Dementia: A Broad Exploration

Dementia is a general word that describes a broad spectrum of signs connected to deterioration in memory and other cognitive abilities. The deterioration is so severe that it reduces a person's ability to carry out their daily duties. The disease affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment.

According to Dementia in Kenya report, approximately 2.76 million Africans above 50 years live with the condition. This number accounts for 2.4% of Africa's population. The World Health Organization (WHO) notes that dementia and Alzheimer's had claimed at least 2,566 lives in Kenya by 2018. Alzheimer's is a degenerative brain disease that often leads to dementia.

Dementia results from damage to the brain cells, which affects their ability to communicate. The lack of communication affects a person's thinking, behaviour, and emotions.

According to Alzheimer’s & Dementia Organization Kenya (ADOK), Alzheimer’s disease is responsible for 60% to 80% of dementia cases. Another rampant cause of dementia in Kenya is Vascular Dementia, a condition that occurs after one suffers from a stroke.

However, the two illnesses are not the only cause of dementia. At times, reversible factors such as thyroid complications or vitamin deficiencies can cause dementia.

Although signs of dementia can differ significantly, at least two basic mental operations must face massive impairments for a doctor to give a dementia diagnosis. One of these operations is memory. A person with dementia may have problems keeping up with short-term memory, which reminds them of essential duties they are supposed to fulfil, such as paying bills.

Dementia also manifests itself in compromised communication and language. A person's concentration, reasoning, judgment, and visual perception may be affected.

The risk factors for dementia can be either modifiable or non-modifiable. A person can control the modifiable factors through their lifestyle. However, one cannot control the non-modifiable factors.

Modifiable risk factors

Certain risk factors can be modified to help prevent or delay up to 40 percent of dementia cases. They include:

1. Hearing Loss 
2. Cognitive Inactivity
3. Heavy Smoking & Alcohol Consumption
4. Depression & Social Isolation 
5. Hypertension
6. Physical Inactivity & Obesity
7. Diabetes

 Non-modifiable risk factors

1.  Aging – Above the age of 65, a person's risk of developing vascular dementia doubles roughly every five years. 

2.  Genetics – Inheriting specific genes associated with dementia increases a person's risk of developing the disease. 

3.  Ethnicity – South Asian people seem to develop dementia – particularly vascular dementia – more often than white Europeans do. Similarly, people of African or African-Caribbean origin seem to develop dementia more often. 

4.  Family history- Belonging to a family with dementia increases a person's risk of developing the condition.

As an incurable condition, dementia poses a substantial economic burden on patients and their families. The high treatment and social care costs force family and friends to be the primary caregivers. A survey carried out by the United Nations in 2015 showed that the overall global societal expenses of dementia were approximately $818 billion. These amounts to 1.1% of the global gross domestic product (GDP). The data on the economic impact of dementia in Kenya is not comprehensive, hence no clear understanding of the disease's impact on Kenya's economy.

Socially, dementia is responsible for the loss of work for the affected persons since their memory functions are not entirely active. The condition also causes a reduction in work hours for family members providing care.

In addition, the condition damages brain cells causing changes in a person's behaviour and emotions. These changes limit their social life, such as social interactions and their ability to enter relationships and sustain them.

Despite the lack of a cure for dementia, one can reduce the risk of getting the disease by avoiding the modifiable causes. Some of the measures to undertake include:

·       Maintaining regular exercise schedules

·       Avoiding smoking and the harmful consumption of alcohol

·       Regulating body weight

·       Consuming a balanced and healthy diet

·       Maintaining regular sugar, blood pressure, and cholesterol levels

Prevention and control measures for dementia in Kenya may be challenging. According to the Dementia in Kenya report, this is the case due to three main factors:

• Widespread lack of information on dementia leads to stigma, delayed diagnosis, and misdiagnosis.
• Stigma, especially in African societies where the disease is associated with witchcraft or curses. Stigma results in isolation and abandonment. 
• Lack of definite statistics on the number of people affected by the condition, thus hindering efforts to lobby the government for action.

The three challenges mentioned above limit the government’s ability to develop a comprehensive action plan for persons with dementia. The following steps are necessary to alleviate the situation:

• Creation of awareness regarding dementia. Such a move will reduce stigma and improve the inclusivity of persons with the condition.
• Training of health professionals. The signs of dementia mimic other illnesses such as depression, making it hard to diagnose the condition. Proper training of healthcare professionals will ensure timely diagnosis of the disease and prevent misdiagnosis.
• Development of a dementia database in Kenya. Such an initiative will help record the cases of dementia in the country and provide a one-stop source of information on the condition. It will also inform relevant action plans by the government and other stakeholders.
• Support for families and caregivers of persons with dementia. Such people require safe spaces and emotional support to care for the sick person. However, financial support to such families would also be significant, as most of them cannot work since they have dedicated themselves to fully caring for the sick ones.