15.2  Dementia

Dementia is a common problem which, like epilepsy, is related to problems with the functioning of the brain. Dementia affects a person’s mental ability, personality and behaviour. People with dementia commonly experience problems with memory and the skills needed to carry out everyday activities. They may also have problems controlling their emotions or behaving appropriately in social situations. Aspects of their personality may change. Most cases of dementia are caused by damage to the structure of the brain, leading to the death of brain cells. There are many different types of dementia; the most common type is called Alzheimer’s disease.

Although it can occur at any age, dementia is more common in older people (but it is not part of normal ageing). The older people get, the more likely they are to develop dementia. Dementia usually gets worse slowly, often over many years, and may mean that the person affected can no longer live independently. The disease therfore affects both people who develop dementia and the people who care for them. It can shorten people’s lives and is an important cause of disability.

Reflecting the ageing global population (with people living longer lives), dementia is a growing problem. There are currently no treatments that can cure or stop the progression of most forms of dementia. However, drugs and other treatments can improve symptoms in some people. There is a significant treatment gap in the provision for people with dementia. Symptoms of dementia can also develop as a result of other long-term health problems, such as epilepsy, alcohol-related brain damage and head injury.

Alzheimer’s disease can develop in people with Down syndrome (see Study Session 17) and this usually happens around the age of 30. The signs and symptoms are similar to those seen in people without this syndrome. Sometimes people with AIDS develop AIDS-related dementia, including forgetfulness, difficulty in concentrating, personality changes and loss of coordination.

Although there is no expectation that you will be involved in the diagnosis of dementia, it is important to reflect on the symptoms above so that you are aware when a referral for treatment is necessary. A useful technique is to use the questions in Box 15.2 to gain greater understanding of the specific features of dementia in the person you are supporting.

Box 15.2  Useful questions for assessing dementia

Questions to ask the family or friends:

  • When did you first notice a problem?
  • How did the illness start? Does the person have problems remembering things?
  • Does the person have difficulty in everyday activities such as eating, bathing and using the toilet?
  • Do they behave in odd manner?
  • Have they seemed sad or lost interest in daily life?

Questions to ask the person with memory problems:

In the following, you should award each correct answer with a mark. If a person answers less than six questions correctly then there is a possibility that they have dementia and should be referred for assessment.

  1. How old are you?
  2. What time is it now?
  3. Which woreda do you live in? (kebele, and village and address)
  4. What is the month and year?
  5. What is the name of the health institution or home address you are at?
  6. Do you recognise the people around you?
  7. Do you know when you were born?
  8. When did the current Ethiopian government win the first election?
  9. Who is the prime minister of Ethiopia?
  10. Name the days of the week backwards.

15.1.7  Reasons for referral

15.2.1  Treatments for dementia