How Ignorance Of Dementia Is Wrecking Lives In Nigeria

The habit of viewing memory loss in elderly persons as part of  the normal aging process, as  well as ignoring forgetfulness in younger individuals, is wrecking many lives and worsening cases of dementia.
Dementia is a disease characterized with a progressive deterioration in the cognitive (thinking, reasoning, knowledge), personality and intellectual functions of an individual, and is associated with decline in activities of normal daily living of conscious patients. 

“Most people don’t come to us until the situation is bad ,” said Dr. Aishatu Yusaha’u Armiya’u a Consultant Psychiatrist with the Jos University Teaching Hospital (JUTH). “By the time patients get to the hospital, they have started hallucinating and behaving aggressively.  At the end of the day, they are left for the psychiatrists, and a lot of them have either high blood pressure or diabetes. ” 
According to Dr  Salisu Abullahi Balarabe , a consultant neurologist, at the Usmanu Danfodiyo University Teaching Hospital, UDUTH , Sokoto , the most serious misconception people have about the disease  is  that there is no point doing anything about it since it is an aging process or that the person is just misbehaving.
How ignorance about dementia wrecks lives
He noted that this increases the rate at which the person progresses from mild to severe form of the disease.
 Dr Balarabe said that if an old man begins to abuse people, the usual thinking is that he is just becoming unnecessarily difficult. He added that it is always good for the community and especially family members to know that  dementia is a disease just as malaria, and  typhoid to mention a few.
“Whatever you do in the hospital setting may not really be compared with when a care giver really understands what it takes to care for a patient with dementia. For instance, if you are caring for someone and he is always crying, and depression sets in, it would even be much more disastrous to  his life than the dementia the person has,” he added.
Mrs Susana Jurbe , 50,  said when her 76-year-old mother started exhibiting forgetfulness, and lost track of time in 2015 , the family mistook it for the normal aging process. 
Jurbe explained that her mother started wandering about, and would realize after sometime and return home. “She also developed high blood pressure and diabetes so when we took her to JUTH, she was given drugs but they also referred us to the Psychiatrist unit and they told us that the symptoms of forgetfulness and hallucinations was an illness.”
Jurbe who takes her mother to the hospital for routine checks once in two months said the medical experts usually asked her a bunch of questions including if she knew who she (Jurbe) was, who her sister is, and what period of the day it was.
Hajara said her sister, Hauwa might have been a lot better today if  her family knew it was  dementia when the problem started in 2011. Then Hauwa was 19 and got involved in accident where a fuel tanker consumed several lives on her way from school. Months after, she became highly forgetful. But her family kept her at home since there was no obvious injury. By the time medical assistance was sought, it was late.
Signs of dementia
A consultant psychiatrist at the Federal Neuro Psychiatric Hospital, Yaba, Lagos, Dr Taiwo Oduguwa said old age comes with forgetfulness and that if someone is forgetful but still behaves and functions normally, that can be regarded as normal. But, if it is persistent, such that the person doesn’t remember the area or streets close to their residential address that is a sign.
Aside forgetfulness, the individual may have change of behavior, says Dr  Salisu Abullahi Balarabe, of the Usmanu Danfodiyo University Teaching Hospital, UDUTH , Sokoto,   “like  if someone who is known to be very calm , starts  becoming aggressive , he may be losing control and that is a sign of early stage dementia.”
 He said others signs a person may be developing dementia, includes when a person begins to forget words, instead of mentioning the name of a thing, he or she begins to describe it.
In advanced stages, he stated that a person has problem recognizing familiar faces and remembering the names of their children, close friends, and relatives.
In addition, Dr  Balarabe  said  by the time a person is not taking subconsciously landmarks that would help him have an  idea of how he should go to a place, that is also a sign of dementia,  noting that when it reaches the  severe stage ,the person  does not know where  the toilet or  bathroom is located in his or her own house.
The medical expert said other signs involves someone repeatedly asking you of something that you just informed him of during discussion.
Prevalence
Out of all psychiatric cases, dementia accounts for 22.4 percent , said Dr Taiwo Oduguwa, a consultant psychiatrist at the Federal Neuro Psychiatric Hospital, Yaba, Lagos. 
Also  a four-year (2007-2011) review of the mental health services rendered to 938 clients aged 60 years and above at a Lagos based mental health treatment facility , carried out by some psychiatrists showed that 216 of them representing 36.7%  were diagnosed of dementia  while 5.5%  (that is 56 persons) had Alzheimer’s dementia , (a type of dementia). 
Also, a clinical psychologist, and head of Department of Clinical Psychology Department at the Neuro Psychiatric Hospital , Kaduna, Oguizu J. Okechukwu, said about three out of  every 100 mentally ill patients that come to the hospital were dementia cases from their observations.
The most common type of dementia is Alzheimer disease.Dr Agbir Terkura Michael a consultant psychiatrist, with the Benue State University Teaching Hospital (BSUTH) explained that it is a neuro- degeneration in the brain, that is the brain deteriorates with age, and it usually happens after the age of 65 or during old age .Those who have parents or siblings with Alzheimer disease are predisposed to having the disorder. 
