When the brain is on hold

by Sujata Kelkar Shetty for Live Mint & The Wall Street JournalDementia is a major concern as we age. Early diagnosis can go a long way in bringing relief. This year’s theme for World Health Day (7 April) is ageing and health, i.e., “Good health adds life to years.” Ageing is associated with very specific health concerns such as dementia, a medical condition of the brain that primarily affects people over the age of 65. It is characterized by a progressive loss of mental faculties and the World Dementia Report (WDR 2010) estimates that 3.7 million people are currently affected with dementia in India.Satish Chandra, director and vice-chancellor of the National Institute of Mental Health and Neuro Sciences (Nimhans), Bangalore, says the number of dementia cases in India will double by 2030 and the cost of taking care of these patients will triple. Currently, WDR 2010 puts the cost of taking care of a dementia patient at Rs. 43,000 a year.Dementia is the loss of brain function that occurs because of different illnesses. In Alzheimer’s, this loss of brain function occurs over a period of time, affecting a person’s ability to think, their memory and their behaviour.The symptomsDementia is generally an irreversible, long-term illness. It eventually results in a complete loss of what we associate with normal brain function, including short-term memory, the capacity to learn, our ability to speak and comprehend language and our ability to judge situations. According to Dr Chandra, the incidence of the disease increases with age so that 5% of people over the age of 65, 10% over the age of 70, and 40% over the age of 80, have dementia.The good news is that though the disease is relentless in its course, the symptoms can be managed. “The earlier the diagnosis of dementia, the better it is for the patient because the symptoms are easier to control then and the patient has enough time to plan and manage his or her affairs,” says Dr Chandra.Dementia is typically diagnosed when someone is no longer able to manage routine tasks (see The 10 signs). Long-term memory is rarely affected in people with dementia, and they can remember events from decades ago with absolute clarity. Dr Wadia says dementia patients often approach doctors after something dramatic happens to them and the family can no longer attribute their behaviour to age-related forgetfulness.The diagnosis, says Dr Chandra, is confirmed by a neuropsychological evaluation followed by a series of tests to determine the type of dementia. The three common forms of dementia include Alzheimer’s disease-related dementia, vascular dementia and infective dementia.Dementia is mostly irreversible but sometimes, if it is caused by nutritional deficiency like a deficiency in vitamin B-12, the patient can be cured if given supplements. A head injury or hypothyroidism can also cause dementia—the first can be treated with surgery, and the latter with thyroid hormone therapy, says Dr Chandra. Dementia of the irreversible type is far more common, however—and in India, the more common forms are Alzheimer’s disease and vascular dementia.Dementia can be accompanied by depression and anxiety—these conditions can be treated effectively. Patients can also be trained to manage their illness better by using memory-aid devices like notebooks and day planners; they can refer to the notebook for information so that there is less anxiety about day-to-day tasks. Making to-do lists, keeping a schedule, writing a diary can all be of help.The caregivers of people with dementia also need support since they may suffer from fatigue, sleeplessness, anxiety and depression. Shamsah Sonawalla, associate director, psychiatry research and consultant psychiatrist, Jaslok Hospital and Research Center, Mumbai, says one-third of caregivers of dementia patients have symptoms of depression.When it comes to prevention of Alzheimer’s disease, Philip Scheltens, professor, neurology, and director of the alzheimer centre at the VU University Medical Center, Amsterdam, says you should eat and live healthy, do some exercise and keep your brain active with the things that you enjoy doing. As Dr Wadia succinctly put it, “If you don’t use it, you lose it.”The 10 SignsLook out for these symptoms in older family members and seek medical intervention1. Memory lossA typical sign is to forget recently learnt information. Forgetting important dates and events can be a part of this. Sometimes forgetting names but remembering them later is NOT dementia.2. Challenges in working with numbersSome people experience changes in their ability to work with numbers. Making mistakes in balancing a chequebook once in a while is NOT dementia.3. Withdrawal from work and social activityA person with dementia may start to remove themselves from work, social activities and sports. Feeling weary of social obligations sometimes is NOT dementia.4. Confusion with time or placePeople with dementia can lose track of dates and the passage of time. Getting confused about the day of the week once in a while is NOT dementia.5. Trouble understanding visual imagesPeople with dementia may not recognize their own reflection. Difficulty in seeing at night due to cataract is NOT dementia.6. Problems with languagePeople with dementia may have trouble following or joining conversation. Sometimes having trouble finding the right word is NOT dementia.7. Misplacing things with an inability to retrace stepsA person with dementia may put things in unusual places. Misplacing things once in a while is NOT dementia.8. Difficulty in completing familiar tasksPeople with dementia can have trouble driving to a familiar location. Needing help with using the settings on a microwave once in a while is NOT dementia.9. Decreased judgementPeople with dementia may experience changes in judgement or decision making. Making a bad decision once in a while is NOT dementia.10. Changes in personalityPeople with dementia can become confused, depressed, suspicious, fearful and anxious. Being irritable when a routine is disrupted is NOT dementia.Advice for family members• Educate yourself about dementia and its management• Accept what you cannot change, have realistic expectations, stay positive• Learn to say “no” to excessive external demands, e.g. from family, relatives, employer, etc.• Take care of yourself—get enough sleep, maintain some sort of an exercise routine, stay in touch with friends• Take short breaks from caregiving when possible to prevent burnout: Get help from family, relatives, home help, etc.• Ensure emotional support for yourself—from family, friends, or a counsellor if required• Recognize symptoms and signs of stress, anxiety or depression in yourself and seek help early to manage them.Source: https://www.livemint.com/Leisure/lhI6gfEDU4xRbCD1yNl6kI/When-the-brain-is-on-hold.htmlPicture Source: Sharper Brains