The black hole of memory

The Lanka Alzheimer’s Foundation issued a clarion call to the governmental health authorities to recognize the country’s situation with regard to the prevalence of Alzheimer’s disease, a type of dementia, which is currently showing progressive growth nationally.

The Foundation went on to say that any assistance with regard to efforts taken to address the situation would be greatly appreciated.
Types of dementia include vascular dementia, Parkinson’s disease, conditions that block or reduce the blood flow to the brain, and dementia associated with other diseases. Previously, President-Elect of the Sri Lanka College of Psychiatrists, Dr. Shehan Williams pointed out that dementia continued to remain a major issue to which one was particularly susceptible when one reached an old age.
Alzheimer’s, the most common type of dementia, in particular causes problems with one’s memory, thoughts and behaviour. The disease starts with behavioural changes such as forgetfulness, short-term memory, wandering off, having suspicions with regard to those one lives with and accusing them of certain things (a person suffering from Alzheimer’s may say that she or he had left something in a certain place only to have it stolen) and/or repetition (repeating the same question – such as those pertaining to where one was going or who one is).

One gets dementia in different ways. Adopting a healthy lifestyle is encouraged, a Director of the Foundation, Yasmin Cader said. High levels of stress, drinking alcohol, smoking, factors which contribute to high blood pressure and cholesterol related problems, were discouraged.

Elsewhere, Public Relations Officer of the Sri Lanka College of Psychiatrists and Consultant Psychiatrist at the Karapitiya Teaching Hospital, Dr. Ramani Ratnaweera pointed out that Alzheimer’s- related dementia, which was one of the most common diseases among the elderly population, was also one of the most unidentified of the diseases afflicting the particular age group.

The reasons for the disease being unidentified are twofold. One is that in certain families, the family members tend to ignore the initial signs of the disease such as old folk not engaging in much conversation, being silent, being forgetful, having poor vision, being hard of hearing, chalking such symptoms up to mere gradual and almost inevitable deterioration resultant due to aging or a fact of being old and getting older and therefore considering such signs as ‘normal’.

The other reason is the stigma erroneously associated with mental illnesses and the fact that having a mental illness in one’s own self or in one’s family is seen by certain persons as a sign of weakness, which should therefore not be revealed or discussed.
The Foundation with the help of doctors conducts fortnightly memory screenings free of charge for persons suspected of having Alzheimer’s. However, the Foundation does not engage in diagnosing patients. A people centered approach is adopted by the Foundation by organizing activity days at their activity centre (including singing and dancing sessions, and art therapy) for persons with dementia registered with them. No two persons with Alzheimer’s behave the same way. Some are extremely passive, kind and loving when interacting with them while others respond differently.

Cader added that it was encouraging for the Foundation when the families of persons diagnosed with Alzheimer’s showed commitment towards the wellbeing and welfare of the person diagnosed with dementia. The Sri Lanka Cancer Society, part of the Non-Communicable Diseases (NCDs) Alliance Lanka (NCDAL) called for Alzheimer’s to be given priority as an NCD when dealing with the disease. In the opinion of the President of the Cancer Society, A.J.B. Anghie, the World Health Organization (WHO) did not seem to be doing enough in the country with regard to the disease in question.

“It is important to recognize this disease. When persons initially exhibit such aforementioned symptoms, the people around them who are not aware of this problematic disease think that she or he is “mental”. This should not be the case as they are not mentally ill. Awareness has been created by us. We have a caller hotline. In other towns, in Districts like Kurunegala, we coordinate with senior citizens societies or societies representing the elderly or branches of medical officers, with regard to conducting outreach programmes where trilingual presentations are made to the elderly who attend the programmes,” Cader said.

“ Since their children are all busy and working during the day, most of the time the elderly are left alone with no one to interact with, thus exacerbating their sense of isolation. The elderly when they are suddenly left with nothing to do, feel useless. They require interaction and pine for company. At the Foundation, we try to give them some quality of life. We engage with them, giving them attention and constantly finding ways to stimulate their minds. We all become emotionally involved in the process,” Cader further explained.

Are we treating the elderly as the new social lepers? In light of Sri Lanka having one of the most rapidly aging populations in the whole of Asia, the psychiatrists community has highlighted the increasingly high prevalence of dementia due to Alzheimer’s and Parkinson’s disease and the fact that the country was woefully underprepared and ill-equipped at present to tackle the scourge in terms of care and prevention.
Dr. Ratnaweera added that at present anti-dementia medication was not made available in the Government hospitals.

The elderly population in the country is also increasing. According to Dr. Ratnaweera, currently the figure of aging among older people is about 10% of the general population which by 2025 is estimated to be 22% and could be much more than 50% by 2050. “The elderly population is more than those whose age is 15 years and below,” she said. “At the same time, life expectancy is on the rise. According to the NCDAL, life expectancy in Sri Lanka is high at 74.9 years. We have found ways of overcoming certain physical illnesses by way of the technological advancements made in medicine,” she said. Accordingly, the global prevalence of Alzheimer’s in those over 65 years of age is 5.6%. “A local study conducted in 2003 found that the prevalence of Alzheimer’s was 3.9%, a percentage which is presently much higher,” she added.

Speaking of treatment modalities, Dr. Ratnaweera outlined that while early diagnosis was key for early treatment, apart from the provision of anti-dementia drugs, therapeutic exercises such as reminding patients of facts about themselves and their environment (reality orientation), validation therapy where medical professionals listen to what the patient has to say in complete tolerance and support without giving out any criticisms, and reminiscence therapy (to relive past experiences) should be administered.
She also highlighted the toll on those caring for Alzheimer’s patients. “Caregivers suffer a lot. Over 50% or more of the caregivers are clinically depressed. This is due to the high levels of burden and stress. They must have some respite. Their well-being too must be looked into.”

She noted that Sri Lankans did not plan well for their retirement and as a result post-retirement following a brief period of being cared for by way of having attention being paid to them, they find out that they are being taken for granted. Addressing the question of prevention, she highlighted the need to maintain a healthy lifestyle and healthy weight and the importance of protecting one’s head from injury, especially those resulting from road related accidents. “With regard to treatment, we must establish special centres at which psychiatrists trained and specialized in old age treatment provide the patients with care based on a multi disciplinary approach,” she said.