Borno State Commissioner of Health , Dr. Haruna Mshelia, said the exact prevalence rate of  dementia in the state was not known because it requires an extensive research, and that has not been conducted yet,  “In advanced countries where many people live for as long as 100 years in considerable comfort, the chances of people  getting dementia are less than what obtains in the developing countries like ours,” he said.
 Causes, and those at risk of the disease
 Dr Musbahu Rabi’u, a consultant neurologist at the Murtala Mohammed Specialist Hospital, Kano said some of the common diseases that could lead to dementia include severe malaria, chronic meningitis, HIV, diabetes, hypertension, stroke, renal failure, brain injury as well as aging.
Dr Adebimpe Alder, a psychiatrist with the Melville Healthcare Resources, a mental health facility in Abuja said brain injuries sustained during bomb blasts, communal attacks and by military personnel predisposes to the disease.
Excessive use of tobacco, unhealthy diet as well as illnesses like depression and social isolation could also pose a risk, Dr. Aishatu Yusaha’u Armiya’u a Consultant Psychiatrist with the Jos University Teaching Hospital (JUTH) said. 
Clinical psychologist and head of Clinical Psychology Department at the Neuro-Psychiatric Hospital, Kaduna,Oguizu J. Okechukwu , added that dementia could also be caused by deficiencies of vitamins like folic acid, B-Complex in the brain, and by substance abuse like cocaine, marijuana, and cigarettes, among others. 
The Medical experts said most people with dementia  were not born with it, and that it could also be as a result of  traumatic causes such as an injury to the head, a gunshot, accident or even rigorous exercises such as punch syndrome associated with boxing.
 “If the head is being punched severally as it is with boxers, they are predisposed,” Dr. Agbir Terkura Michael said. 
According to Dr Taiwo Oduguwa,  HIV in a person which has led to AIDs can also cause dementia . In addition he said chronic alcoholic use, and lots of losses like money , or family members can  cause depression which later leads to dementia. 
Can dementia be prevented? 
People have to modify their lifestyle as a preventive measure against dementia.
 “It is important to reduce intake of alcohol or any  psycho-active substances, and engage in regular exercise,” says Dr. Agbir Terkura Michael. 
He said persons who are diabetic and hypertensive should control their blood sugar and pressure and also engage in social activities such as supportive clubs, Ludo games. “It helps people keep their brain functioning well. Chess, dancing and reading throughout people’s life span is also very important in keeping a mental balance. Regular writing too prevents dementia to certain levels as it tasks the brain to think while writing.”
Another preventive measure is through the use of non-steroidal inflammatory drugs and studies have shown that they are quite effective ,”  Dr Balarabe of UDUTH explained.
Link between dementia and HIV
Medical experts said HIV infection is associated with  dementia and that is why part of the clinical presentation of HIV, is AIDS dementia complex.
Dr Adebimpe Alder, a psychiatrist with the Melville Healthcare Resources, a mental health facility in Abuja said as HIV progresses, at the end stages one gets a bit degenerated and starts to forget things, “it affects your communication and overall daily life activities,” she added.
Daily Trust reports that in Kano, HIV infected persons who are not receiving anti-retroviral therapy constitute 23% of recorded cases of dementia.
Dr Musbahu Rabi’u, attributed the prevalence to the depletion in their immune system which predisposes them to various chronic infections that eventually metamorphose into progressive loss of memory.
Treatment
There is no absolute cure for dementia but that there are drugs to manage it, according Oguizu J. Okechukwu,  a clinical psychologist  adding, “We also use cognitive training, as there is always a deficiency in cognitive functions like thinking, reasoning, retrieving information and a lot more.”
Dr Taiwo Oduguwa , a consultant psychiatrist said treatment involves  giving drugs that delay or slow down the progression of the disease. So that instead of it progressing like three years, it prolongs the period to five or 15 years. “The person can live long after being diagnosed with dementia but the sad part is, such a person will be a shadow of his or her former self.” 
Does dementia lead to death?
The clinical psychologist, Oguizu Okechukwu said when the brain shrinks to a level that it can no longer function,  the person will die, though this can take some time . “The patient usually dies in dementia,” he said. 
What families of sufferers should know and how to cope
Dr Balarabe of the UDUTH said understanding is what a person suffering from dementia requires the most from family members, saying they could be demoralized or  psychologically  unhappy, when they don’t get it.
He said it is quite challenging taking care of a person with dementia especially at the advanced stage  and that there is need for the family member or care giver to make sacrifices not just on medical bills but on time given to the affected individual.
Oguizu J. Okechukwu,  clinical psychologist,  advised family of sufferers to take patients to a psychiatric hospital where there are mental health professionals comprising  psychiatrists, clinical psychologists, medical social workers, among others.
People staying with a dementia patient for a period of time can develop anxiety, become irritable and even get high BP, said Dr. Aishatu Yusaha’u Armiya’u , so they need to be psycho-educated and monitored closely. There should be two or three persons caring for a dementia patient so that there can be shifts, she advised.  Dr Taiwo Oduguwa said when two old couples are living together and one has dementia, they need the assistance of two caregivers. “Mama cannot take care of papa, the house, go to the market to buy things, cook and do all sorts of things.”
The mental health experts said that caregivers should always engage sufferers in physical and social activities, in order to slow the progressive deterioration in their health.

Source: blogspot