Now many people are aware that memory loss, forgetfulness and incoherent speech and behavioural abnormalities in elderly people could be indicative of brain problem rather than witchcraft. In this interview by Sade Oguntola, a consultant neurologist, Dr Temitope Farombi, explains why this is so.
What is dementia?
Dementia is not a specific disease, but a group of medical conditions that affect the brain. But it is characterised by loss of memory and, to some extent, behavioural abnormality.
Everybody loses memory, even older people lose memory. It becomes an issue when the loss of memory becomes a cause of concern for the individual or people living with or close to such an individual.
Of course, such an individual experiences difficulty thinking things through. It could get to a point that such persons are not able to take care of themselves, know who they are or where they live. They will not be able to recognise faces or things that are common. Even when they go out, they easily get lost because they cannot find their way home.
Imagine an individual that normally puts his phone or purse in a specific place that is known to everyone, but he will be looking for it everywhere. Or, a woman who knows where foodstuffs are kept upturning the kitchen because she is searching for the rice to cook.
People experiencing memory loss become over-anxious that they are losing their memory. That is why they become easily irritable and snap at people because they are scared that they are losing it.
So how do you differentiate this condition from the normal forgetfulness and memory loss that is due to age?
Certainly, as people grow older, the way they think in a way slows down- which is normal. However, when it becomes worrisome to the person who is being forgetful, it is more or less an indication of a problem going on. And this could be dementia.
Cause of dementia
There are different types of dementia, but the commonest is Alzheimer’s disease. Till date, its exact cause is unknown, but many factors that can predispose individuals to developing dementia have been identified.
Studies have shown that it does run in some families; those who have dementia in the family stand a higher risk of developing the condition when they grow older.
Age is a strong factor. Six out of 100 people who are older than 70 years will develop dementia. By 80 years, this number will have doubled. Also, women have a higher risk of having dementia compared to men, just as more whites develop dementia than blacks.
An uncontrolled hypertension is a risk factor for dementia. That is why it is of great concern in Nigeria where recent studies indicate that one out of every four persons older than 25 years now has hypertension.
What does this suggest in terms of the number of Nigerians that will be living with this condition in the future?
In years to come, as Nigerians live longer, we might have more people coming down with this condition because of hypertension and other conditions such as diabetes, high blood cholesterol level, sedentary living and smoking.
Hypertension is an established risk factor for Alzheimer’s disease. Unfortunately, many Nigerians do not know that they have hypertension.
Currently, a lot of young adults are coming down with stroke. Stroke is the number one medical emergency now in Nigeria. Evidence indicates that in 10 years, people who have a stroke have 60 to 70 per cent greater risk chance of coming down with dementia.
Is dementia preventable, therefore?
Risk factors for dementia include hypertension, high cholesterol, diabetes, smoking, heavy alcohol ingestion and lack of exercise. Of course, you may not be able to decide if you are going to develop, say hypertension or even diabetes, but you can control these diseases.
So, it is important that individuals take charge of their health; annual medical checks are very important. Maintaining a healthy lifestyle is also important.
Both physical and mental exercises are important to ward off dementia. Playing games like ayo olopon, draughts, chess and scrabble, which entail thinking through moves to take during the game promote healthy brains.
Air pollution had been linked with cardiovascular disease, is it also a factor to consider with dementia?
Air pollution is a risk factor for brain injury. Old cars are pouring out soots, same with generators; and people burn bushes haphazardly. Everybody is exposed to air pollutants. Science has linked air pollutants to brain injury, meaning increased chances of dementia later in life.
Are there drugs that predispose to dementia?
Psychoactive drugs like cocaine, tramadol and codeine all have a long term effect on the brain and in the future may increase a person’s risk of developing dementia.
Older people with memory loss and incoherent speech are often stigmatised in Nigeria. Some are called witches. Why is this the case?
I have witnessed how people who have dementia have been treated badly, in an inhuman way. Many times, they are locked away.
Those who find their way out wander away and are not found; some lynched or beaten to death because somebody claims that they were seen turning from a bird to a human being or their incoherent speech is suggestive of them coming to the street to confess their past misdeeds. This has become a common practice that is seen now more and more.
But on a closer look, you find that they are not even aware of their environment, who they are or that they are saying things.
Sadly, people in the community are not aware of any medical condition called dementia. The word dementia is not in our local vocabulary or languages and as such to pass across an appropriate message on the condition is difficult.
People need to know that there is a disease that can make elderly people forgetful, lose their memory, and start to talk irrationally, and that they are not witches or wizards.
It is not that they are confessing their past sins because that is what is usually alluded to or that the person he or she offended in their past life had come back for revenge.
They need not be locked away, maltreated or left uncared for by their children and relatives because of stigma.
A lot of elderly people are abused, even by their domestic staff. There was a rich man who had a problem with his memory and his children were away abroad. His carers would drive him to the bank to withdraw his money.
Unfortunately, in Nigeria we do not have any policy on care of the elderly; neither is the government doing anything about the rights of older adults.
You can see the way even our pensioners are treated; they die even while trying to collect their money. No hospital is designated for their care.
Yes, University College Hospital (UCH), Ibadan, started a geriatric centre, but that is yet to go down to the community. All the geriatric centres and units in Nigeria are still domiciled within teaching hospitals.
What can be done at the community level to help people with dementia?
For now, the first thing is identifying this problem, sign-post them to where they can get help. What do I mean? In our clinic, we have a lot of patients who have dementia.
Drugs are available to help alleviate symptoms and risk factors for dementia. So, it is possible to delay its progression to the severe form of dementia.
For instance, without any intervention, a person could develop full-blown dementia within five years without intervention. But by the time we intervene, it can be increased to at least 10 years.
So, there is medical and social management of the condition. Aside from that, we would enlighten the carer better so that they can know how to take care of these people the more.
Currently, we have dementia carer group in UCH, Ibadan so we can enlighten them on what dementia is, what to expect, and also to support one another.
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