Dealing with dementia

Fifty million people today live with dementia globally, among which Alzheimer’s disease (AD) is the most common form (60-70 per cent of total cases). The WHO estimates the number to rise to 82 million by 2030, of which low- and middle-income countries will have the highest burden.

In Nepal, although we do not have specific data, it is estimated that around 80,000 people live with dementia, which is expected to escalate. Management of AD patients is an extremely demanding task requiring considerable financial and healthcare support. In the least developed and low-income country like Nepal, the general population may not have enough resources and access to suitable healthcare required for older adults. Therefore, people should be aware of old age disease like the AD and should know that AD may be prevented.

During the early stage of AD, minor memory problem could be experienced, like increasing forgetfulness, losing track of time and sometimes being lost in very familiar places. Problems become more severe in the middle stage with increased memory loss (forgetting recent events, names of people), poor decisions, trouble performing daily tasks (handling money, personal care) and difficulty in communication (finding right words, reading and writing).

Worst is the behavioural changes which include depression, anxiety, hiding things, losing things, aggression, unusual sexual behaviour, wandering away from home and getting lost. Older adults with the late-stage AD are most likely to be completely dependent for their daily care, almost unable to communicate, spend more time on the bed, unaware of time and places, unable to recognise family and friends and have difficulty swallowing food, leading to aspiration pneumonia and rapid weight loss.

There are evidences that it may be possible to prevent or delay AD, mainly by improving or modifying the environmental risk factors. Stopping smoking and excess alcohol intake, taking a balanced diet, regular exercise, monitoring and maintenance of blood pressure and blood sugar are helpful. Staying mentally active by reading, learning a new language or musical instruments is known to improve brain function, and thus may prevent or delay AD.

Being socially active may be beneficial. These preventive strategies at the community level can help to reduce the healthcare and social burden of the AD and other dementias in Nepal.