By Dr Sebestina Anita D’Souza

Sep 21: World Alzheimer’s day is celebrated on September 21. This article by the Centre for Studies on Health Aging, MAHE, is an initiative to increase awareness in the community about Alzheimer’s and other dementias as a part of its World Alzheimer’s day observations.

Dementia is a broad term for neurological disorders affecting memory, thinking and social abilities that affects the person’s abilities to do their daily activities independently and safely. It is a progressive condition and is considered as one of the major problems of older adults. Dementia affects around 7% of older adults and is expected to increase with the aging population, especially in developing countries like India. People with dementia are mostly looked after by their family members and caregiving could be quite demanding. It is therefore important for both older adults and their family members to have adequate knowledge about dementia.

One of the first steps in understanding dementia, is to know its cause and features. Alzheimer’s disease is one of the most common types of dementia, with no known cause. Dementia is also commonly associated with conditions like Parkinson’s disease or stroke. Some conditions such as infections or vitamin deficiencies may occur with dementia-like symptoms that may be reversed or corrected. Dementia initially affects a few parts of the brain, especially the memory areas. The brain cells or neurons get affected and reduce in number and gradually the connections between the various parts of the brain also get affected. These brain changes gradually affect a person’s ability to remember, think, understand what is going on around and make decisions. The early indicators of dementia are:

• Memory loss, for e.g., forgetting recently learned information, important dates or events, ask the same questions over and over, misplacing things.

• Difficulty concentrating and take much longer to do things than before.

• Difficulty completing familiar tasks, for e.g., difficulty in finding their way in familiar location, organizing a grocery list or remembering the rules of a favourite game, difficulty in following a familiar recipe.

• Confusion with time or place, for e.g., unable to tell the time of the day, the date, or month or season

• Difficulty in speaking or writing, for e.g., they may have difficulty in finding words for a familiar object, have difficulty in understanding a conversation.

• Changes in mood and personality. They may become confused, suspicious, depressed, fearful, and anxious, overreact or get easily upset.

• Difficulty in planning or solving problems and making judgments, especially financial matters or safety.

These features gradually increase as the disease progresses and the older person may need help to do their daily activities.

Early identification of dementia would significantly help the older person and their family members manage the condition better. However, delayed diagnosis is one of the major issues we see in clinical practice. This is because the early signs and symptoms of dementia are often mistaken as normal ageing and are overlooked or neglected. It is therefore important to understand the difference between normal or typical ageing and dementia. In typical age-related changes of the brain, similar issues may be there, such as forgetting the day, missing a payment, difficulty in finding their things. But these problems occur once a while and if it occurs, they are able to solve it. For e.g., if they misplace an object, they are able to retrace their steps. Sometimes, dementia may also be mistaken for depression and may be overlooked. Another condition that one should be aware of is Mild Cognitive Impairment (MCI). This is a condition wherein elderly have memory problems while other cognitive functions are normal. Some older persons with MCI may develop dementia later.

Therefore, it is advisable for older persons with considerable memory problems to go for a proper assessment to a doctor as early as possible. The diagnosis is usually done by a neurologist or psychiatrist. There is no single test to diagnose dementia. So, doctors are likely to advise a number of neuropsychological tests, brain scans, clinical tests, etc. The disease process of dementia starts many years before the development of clinical symptoms. Therefore, screening of cognitive functions in otherwise healthy older persons may also help in early identification of dementia.

The overall management of dementia emphasizes on regular screening, early identification and intervention to control its progress and manage it better. Intervention involves both medical and non-medical management and may require several professionals such as doctors, psychologists, nurses, social workers and occupational therapists. Non-medical management plays a critical role in dementia care, such as cognitive training in early stages, supporting daily activities, and safety management. For e.g., modifying the home and simplifying daily activities to support safety and independence, using assistive devices to support time sense and orientation. It is also very important that the person with dementia is allowed to participate in their daily and valued activities as much as they can and as safely as possible, so that their cognitive abilities are used. Very often family members are overprotective and do not allow the older person to do anything. This may lead to further worsening of brain and also their physical abilities. They should be kept busy in simple tasks such as folding clothes, assisting in household tasks etc., as much as possible and should have a good routine.

Family members are the most important persons in dementia care. They should take care of themselves while taking care of the person with dementia. Caregiver education and training involves using emotional and practical coping strategies to enable them to carry out their care giving and other life roles within their available resources. As each person and their living situation is unique, dementia care needs to be personalized and would differ from person to person. Early intervention would help both the caregiver and the person with dementia enjoy a better quality of life.

Dr Sebestina Anita Dsouza, PhD is a Professor in the Department of Occupational Therapy, Manipal College of Health Professions, MAHE, Manipal. She is also the coordinator for the Centre for Studies on Healthy Aging at MAHE and the principal investigator for an ongoing Indo-Sweden research project funded by the Indian Council of Medical Research to study if assistive devices to improve the time sense of persons with dementia would help them do their daily activities better with less help from their caregivers. She can be contacted by email (sebestina.dsouza@manipal.edu) or phone (0820-2937305).