Dr. Sylvester Ikhisemojie
Dementia is a broad term used in describing a range of conditions that affect the brain of an individual during advanced age. Some of these symptoms include difficulties with judgment, difficulties with language, the ability to solve problems, and issues with memory. This is a huge and growing problem being seen around the world as more people live longer than ever before.
It is commonly seen in people who have gone above the age of 60 years. This is not a regular problem that is associated with aging and there is no guaranteed way to prevent it. However, early detection and the institution of treatment may help to slow its progression. The World Health Organisation estimates that there is a prevalence of this disease ranging from five to eight per cent among people aged 60 years and above.
With those kinks of statistics, it is evident that this is perhaps a much more common problem than is apparent to us at the present time. In brief, dementia refers to a range of degenerative diseases of the nervous system characterised by serious cognitive decline. With this association, the person would experience changes in mood and behaviour in addition to the other features previously mentioned above. Dementia is usually progressive. The symptoms are mild at first, so subtle that people around the sufferer do not notice, and become serious over time.
Dementia can result from various brain injuries and diseases. There are different types of dementia as a result and each one of them has got slightly different effects on the brain. The most common of them is called Alzheimer’s disease and it accounts for more than two-thirds of all cases. In this disease condition, the nerve tissue within the brain would contain tiny protein deposits called plaques and tangles. These surround the cells and cause damage to their internal structure resulting in cell death.
Then there is another variant called frontotemporal dementia in which there is damage to the front and sides of the brain. There is an aggregation of proteins inside the brain cells that causes the cells to die. Then there is an entity called vascular dementia described as a consequence of a lack of adequate blood flow to the brain, which in turn causes a reduction in the level of oxygen supply to the brain. This causes brain cell damage or death, and these are often caused by a stroke or as a result of damaged blood vessels in the brain.
Finally, there is an entity known as Lewy bodies dementia which is caused by the deposition of tiny protein substances which then organise into protein structures that form within brain cells. There, they interfere with the normal functioning of the brain cells and lead to the death of such cells. Less commonly, other disease conditions such as HIV/AIDS, Parkinson’s disease and Creuzfelt-Jakob disease can also cause dementia. Traumatic brain injuries from accidents and contact sports, especially boxing, can also contribute.
During the early phase of this complex illness, an affected person may find it difficult to remember what they ate for breakfast or indeed recall some of the events that happened the previous day. In most instances, however, one of the early features of the initial stages of this illness is an inability to follow a conversation. It is either this happens or they actually seek to create their own version of the ongoing conversation by veering off into an unrelated issue that bears no connection to the topic being discussed.
In addition, such a person can experience certain difficulties with communication such that they find it difficult to find the regular words that would make a conversation sensible. Instead, they would substitute the words for others that would not make sense or fit the context of the ongoing conversation. This kind of hindrance is also detectable in their writing and it would make it difficult to understand.
Furthermore, such an individual may have difficulty with awareness in each specific space and could bump into objects as a result. They may have problems with judging distances and would be at an increased risk of falling especially on stairs. At this stage of the illness, there is also an evident difficulty with remembering which clothes to wear first or the steps involved with cooking a familiar meal.
During the middle stage of this illness, the affected person would begin to develop an increased difficulty with communicating with others and would need increased help with taking care of themselves. They would also demonstrate certain changes in behaviour that could make them more aggressive and ask the same questions repeatedly. They would also become more forgetful and could get lost even within their own home.
In a famous case, one 76-year-old American drove in a direction opposite his own home and was found more than 300 kilometres away by police after a report was lodged. Here at home, a healthcare colleague was forced to make a police report about a missing person when her father left his home in Somolu, Lagos for a particular address at Yaba but was eventually found in Ibadan, Oyo State, after four days. He was about 73 years of age at the time and not known to be suffering from any illness.
When any suspected person suffering from dementia has gotten to this point in their lives, they need more attention to their daily needs and closer monitoring so that they do not wander away into dangerous situations. Certainly, it is clear that anyone who no longer knows or recognises where they are headed can easily fall prey to violent crime. In our dear country where every person is essentially waiting to take unfair advantage of the unwary, people like these are especially vulnerable.
In the realm of diagnosis for this condition, there are no clear, specific tests that ought to be performed; a physical examination conducted by a doctor is mandatory to exclude possible causes of symptoms. Other tests that must be conducted include blood tests and cognitive assessments, the latter of which assess a person’s memory and thinking.
Sometimes, various scans may be requested such as a brain CT scan or MRI to determine if there is an underlying brain condition that may have been missed but which can contribute to the development of this problem.
Treatment is time-consuming and painstaking because this is an incurable condition. The aim of treatment is to increase the levels of circulating acetylcholine in the brain. That substance is described as a neurotransmitter, and it plays a huge role in memory and judgement. Only a handful of medications have been licensed for use in the treatment of this condition and they are not available everywhere. However, the most important aspect of the illness that people need the most awareness about is the fact that there is no cure and that it is a progressive disease no matter what is done in the way of treatment. If there is a possible underlying cause such as a stroke, the treatment of such a condition could have a positive impact on the progression of dementia.
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