A disease that affects memory, thinking and judgement
On January 17, 2020 an article was published by the above name in The Economic Times by Teena Thacker. We reproduce the article verbatim as we found it to be not only informative but also quite engaging. We believe you too shall gain useful insights on an issue like dementia.
He walks up and down the staircase in his pyjamas and kurta, keys of his car that he once used to drive clutched in one hand and a glass of milk in another, with anxiety writ large on his face.
“Where is Mataji (mother)?” he asks his wife, and then his son. “She is not here,” comes the answer, as they look at each other in worry. His mother had died several years ago. They try to calm him down and suggest he watch television, but he is instantly on his feet, asking the same question again.
Ashok Sachdeva, 67, does not quite remember what happened a few minutes ago and when he last ate, with the result that sometimes he is overfed because he asks for food even after he has eaten a meal. At times, the situation can turn potentially dangerous, especially when he slips out of house without telling anyone. Once an immaculate man, who would drive daily to his West Delhi automobile components shop, come back home and often take his family out for dinner, Sachdeva is among an increasing number of people suffering from dementia.
According to the World Health Organization (WHO), around 50 million people have dementia, with nearly 60% living in low- and middle income countries, and nearly 10 million new cases get added every year.
India has the second highest number of individuals suffering from dementia, at an estimated 4.1 million. The figure is expected to double by 2035, as per the ‘Dementia India’ report published by the Alzheimer’s and Related Disorders Society of India. Maharashtra and Uttar Pradesh alone are expected to house more than 500,000 patients by 2026, it says.
“India is soon going to witness an epidemic of dementia,” said Dr JD Mukherji senior director and head of neurology at Max Healthcare in Delhi’s Saket. “As life expectancy increases, non-communicable diseases like cancer and dementia are going to become more and more prevalent. By 2050 the largest number of patients of Dementia will probably be in India.”
Dementia is a syndrome, usually of a chronic or progressive nature, in which there is deterioration in cognitive function or the ability to process thought beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour or motivation. In the case of Usha Kumari, 65, for instance, she even forgot her son’s name a month ago. “That was a painful blow,” said her son Sumit.
Memory loss and confused behaviour is the most common symptom in people with dementia. When PK Sharma, a retired bureaucrat who once occupied a high office and position in the government started showing symptoms, junior officers could not muster courage to encounter their senior who was making “unusual mistakes”. “He started making mistakes in simple calculations, when to take meals and would repeatedly mistake bedroom for toilet and toilet for bedroom,” said Veena Sharma, his wife. It has been even years since he retired, and problems have grown manifold. Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimer's disease or stroke. It is a disease of the elderly and is mostly irreversible. The irony of dementia is the victim’s inability to recognise it. This necessitates 24-hour care for people suffering from dementia. Patients need constant care not only because of memory issues but also with bedsores management, infection and other diseases such as hypertension and diabetes.
In the near absence of external help, family members are left to take care of dementia patients. With no professional adult day-care options or structured cognitive rehabilitation programmes available, caregivers have little time to rest, run errands or finish other tasks.
Ask Jagjeet Singh, whose father Satinder Singh has a problem controlling his urine. “He is uncomfortable with anyone else helping him, so I have to be at his beck and call. At first, he had trouble with mild leaking but as the dementia advanced managing his urine inconsistency has become unmanageable. From rashes to urinary tract infections to increased falls due to hurrying to make it to the toilet, the problems are increasing every day,” he said.
Dr Mukherji gets to see at least a couple of dementia patients every day, and about as many new patients every week. “In India, family members look after the elderly. But with the concept of nuclear family developing, elderly people are left on their own. There are not enough centres in the country where the elderly can be taken care of. They are very expensive and not very well planned,” he said. According to the WHO data the total number of people with dementia is projected to reach 82 million in 2030 and 152 million in 2050. Much of this increase is attributable to the growing number of people with dementia living in low and middle-income countries.
Although numerous new treatments are in various stages of clinical trials, there is no treatment currently available to cure dementia or to alter its progression. Dr Sandeep Vaishya, executive director, neurosurgery, Fortis healthcare said, “Normal Pressure Hydrocephalus is one of the cases of dementia which is treatable “Dementia is a devastating illness and in most cases there is no specific treatment for it. Unfortunately, this condition is often missed by physicians. The typical presentation is that patient has memory loss, difficulty in walking and difficulty in controlling urine. It can be treated by a simple surgery called ventriculoperitoneal shunt.” Although age is the strongest known risk factor for dementia, it is not an inevitable consequence of ageing. Besides, WHO says dementia does not exclusively affect older people – young onset dementia (defined as the onset of symptoms before the age of 65 years) accounts for up to 9% of cases.
WHO has also found that dementia has significant social and economic implications in terms of direct medical and social care costs, and the costs of informal care. As per the International Health Agency, in 2015, the total global societal cost of dementia was estimated to be $818 billion, equivalent to 1.1% of global gross domestic product (GDP). The total cost as a proportion of GDP varied from 0.2% in low- and middle-income countries to 1.4% in high-income countries.