Dementia: When forgetfulness can become serious

Dementia: When forgetfulness can become serious

Dr Colin Michie FRCPCH FRSPH FLS

Uncle Time is a spider-man, cunnin’ an’ cool,

Him tell yu: watch de hill an’ yu se mi.

Huhn! Fe yu yi no quick enough fe si

how ‘im move like mongoose; man, yu tink ‘im fool?

Dennis Scott ‘Uncle Time’

Time passes with impressive agility. We are left with sensations of being left behind, often in a slightly less-able body. Our clear voices and dance moves become less impressive, particularly to children. We become a little more forgetful, reminding ourselves of bygone eras with images and music. We develop habits to remind us about our keys, cards, the sun glasses. Birthdays march on and we hide from the obvious – that Anansi man of time challenges our brains.

Humans are forgetting machines. Our brain, 1.5 kg of warm, soft, intricate circuit board, has more connections than there are people on the planet. That grey matter works modestly, using 10-12 calories an hour and about 20% of our oxygen, whether we are chatting, sleeping, throwing dominoes, or watching the television. Much routine brain activity is to forget our unnecessary daily nerve inputs. Can you remember the colour of the T-shirt you wore two weeks back? Somehow, our minds carefully review what we touch, see, smell, say or experience, storing treasure banks of memories and removing the rest. Our filtered, processed records become the essences that make us the individuals we are – our skills, knowledge, language, loves, hopes, fears, dreams, beliefs, fantasies, superstitions.

Our mental strongboxes are not always safe. About 2% of those under 70 will develop issues with recall that interfere with independent life. This is dementia. The problem becomes more common with age – it involves 20% of those over 85. Brain cells and their connections degenerate more quickly in those with dementia, damaging thinking, cognition. Access to those treasured memories melts away: sufferers describe losing themselves. Forgetfulness progresses to disorientation and changes in personality, then slides steadily into confusion and problems with daily activities, including sleeping or eating. Dementia can eventually restrict sufferers to bed, to total dependence and the complications this causes with families, friends and neighbours.

Ageing is the most important risk for dementia. Vision and hearing are crucial inputs too – if these are damaged, dementia becomes more likely. Diabetes and cardiovascular disease interfere with the amazing blood supply to brain cells, so they can contribute to dementia. Head trauma, infections, inflammation and some toxins – including tobacco smoking and alcohol – can cause dementia. Dementia can happen to all of us, whatever our culture or background. Dr. Solomon Fuller, a Liberian working in the United States, published careful observations showing that not all demented patients had the same changes in their brains: there is much we do not understand about this disorder.

Dementia can be divided depending on its patterns. For instance, Alzheimer’s disease, the most common form, is often dependent on family inheritance. Multi-infarct dementia, frequent in Caribbean populations, follows many small strokes, mostly “silent”, in which blood supply to areas of the brain is damaged. All dementias progress; they are often missed or ignored in their early stages.

This situation challenges health in the Caribbean where there will be more older-individuals and therefore more dementia in future. This is an international challenge: In Europe, the number of people with dementia is estimated to double by 2050. The World Health Organisation has laid out a global plan, aimed at improving the dignity and meaning of lives for sufferers and their families, as well as supporting their communities. A network of Alzheimer’s associations around the Caribbean has been developed. Most care for the elderly is provided by families – a great blessing – but do we have a mental health army to support them?

No effective treatments are currently available for dementias. Although young brains are adaptable, continually learning and making new connections, we do not yet know how to revive these wonderful processes, once dementia is detected. Research is encouraging, but the current focus is on avoiding or slowing the progression of dementias.

The virtuous life seems a good place to start. Regular physical activities; less salt, sugar, fat and alcohol in our diets; weight reduction and no tobacco will enhance our health. It is not clear if this will prevent or slow dementia, but the approach is reasonable and reduces frailty. Enjoying music, reading, talking, singing, dancing, even dominoes – the cultural and spiritual sides of our life – are important investments in keeping all our minds sharp. Music is a valuable key to opening chests of memories; so are stories, poems or drawing. Social health is greatly improved by tackling loneliness and isolation in our ageing communities. All of us can accumulate mental treasures when we work together, not just those with dementia.

Useful resources:

https://www.who.int/mental_health/neurology/dementia/action_plan_2017_2025/en/

https://www.scie.org.uk/dementia/resources/

https://www.dementiasociety.org/