LOSS: Amongst the earliest symptoms of dementia is loss of memory. In the extreme stages parents may not be able to recognise their children and many walk out of the house and are unable to find their way back home

DR AMIT DIAS of the Department of Preventive & Social Medicine at Goa Medical College & hospital was one of the experts on the Lancet Commission that recently published scientific evidence on `Prevention of Alzheimer’s Disease & Other Causes of Dementia.’ Prof Gill Livingston of University College, London (UK) was the lead author with 28 of the world’s leading dementia experts providing an up-to-date analysis of the best evidence on how to prevent dementia…

WE spoke to Dr Dias, to understand the implications of the report to the Low and Middle income countries and why prevention is better than cure. “The 12 risk factors identified in the report are estimated to affect 40% of people with dementia,” he informs, “this understanding can help deal with the rising tide of dementia in India by focussing on preventive strategies.”

What is dementia?
DEMENTIA is the umbrella term for a group of progressive, degenerative brain syndrome that result in memory loss, difficulty in thinking behaviour and emotion. It is not normal part of aging as it is often thought to be. Alzheimer’s disease is the most common form of dementia.

Can you simplify what the Lancet Commission report states on prevention of Dementia? Why is Prevention better than cure in this case?
Let me start by stating that for most types of dementia including Alzheimer’s disease, there is no known cure as of today. There are medications that help in slowing the progress of neuro-degeneration, but no cure. The news that dementia can be prevented or delayed comes as a ray of hope.
We found in the report that 12 risk factors contribute to 40 % of people with dementia and therefore a targeted approach at risk reduction can potentially delay or protect a significant number of people from getting dementia. Even the possibility of delaying the onset of dementia by a few years can have a great impact on the quality of life and cost of care for the family.
There is a huge difference if someone develops dementia at the age of 60 years as compared to at the age of 80 years. In the low and middle income countries, such as India, we have a significantly higher proportion of people living with the risk factors and therefore the potential and impact of prevention strategies will be much higher.
Our society and lifestyle is rapidly changing, resulting in an increase in the non-communicable diseases. The policy makers and the community at large needs to take active measures in the prevention and control of dementia by making active efforts to stay active and adopt a healthy lifestyle and reduce risk. As our country goes thorough a demographic transition we will see a larger proportion of elderly and conditions such as dementia will rise further.

“We found that there is evidence to show that prevention of head injury, prevention of intake of excessive alcohol and lowering the exposure to air pollution can also help in preventing dementia.”
“With the demographic transition, the numbers of people with dementia are rising very rapidly in the low and middle income countries such as India. There are an estimated four million people with dementia in India. What is worse is that due to stigma and lack of awareness more than 90 % of the people with dementia in India, do not even get a diagnosis and grapple with the condition in confusion, this adversely affects the life of the person with dementia as well as the caregivers.”
“ Worldwide 50 million people live with dementia, and the number is projected to increase to 152 million by 2050, rising particularly in the low and middle income countries where around two thirds of people with dementia live. Dementia affects individuals, their families and the economy, with global costs estimated to about US $ 1 trillion.” (Source ADI, UK)
“With one new case of dementia occurring every three seconds in the world, there is a need for collective action at all levels on a war footing to deal with the growing burden of dementia.”

“We now know that what was known to be good for the heart is also good for the brain, one must adopt a brain-friendly lifestyle to prevent dementia in late life.”

What should we do to prevent dementia?
The authors while working on the prevention estimates, have reported the risk factors that have a strong evidence of a causal link to dementia. Three more risk factors have been added to the list in this report:
• Control your blood pressure: Keep the systolic blood pressure to 130 mm of mercury or less in mid-life from the age of 40 years
• Reduce exposure to air pollution and second hand tobacco smoke
• Prevent alcohol misuse — limit drinking as much as possible, the study shows that consumption of more than 21 units a week is a risk for developing dementia
• Prevent head injury, repeated injury is shown to give rise to dementia
• Smoking is BAD and should be stopped – stop smoking and actively encourage others to stop.
• Exercise – lead an active life into midlife and even into late life. Physical activity has a lot of benefits
• Education keeps your mind stimulated and is also shown to be beneficial. All children should be provided primary and secondary education
• Encourage the use for hearing aids for hearing loss and reduce hearing loss by protecting ears from high noise levels
• Reduce obesity and diabetes, which are also recognised as significant risk factors for dementia
• Improve sleep through lifestyle changes

Can you throw more light in the relationship between dementia and alcohol? What were the findings in your Lancet paper?
Heavy drinking is associated with brain changes, cognitive impairment, and dementia, a risk known for centuries. In our research we saw an increasing body of evidence is emerging on alcohol’s complex relationship with cognition and dementia outcomes, from a variety of sources including detailed cohorts and large-scale record based studies.
Alcohol is strongly associated with cultural patterns and other socio-cultural and health-related factors, making it particularly challenging to understand the evidence base.
AFTER carefully evaluating the global research, we found that there is evidence to show that drinking more than 21 units per week was associated with a 17% increase in dementia, compared to drinking less than 14 units per week. It is also significant to note that drinking more than 14 units was also associated with right sided hippocampal atrophy on MRI, which is part of the brain responsible for memory.

Can you clarify on what is a unit of alcohol?
One unit of alcohol is 10ml or 8g of pure alcohol. However, as you know, alcohol comes in various strengths and sizes. This is a simple way of expressing the amount of pure alcohol in a drink. An average adult takes one hour to process one unit of alcohol so that there is none left in the blood. Therefore we always caution people against drinking in large amounts at a time. If at all they have to drink, it should be restricted to 14 units per week and spread over time. This translates to around 6 pints of average strength of average strength beer or 10 small glasses of low strength red wine in a week. Above this causes severe brain damage and we now know that above 21 units can also lead to dementia.

What is your message?
While the scientific community is trying to find a cure to the problem, let us do our bit in raising awareness about the condition, contribute towards developing a dementia-friendly community and stay free from dementia as far as possible by adopting a healthy lifestyle.
“Though it is never too late to change our lifestyle, the maximum impact is seen if we change our lifestyle early. Adopting a healthy lifestyle and controlling the risk factors to prevent dementia has far reaching benefits both to the individual as well as to the policy makers as it will also prevent several other conditions such as heart disease, stroke, cancer as they have common risk factors.”
“It’s always better to invest in prevention because prevention is always better than cure, in the case of Alzheimer’s disease and other irreversible dementias, we have no cure and prevention is our best option.”

What are the warning signs of dementia ?

Everyone should be aware of the 10 warning signs of dementia. Memory problems and confusion in the elderly could be a sign of a disease and one must seek help from a physician:
• Recent memory loss
• Difficulty in performing familiar tasks
• Poor or decreased judgement
• Misplacing things
• Disorientation in time and place
• Problems in language
• Problems keeping track of things
• Changes in mood and behaviour
• Trouble with images
• Withdrawal from social activities

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