueprint, together with researchers and academics around the world
- Alzheimer’s and Related Disorders Society of India