PROF. Sola Ogunniyi, a Consultant Neurologist and the foremost African authority on Dementia explains what the disease is and how it affects its victims. Excerpts:What is DementiaDEMENTIA can be simply described as brain failure or loss of the mind.(not madness!) It is a medical condition characterized by deterioration in brain functions sufficient to affect the performance of usual daily activities or business in an individual who is conscious and alert. It is a characterized by a progressive deterioration to the point when family members need to supervise such affected persons to avoid injuries to the affected and even others. It is often a wonder that the brain can fail! But the reality of the human body is that any part can fail possibly from long standing disease in that organ. Thus, we talk about heart failure lung failure kidney failureWhat are the causes of DementiaThe basic causation of dementia is death of brain cells from any cause whatsoever. The important ones are ageing; stroke; traumatic injuries to the brain such as in accidents or as found among punch drunk boxers, other exposure to toxic agents, chronic alcohol ingestion, long standing diseases of such organs of the body as liver, heart, lungs, derangement of body constituents such as salts of the body called electrolytes, acute and/or chronic infections of the brain and its covering membranes, accumulation of blood under the skull from trivial injuries in the elderly, use of certain medications in the elderly, poor diet lacking in vitamins and protein. HIV/AIDS is an important cause in young individuals. Eating of infected meat contaminated by viruses as in the infamous mad cow disease previously reported in European countries.. In a small proportion of cases, the condition may be inherited. In some cases, no cause is identified.Is it a problem among NigeriansYES. Our research have shown that dementia affects about 2.3% of individuals older than 65 years of age. according to data available from a study carried out in a community in Ibadan.How does the condition presentThe presentation of dementia is variable depending on the cause and the severity of the disease at the time of presentation. The usual mode of presentation is in the form of forgetfulness of names of persons,or where things are placed as well as forgetting faces. Thus you may have the affected forgetting their spouses or childrens names or faces.!! Some present with inability to find their way around a normally familiar environment. Other ways of presenting include inability to take decisions, poor judgment, and difficulty with speaking or finding the right words to use. Misplacement or misuse of money is another mode of presentation and relations may become aware of the problem if the person afflicted is a trader and is reported by customers to give wrong change after a purchase!!. Some present with behavioural changes like being unusually suspicious of family members and thus accuse them of stealing their properties. Others see visions that others do not see or even hear voices like individuals with mental problems. With progression, more alarming features include problems with dressing such as inappropriate dressing like a man wearing a jacket on local native dress! They may also be messy while eating by spilling food all over like a baby. Some may have difficulty with self cleanliness and use of toiletWhat groups of persons are affectedDementia commonly affects persons older than 65 years of age and its burden increases as the population gets older. It affects both men and women but appears to affect more women because they live longer. If individuals younger than 65 years are affected, one may think of an underlying brain disease of the inherited variety or infections.How does dementia differ from forgetfulnessForgetfulness occurs as individuals get older but such individuals would remember what they were trying to recall after some time. This is not a disease and may occur as a result of distraction or not paying sufficient attention. In dementia, the individual forgets and does not remember again. They then disturb other people by endless searching for something that may just be lying close by or may accuse other people of stealing their things. Dementia is thus a disease and not a part of normal ageing.Is Alzheimer a cause of DementiaAlzheimers disease is a type of dementia; in fact, it is the most common type of dementia affecting about half to three quarters of all cases. The condition was named after a German doctor who first described the case of a middle aged woman who was forgetful and behaved abnormally. When she died, her brain was shown to contain some abnormal proteins that caused her early death and the memory problem. Other types of dementia are named after the identified cause or lesions in the brain like strokes, depression, dementia associated with shaking palsy (Parkinsons disease) and others.What are the predisposing factorsOld age is far the most important. Conditions like high blood pressure, high blood sugar, being fat, lack of exercise, smoking, alcohol can predispose individuals to stroke which can then result in such a disease.What social and health problems are associated with dementiaThese include embarrassing behavior like undressing in public, false accusation, aggression; stress of family members who have to provide care and prevent accidental injuries, need for supervision of self care like toileting and personal hygiene, getting lost and being mistaken for witches/wizards which could result in stoning to death.!! Some cultural norms in Nigeria!! The health problems include proneness to infections, soiling of clothes resulting in skin diseases, proneness to clot formation in the legs and sudden death.Are there useful investigations for diagnosisImaging of the brain is most useful for detecting any brain lesion that could be responsible for the condition. In this regard, not many hospitals in Nigeria have such facilities. Blood tests for sugar, electrolytes to exclude diseases like diabetes, diseases of other organs of the body like the kidneys and liver. Other tests are carried out depending on the clinical suspicion and affordability of family members. It is important to test the level of brain performance using special test instruments that are currently available and have been shown to be useful for diagnosing the condition in elderly Nigerians.What is the likelihood of having dementia if a family member has itFortunately not very high likelihood. It is of the order of 5%What are the common misconceptions about dementia in our countryOne common wrong belief is that elderly people with such conditions are possessed and are witches/wizards who then may be unlucky to be stoned to death.That is mainly due to the fact that some of these persons develop some guilty thoughts which they express freely. There are also beliefs that such affected have been cursed Some people believe that dementia is a disease of those who live in Europe and America and is not present in our country. This is wrong. Other people believe that all old people who forget things are demented. We are all liable to forget things at all ages!. Some persons also wrongly believe that there is no treatment available for most diseases of the brain including Dementia.What is the treatmentManagement is in many parts. The most important is early referral for an accurate diagnosis by a physician trained in diseases of the brain(Neurologist) or those caring for older persons(Geriatrician). Treatable conditions are then appropriately managed and such individuals tend to recover with minimal residual damage. Next in importance is family support and prevention of injuries. Good understanding of the condition is essential and families may have to employ nurses or care providers to lessen the burden on them. The routine should be kept very simple so that the affected person can still help himself/herself when possible. Drugs available for improving memory can be prescribed as appropriate. Certain blood tonics are also tried. If behavioural problems are worrisome, drugs are available for taking care of these. It is best to consult a doctor for the appropriate treatment. Surgery may be necessary if the investigations carried out showed a brain tumour that is amenable to such treatment modalities. It is possible that some local herbs may enhance memory but the possibility of unwanted effects should be borne in mind. It is important that the affected are not treated savagely by tying them down and having all forms of scarification marks or forcing down all sorts of concoctions, whose constituents are unknownAre there new drugs being developedNew drugs are being developed based on our better understanding of the disease process including immunization against the abnormal proteins deposited in the brain of individuals that have Alzheimers disease. The newer drugs tend to be quite expensive and are not readily available for use on affected individuals in developing countries.
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