One of Bollywoods yesteryear stars was recently admitted to a well-known private hospital in New Delhi. The staff was excited upon his arrival but only until he insisted on a walk in the grounds at 4 am. When doctors tried to give him an injection,he pointed to his wife and said,Usko laga do (give it to her).
The actor is suffering from dementia a largely unrecognised disease in India and one which threatens to emerge as the biggest public health challenge in the country in the coming years. Despite being a major topic of discussion on a senior citizens policy,it is largely absent from debates on public health.
Medically,dementia is defined as a loss of brain function that occurs with certain diseases. It affects memory,thinking,language,judgement and behaviour. While patients often turn up with non-specific complaints like,I do not remember where I have kept things,typical dementia patients present more serious instances of forgetfulness like not remembering where they live,or how to wear a sari.
It is more common in the elderly. In fact,it is rare in people aged below 60 years,unless triggered by a head injury. There are several reversible causes of the disease too,including alcohol abuse,low vitamin B12 levels and normal pressure hydrocephalus (when the flow of fluid between the brain coverings is obstructed).
According to the Dementia India Report,2010,prepared by the Alzheimers and Related Disorders Society of India (ARDSI),an estimated 3.7 million Indians suffer from dementia. This is expected to double by 2030. It is estimated that the annual cost of taking care of a person with dementia is about Rs 43,000. For the first time ever,there is a proposal to include mental health as a focus area in the 12th Five Year Plan. The Rs 60-crore scheme of the Ministry of Social Justice and Empowerment to develop dementia day care homes has not led to a single such home seeing the light of the day.
A month ago,World Health Organisation and Alzheimers Disease International called for a global strategy to tackle dementia. In India,the dementia mortality rate is 13.5 per 100,000 males and 11.1 per 100,000 females. It is the fourth leading cause of death in the Asia-Pacific region, read the statement released on April 11. It urged India to immediately adopt strategies developed by civil society organisations into a comprehensive national plan,and also warned that one in eight people over 65 years of age are at risk. The figure is two in five for those over 85 years old. As is evident,the older the person,the higher the risk of suffering from the disease.
Dr J M Wadhwan,chairman,Psychiatry,at Delhis Sir Ganga Ram Hospital,says,When there were joint families,the old man of the family was taken to a doctor only when he became incapable of looking after his daily needs. Now,patients come because they find it difficult to go through their daily routine due to a failing mind.
New age drugs have brought a change in the prognosis of dementia patients. A neurotransmitter called acetylcholine is believed to play a crucial role in the memory functions of the brain. Memory loss is explained by the action of an enzyme called choline esterase that causes breakdown of acetylcholine. Drugs that hamper the action of choline esterase can therefore slowdown the process of dementia but the key is early diagnosis. This is why it is important for families to look out for symptoms in the elderly and take them to a doctor sooner, Dr Wadhwan says.
For this reason,organisations like ARDSI have been mounting pressure on the government for a national plan against dementia and to use National Rural Health Mission infrastructure to generate awareness. At present,our preparedness to tackle the impending dementia epidemic is nil. There is still a lot of resistance against budgetary allocation and officials seem to suggest the budget can be taken off other programmes for this. It seems sensitisation of the officialdom is the first hurdle, says R Narender,national director of ARDSI.
Symptoms of dementia
* Change in sleep patterns,often waking up at night
* Difficulty doing basic tasks like cooking,driving,wearing clothes
* Forgetting current events
* Forgetting events of own life,losing awareness of onseself
* Hallucinations,arguments,striking out,violent behaviour
* Difficulty in reading or writing
* Poor judgement and loss of ability to recognise danger
* Using the wrong word,not pronouncing words correctly,speaking in confusing sentences
* Social withdrawal