Family medicine practitioner Dr. Patrick Whitfield says support is required at the governmental, societal and individual levels if the challenges posed by Alzheimer's disease and dimentia are to be met.
Antoinette Sands (name changed) recalls the years she and her siblings made light of their grandmother forgetting she had spoken to them just moments before. Almost a decade later, Sands' grandmother does not even know her grandchildren. Sands says this has disturbed her so much that she does not even visit her grandmother, but that she does ask family members about her welfare.
Sands' grandmother is just one member of an ageing population combined with an increasing cross-section of the population diagnosed with uncontrolled high blood pressure, diabetes and elevated cholesterol that has medical professionals projecting that there will be a marked increased in the number of Bahamians developing dementia during the next decade. This projected spike is of concern to members of the medical community as the baby boomer generation they say will be significantly impacted as the common forms of dementia occurs with equal frequency among all social and economic groups.
Family medicine practitioner Dr. Patrick Whitfield says support is required at the governmental, societal and individual levels if the challenges posed by this disorder are to be met.
"Research has shown that individuals with a family history of heart disease in both parents have a far greater risk of developing Alzheimer's disease compared to the normal population. We as a community need to place focus on dementia especially as it relates to creating awareness, prevention and support for families and caregivers," said Dr. Whitfield who practices out of the Chesapeake Comprehensive Clinic.
The prevalence rate in North America and most industrialized countries is that approximately six to 10 percent of people over the age of 65 with Alzheimer's disease accounted for two thirds of the cases. It's a number the doctor said is expected to increase significantly over the next decade-and-a-half due to an ageing population.
While there is no similar data in The Bahamas, Dr. Whitfield said it was reasonable to assume that a similar prevalence rate exists locally.
"Likewise, we can expect that these numbers will increase dramatically in The Bahamas due to the fact that our population is ageing combined with the relatively high number of persons with uncontrolled high blood pressure, diabetes and elevated cholesterol," he said.
The problem
"Short term memory loss is a normal part of the ageing process and typically exerts minimal disruption in day-to-day living. 'I can't remember where I left my keys. I forgot what I came to the store to buy,' are examples of situations that affect most people over 65 years of age.
Memory loss in the elderly, however, can also be an early presenting symptom of a more debilitating and deadly disease such as Alzheimer's disease. The distinction between the two lies in the effect that a dementia such as Alzheimer's disease can have on ability to perform the most menial of tasks such as feeding oneself, not recognizing close relatives and taking care of their personal hygiene."
Sands recalls standing in a room and talking with her grandmother, walking into another room and returning to continue her conversation with her grandmother, who would then say to her that she had not seen her in years. As her condition worsened, Sands said her grandmother could not even tell her who she was.
Dr. Whitfield said that the diseases have an effect not only on the individual, but on the family as well. He said that the costs associated with medications, reorienting living facilities and the provision of day care by a custodian, the emotional trauma experienced by family members and legal issues as it relates to the control of possessions can present formidable challenges. And that elderly people who are of limited means, lack family support or are abandoned, suffer at a disproportionate level.
Dementia
A dementia is an acquired disorder that causes severe memory loss, an inability to perform basic functions and behavioral impairment that markedly interferes with social and occupational functioning. Dr. Whitfield said it's an incurable disease with a long and progressive course. He said dementias not only have detrimental effects on the patient, but often takes a significant toll on patients' families and caretakers as well.
"Age-related memory loss is natural progression as we age, however, this is distinctly different from the amnesia associated with medical conditions such as mild cognitive impairment, Alzheimer's disease and vascular dementia. They differ in that they are associated with additional psychiatric symptoms and loss of control of basic life functions."
Mild cognitive impairment
This condition is often a precursor for the development of Alzheimer's and extends beyond the normal short-term memory loss as people age, to include repeating statements, difficulty in remembering the date, year and time, difficulty in managing finances and a decreased sense of direction.
Different types of dementia
The different types of dementia are Alzheimer's disease and vascular dementia.
"Alzheimer's is the most common form of dementia and economically is a major public health problem. The cost of healthcare, long-term care and the contributions of unpaid caregivers are significant contributors to the associated costs. Currently, an autopsy or brain biopsy is the only way to make a definitive diagnosis, however, in clinical practice the diagnosis is usually made on the basis of the history and findings of a mental status examination."
The doctor said rapid and progressive memory loss is the most common presenting symptom with slowly progressive behavioral changes, difficulty in expressing themselves verbally, executive functions and impairment of orientation in space and time.
Medications to manage the symptoms, he said, are the only treatments available. Psychiatric medications are also used to treat secondary symptoms including depression, agitation and sleep disorders.
According to Dr. Whitfield, the cause is unknown, however researchers believe that environmental and genetic risk factors trigger pathological changes that over decades lead to Alzheimer's. He said risk factors that have been identified include advancing age, family history, obesity, elevated cholesterol, high blood pressure and elevated blood sugar levels.
"Alzheimer's disease is initially associated with memory loss that progressively worsens and over time patients can display anxiety, depression, insomnia, agitation and paranoia. As the disease progresses, patients require assistance with basic activities of daily living --dressing, bathing and toileting. Eventually difficulties with walking and swallowing may develop. The time from diagnosis to death varies from as little as three years to up to 10 years. Patients with an early onset dementia [less than 60 years] tend to have a more aggressive disease with a more rapid course than late onset dementia."
As the patient's symptoms become more pronounced, Dr. Whitfield said dialogue must begin regarding the person's wish for care when he or she is no longer able to make the necessary choices. He said a power of attorney should be discussed, with particular attention to who will make decisions for medical and financial issues.
Vascular dementia
Vascular dementia, the second most common form of dementia after Alzheimer's disease is preventable, and as a result early detection is important, said the doctor. Patients who have had a stroke are at an increased risk of vascular dementia which results from damage to parts of the brain due to compromised blood flow to the respective areas.
Blood vessels that were damaged as a result of elevated cholesterol levels, uncontrolled high blood pressure and diabetes are the main contributors to compromised blood flow in the brain. Risk factors include high blood pressure, smoking, high LDL (bad) cholesterol levels and/or low HDL (good) cholesterol levels, diabetes, heart disease, strokes and mini strokes (transient ischaemic attacks). Signs and symptoms are similar to Alzheimer's disease, except the rapid onset and progression of symptoms.
Effects of dementia
"The concept of once a man, twice a child encapsulates the effect of dementias on individuals and families," said Dr. Whitfield.
"Patients with advanced dementias are totally dependent on caregivers and relatives for feeding, personal hygiene and healthcare needs. This can be not only a traumatic experience for the families, but also a very expensive and time-consuming experience for those involved. Personal sacrifice by family members is an absolute necessity as it relates to the cost of care for caregivers, and supplies like diapers, taking a leave of absence from work, loss of quality time with their own families and the physical toll experienced by primary care givers."
Dr. Whitfield said the lack of local-based support groups for family members, a lack of sufficient in-patient hospice care beds and the lack of day care facilities represent weaknesses in the local community. He also said that there is a need to place focus on dementia, especially as it relates to creating awareness, prevention and support for families and caregivers.
Shavaughn Moss, Guardian Lifestyles Editor
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