FACING DEMENTIA

Dementia is a term describing a number of conditions characterised by progressive deterioration in mental functions including memory, judgement, communication skills and behavioural changes serious enough to interfere with daily life. Although dementia be

Dementia is a syndrome due to illness of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. These symptoms of cognitive function are mostly the result of structural and chemical changes that occur in the brain leading to considerable cell death. It is a progressive illness with patients becoming more in need of help and support in performing everyday activities.

Individuals with dementia may also develop behavioural and psychological symptoms including disinhibited behaviour, delusions and hallucinations, verbal and physical aggression, agitation, anxiety and depression. Although different individuals experience dementia differently, understanding how the disease progresses is crucial in planning and providing the right amount of care as well as helping caregivers and patients to foresee the changes that will occur with time.

There are various types of dementia with Alzheimer’s disease (AD) accounting to approximately 70 per cent of all dementia cases. Other common forms of dementia include vascular dementia, Lewy-body dementia, frontotemporal dementia and dementia secondary to disease including other neurodegenerative conditions such as Parkinson’s disease, Huntington’s disease and amyotrophic lateral sclerosis. It is not uncommon that various types of dementia co-exist (mixed dementia), especially in the late stages of the condition. According to the World Health Organisation’s (WHO) Global Burden of Disease Report, dementia contributes to 11.2 per cent of years lived with disability in people aged 60 years and over. This is due to the fact that dementia has a disproportionate impact on independent living in the older adult population.

It is estimated that in the Maltese Islands, 6,071 individuals had dementia in 2015, a figure equivalent to approximately 1.5 per cent of the general population. As the population ages, the number of individuals with dementia will increase significantly such that by the year 2030, it is projected that 9,883 individuals will be affected. It is well recognised that dementia presents a psychological and financial challenge both to those with the condition as well as their caregivers and family members.

A diagnosis of dementia has a significant social, psychological and financial impact on the individual. Disease progression varies between subjects and although a number of drugs are present that slow down the cognitive decline, no cure is currently available.

With time, the affected individual gradually loses mental function and thus autonomous capacity, becoming more dependent on others for personal care. Professional advice should be sought at an early stage to help the individual with dementia in planning for future personal, financial and legal issues. Activities of daily living will become progressively impaired together with loss of communication skills, changes in mood and behaviour leading to increased agitation, confusion, anxiety and aggression. These disturbances in behaviour are the usual trigger for hospitalisation and need for admission in nursing care homes.

Most of the care for individuals with dementia occurs at home with relatives acting as the main caregivers. The major burden of support for individuals with dementia usually falls on one person (in most cases the spouse) who takes on the role of the main domestic caregiver and, as a result, often experiences considerable hardship in terms of the physical and emotional burden. Interestingly, gender-specific differences exist in the provision of dementia care with women mostly affected in terms of number of caregivers and level of caregiver stress. According to Alzheimer Europe (2006), almost half of the caregivers spend more than 10 hours per day caring for an individual with late stage dementia.

Age remains the most important non-modifiable risk factor in developing dementia and although it is possible to have dementia early on in life, the risk increases exponentially with advancing age. Women are more likely to develop Alzheimer’s disease whilst men are more prone to vascular dementia. Having a first degree relative increases the risk slightly compared to absent family history. Cardiovascular morbidities such as high blood pressure especially in mid-life, hypercholesterolaemia, diabetes and obesity are major risk factors, as is stroke.

Recent studies have also suggested that a link exists between depression and dementia even though the exact cause is not yet known. Repeated head trauma may trigger processes in the brain that results in dementia pugilistica, a form of the condition usually found in individuals practicing sport where head injury is likely. Conversely, active engagement in mental, physical and social activities may act as protective factors and delay the onset of the most common forms of dementia. A healthy and balanced diet low in saturated fat reduces the likelihood of developing dementia as it reduces the risk of heart disease and stroke.

This article first appeared in the September 2020 edition of FIRST Magazine. Information sourced from the national dementia strategy document Empowering Change: A National Strategy for Dementia in the Maltese Islands, 2015-2023, by Charles Scerri PhD. Dr Scerri is a graduate from the University of Dundee in Scotland and lectures neuropharmacology and dementia studies at the Faculty of Medicine and Surgery, University of Malta. He is the Chairperson of the Malta Dementia Society, Vice-Chairperson of Alzheimer Europe and National Focal Point on Dementia in Malta. For further reading the strategy document may be accessed from the Dementia section on activeaging.com.mt.