Experts in old age management have given insights to managing and overcoming dementia. According to them, it is an aggregation of signs and symptoms…
Sometime in September 2017, Pa Emmanuel (not real name), in his late 70s, drove his car from his Abule-Egba home unaccompanied to the Ikeja Shopping Mall in Lagos to pick up some items.
His children were shocked and confused when he returned home hours later in a commercial taxi. Many things ran through their minds on what could have happened to their father’s car.
As the curious children simultaneously bombarded their father with many questions on the whereabouts of the car, the old man quickly remembered that he had left home with his car but ended up abandoning it where he had parked it at the shopping mall. Apparently disappointed with himself, he made a U-turn to pick his vehicle while everybody laughed over the drama. The children as well as their dad thought it was normal memory loss and treated it with levity. But when it became a recurring occurrence and got worse, they consulted their family doctor and, after subjecting the man to clinical examination, it was discovered that he was suffering from dementia – cognitive, recognizing and behavioural problems. Dementia, simply put, is a mental distortion.
Experts in old age management have given insights to managing and overcoming dementia. According to them, it is not a disease on its own but an aggregation of signs and symptoms of other health issues. They have noted that the condition could be brought under control through early diagnosis and treatment.
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A neurologist based in Abuja, Dr. Gerald Onwuegbuzie, defined dementia as the loss of mind resulting in difficulty in reasoning, taking initiative and making sound judgement.
In the same vein, Vincent Udenzi, a psychiatrist based in Birmingham, United Kingdom (UK), described dementia as progressive and usually irreversible symptoms characterised by an impairment of global mental function.
A clinical psychologist based in Abuja, Chinyereugo Udensi, agreed with other experts and said the condition was a group of symptoms that affect the human brain and the human ability to remember things and interact with people and the environment. She said some cases grow rapidly while others could be very slow.
On causes of dementia, the president of the Association of Nigerian Physicians in America, Dr. Johnson Adeyanju, said there were several factors. He said Huntington’s disease generally begins earlier in life, between ages 30 and 45, and is characterised by mood swings, lack of coordination and involuntary movement of the head, trunk and limbs. That, he said, was responsible for more than 70 per cent of the cases of dementia in the United States.
“Other causes are vascular dementia of people who have had stroke, then memory loss, thought processes and behavioural problems. There are other causes such as Parkinson and other neurodegenerative diseases. Even people with thyroid or vitamin B12 deficiency can start having memory loss. People living with HIV, tuberculosis and a host of others may have dementia,” he said.
Onwuegbuzie added that the causes that were progressive and usually not reversible in Nigeria were Alzheimer, frontotemporal and vascular diseases. He said other causes such as infections, brain tumour, meningitis, chronic alcohol consumption and HIV were treatable. He noted that HIV/AIDS was an opportunistic ailment that predisposes the patient to dementia and other diseases.
An expert in dementia care and consultant in old age psychiatry at the University College Hospital, Ibadan, Oyo State, Akinsola Ojagbemi, described dementia as a deterioration of the brain process that helps us to understand and acquire knowledge through our senses and experience throughout an individual’s lifetime. On that ground, he said when a stroke happens and affects a strategic part of the brain that coordinates that process of acquiring knowledge, the patient could come down with dementia.
On too much alcohol as a cause of dementia, he said: “This cause is one of the reversible dementia. It is simply through long-term abstinence. However, if alcohol must cause dementia, it has to be a long-term dependence on it, which causes damage to the liver and the brain. Actually, moderate use of alcohol is protective against dementia.”
He also spoke on the link between age and dementia as well as its prevalence in men or women. Ojagbemi said: “I need to correct a popular misconception. Dementia is not caused by aging. Aged people should not have dementia. Although, for most types of dementia, the propensity to develop the signs and symptoms increases with age, there are also types of dementia that are common with people younger than 65 years. Age is simply a risk factor, not necessarily a cause.
“Because of a lot of misconceptions, patients don’t usually present early until they begin to have bewildering behaviours. We have heard of people accused of witchcraft. And when family members see their loved one behave this way that is when they come to the hospital. Most times, it is too late to reverse at this stage. If the person you have known and respected begins to manifest some behaviour unbecoming of him, there must be urgent medical help instead of labelling and condemning the person.
“Regarding gender, it depends on the types of dementia. Alzheimer, which is most common in Nigeria, can be found more in women. This is because women usually live longer than men. Most of the men that would have developed dementia would have died before they clocked 80 or 90. On the other hand, vascular dementia is more common in men. If you look at the condition globally, you could say it is more common in women.”
Adeyanju said African-Americans were more predisposed to the condition because of the stress they go through, untreated high blood pressure, poor accessibility to health care, unaffordable medicare and other factors that Nigerians were grappling with.
“Poor access to health care has caused Nigerians a lot and we are still suffering it till date,” he lamented.
On the contrary, Onwuegbuzie said dementia was actually not common in Africans. He explained that several researches had showed that most people that would have developed dementia die early as a result of poor access to quality health care.
Speaking on the psychological implications, Udensi said: “It is a serious life-changing experience when you realise that you can no longer interpret your words, understand yourself or interact with people. It can be quite a chronic health challenge for the person. Most people can come down with depression and anxiety. They can get irritable, easily agitated. This is in a bid to manage these strange changes they are going through. Some people can start to get into some sort of destructive behaviour; it will at the end affect their mental health.
“When people experience dementia, they can go through hallucination, which is purely the interpretation in their senses even in the absence of physical or visible stimuli. They can also suffer delusions.
“For example, they can begin to hear, feel or see things that others cannot see. On delusion, it is a false belief and they admit things they didn’t do. When you tell them the truth, they still don’t believe it.
“The sad thing is that most people fold their arms and do nothing about it. It can be treated or effectively managed through medication and psychotherapy. In most cases, we usually use the combination.”
Research has shown that about 5 per cent to 8 per cent of adults over age 65 have some form of dementia. And it is said that the percentage doubles every five years after 65.
Adeyanju said the team approach was the best way to manage dementia, where the combination of primary care, neurology and social service support is needed. He said care from family members could be vital in a patient’s recovery process.
Onwuegbuzie added that treating the patient must also involve the patient’s relatives. He said there are drugs that could slow down the behavioural and anti-social processes, adding that patients could sometimes get violent and inflict injuries on themselves or others.
On his part, Ojagbemi advised patients and family members to quickly start seeking expert advice when symptoms persist for six months or one year. He described the symptoms as abnormal and argued that not everyone is necessarily ill because of old age.
Also contributing to the issue, the chairman of the Gerontology Association of Nigeria, Usman Sarki, said, apart from the clinical remedy, his association was looking at the social issues associated with dementia, especially for elderly persons. He said the body was also into creating awareness and advocacy, where it prevails on government to render financial assistance to elderly persons, especially to those with dementia and other conditions.
On the state of care for people suffering dementia, particularly with little or no family support, he said: “Ideally, there should be two levels of care, formal and informal. To be honest with you, it is difficult to assess the level and scope of care for persons with dementia in Nigeria because of the lack of statistics. But from the general studies we have made, the level of care is very low.”
Sarki urged government to pay special attention to the condition of elderly persons, particularly as part of the broader framework of public policy and implementation in the ministries of health and women affairs and social development.