During the time of COVID-19, people with dementia faced various difficulties such as disruption of medical services. DR VIVEK NAMBIAR talks about other challenegs also faced
The Brazilian study published in 2021 showed that there is three times increased mortality in patients of covid if they have concurrent dementia. A similar picture has been seen in England and Wales that there was a significant high death among dementia patients. So, COVID and dementia is a challenge. Even though COVID affects elderly people, they are still prone to Alzheimer's because their brain is vulnerable to the virus and further immunological damage. Also, they will have other concurrent illnesses like pneumonia, and all this can make these people more prone to death. So, the mortality of Alzheimer's disease is much more when they get COVID-19 infection.
On the other hand, if we look at the age wise prevalence of dementia about 2% of people belonging to the age group of 60-70 have dementia. Also, when 70 progresses to 80 - 90 years, there is 20% prevalence of dementia and 34% of prevalence of dementia in people above the age of 90 years. Thus, it is very evident that with the rise of age, prevalence of dementia increases and the majority of these dementias are Alzheimer's disease.
A pre runner of dementia is called minimal cognitive impairments (MCI). MCI is a condition where certain membrane impairment does not amount to the disruption of normal life. This type of mild cognitive impairment is actually the start of brain deterioration for memory faculty. So, there will be certain difficulties in the memory, language, reasoning, and personality in these patients. so gradually it will gain momentum and one third of the people can progress to dementia and one third will remain in the same state of mild impairment without social disruption and others will sometimes improve also. so the annual conversion rate of the MCI to dementia in community samples is about 10%. The prevalence of MCI in Indian studies is about 14-25%. This is what numerous studies across India from 2007-2019 show. But, out of this, only 10-15 % progress to dementia. They can get good medical attention to begin with and can identify the cause of dementia, if they can have medication to prevent the progression from MCI to the complete dementia.
The percentage of elderly people population is high in Punjab, Karnataka, Andhra Pradesh, and Kerala. In 2021, the percentage of people with dementia is extremely high in Maharashtra, West Bengal, and Andhra Pradesh. The number of elderly people with MCI likely to develop dementia in one year is maximum in Andhra Pradesh, Uttar Pradesh, and Maharashtra.
Proper neurological assistance and diagnosis of dementia is of paramount importance because when somebody experiences memory impairment consistently and starts disrupting his normal life, then they should consult a proper specialist to assess the function, conduct various memory tests and if it is found to be low, then he has to undergo proper evaluation.
Then there will be hormone deficiency hypothyroidism, nutritional deficiencies and sometimes liver diseases can make our memories slow and patients get confused. At times, a simple CT scan will prove especially useful to identify subdural hematoma. Subdural hematoma is caused by a head injury strong enough to burst blood vessels. This can cause pooled blood to push on the brain.
These all are treatable to considerable extent and there is substance abuse like alcohol, heavy metal poisoning, which all can cause dementia. The identification of these potentially reversible things will really help to change the life of people who are affected by memory impairment. And in patients who have been diagnosed with dementia, there are several medications to reduce the progression of dementia and improve the quality of life. The major challenge of the health care system in India would be to support these upcoming enormous numbers of dementia people with various disabilities. The number of care homes even in metropolitan cities is much insufficient to cater the enormous number of potentially disabling patients.
The writer is Clinical Assistant Professor, Stroke Medicine Department, Amrita Hospital, Kochi