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Thursday, April 3, 2025

Coping with dementia

by

20131009

Au­drey Karim and her moth­er used to quar­rel a lot. They were two strong per­son­al­i­ties who be­lieved their way was the right way. Their dis­agree­ments were reg­u­lar events, to the point it got Au­drey dis­tressed.

Un­til dur­ing one of their tiffs, Au­drey told her moth­er, "Enough!" and let her have it. Al­though she felt this time she had the fi­nal word, there was no sat­is­fac­tion in it.

It was on­ly af­ter that last in­ci­dent she re­alised some­thing was wrong.

Her moth­er re­gressed from ag­gres­sive, to bel­liger­ent, to docile.

She was di­ag­nosed with Alzheimer's dis­ease, a pro­gres­sive, de­gen­er­a­tive dis­ease that at­tacks the brain.

In its pro­gres­sive state, Au­drey says her moth­er now has very lit­tle lan­guage skills. "She would laugh. At most she would say is yes or no. How you ask the ques­tion, is how she re­sponds," she said of her moth­er, who was once a self-as­sertive woman who ran her own busi­ness.

Au­drey's ex­pe­ri­ence ac­counts for sev­en per cent of the T&T pop­u­la­tion that may be di­ag­nosed with de­men­tia. Alzheimer's is just one type of dis­ease as­so­ci­at­ed with de­men­tia, a non-spe­cif­ic syn­drome which af­fects cog­ni­tive ar­eas such as mem­o­ry, at­ten­tion, lan­guage and prob­lem-solv­ing.

Ac­cord­ing to the Med­ical News To­day Web site, oth­er dis­eases as­so­ci­at­ed with de­men­tia are vas­cu­lar de­men­tia (caused by prob­lems in sup­ply of blood to the brain ie a stroke), fron­totem­po­ral de­men­tia (pro­gres­sive de­te­ri­o­ra­tion of the frontal lobe of the brain), se­man­tic de­men­tia (lan­guage) and de­men­tia with Lewy bod­ies (spher­i­cal struc­tures in the brain that dam­age brain tis­sue). Au­drey's tes­ti­mo­ny as care­giv­er for her moth­er was part of the dis­cus­sion on de­men­tia: Aware­ness of Dis­ease and Im­pact as part of the Uni­ver­si­ty of the West In­dies' Re­search Ex­po last week.

The Fac­ul­ty of Med­ical Sci­ences host­ed the swift hour-long pre­sen­ta­tion at UWI's En­gi­neer­ing Build­ing.

"Sev­en­ty per cent of de­men­tia is Alzheimer's," said Dr Gersh­win Davis, a se­nior lec­tur­er in chem­i­cal pathol­o­gy of UWI's Med­ical Sci­ence fac­ul­ty, as he ex­plained the dis­ease.

Glob­al­ly, Alzheimer's af­fects 16 per cent women and 11 per cent of men who are over the age of 65.

Sta­tis­tics al­so re­veal that this de­gen­er­a­tive dis­ease af­fects one in ten peo­ple in that age group.

He said the chal­lenge is mea­sur­ing de­men­tia since it moves from no im­pair­ment to very mild, to mild cog­ni­tive to mod­er­ate stages of de­bil­i­ta­tion. Di­ag­nos­tic cri­te­ria in­volve mem­o­ry, lan­guage, mo­tor ac­tiv­i­ties, fail­ure to recog­nise and ex­ec­u­tive func­tion­ing.

Thus the ques­tion raised by Hu­man Anato­my Prof Aman­da McRae in her pre­sen­ta­tion, "Are we pre­pared for the im­pact of the De­men­tia Tsuna­mi in T&T?"

In a preva­lence de­men­tia study con­duct­ed at geri­atric homes and se­nior ac­tiv­i­ty cen­tres in north Trinidad and the so­cial wel­fare of­fice in Tu­na­puna, Prof McRae said age was the strongest pre­dic­tor among the 2,000 who were ran­dom­ly se­lect­ed for the sur­vey.

Prof McRae al­so sug­gest­ed that risk pre­ven­tion is pos­si­ble. She list­ed aer­o­bic ex­er­cise, an ac­tive so­cial life, in­tel­lec­tu­al ac­tiv­i­ties and a healthy di­et as ways to de­lay or pre­vent an el­e­ment of the dis­ease.

That hu­man in­ter­ac­tion as some­one gets old­er should be main­tained, said Dr Nelleen Ba­boolal, a se­nior lec­ture in psy­chi­a­try. It helps de­lay the course of de­men­tia. She al­so not­ed that 15 per cent of de­men­tia is re­versible, once there is ear­ly di­ag­no­sis.

How­ev­er, she not­ed that 50 per cent of pa­tients who suf­fer from men­tal desta­bil­i­sa­tion are not prop­er­ly di­ag­nosed.

Al­though there is no cure for Alzheimer's or de­men­tia, Dr Ba­boolal said there are sev­er­al treat­ments that can pro­long mem­o­ry, pro­vid­ing three to five ex­tra years of work­ing mem­o­ry.

Some of the risk fac­tors for de­men­tia are age, fam­i­ly his­to­ry, ge­net­ics, high cho­les­terol, high blood pres­sure or head trau­ma.


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