UNDER THE MICROSCOPE
Recently, we got news that my cousin was diagnosed with dementia, forcing her only daughter, a nurse, to take leave from work and fly from Australia to be with her mother. This cousin of mine was someone I grew up with and it pains me to know that she is mentally deteriorating.
But she’s not the only one I know with dementia. My father-in-law also had dementia. We cared for him for years until he succumbed to a stroke. It was emotionally and financially draining. A medical colleague who was a hematologist also had dementia and stopped practicing. They are but a few of those I know with dementia.
What they had in common was they all had uncontrolled hypertension. Studies have shown a strong association of hypertension with vascular dementia as well as Alzheimer’s disease. Oddly enough, hypotension (diastolic BP lower than 70 mmHg) was also associated with development of dementia in the elderly.
Dementia, which includes Alzheimer’s Disease, is one of the most disabling and burdensome conditions in the world. It is a gradual, progressive loss of cognitive functioning— of thinking, remembering and reasoning — to such an extent that it interferes with daily life and activities. People with dementia often can’t control their emotions, and may have personality changes such that their relatives and friends can no longer recognize the person as they know him or her.
The prevalence of dementia is five percent in the population 65 years and older, and it is expected to increase with the shift in population demographics. From 24.3 million in 2001, there will be 81.1 million with dementia by 2040. Most people with dementia live in developing countries (60 percent in 2001, rising to 71 percent in 2040).
As our population enters a demographic winter, there will be more and more elderly diagnosed with dementia with the consequent social burden attached to their care.
How does it happen? Many walk around with elevated BP without knowing they have hypertension, which is why hypertension is known as the silent killer. The association of hypertension with strokes and heart attacks are well-known. These are causes of sudden death. While these catastrophic conditions have a devastating impact on their loved ones, it is a one-time affair. We mourn the loss of our loved ones and get on with life after a period of bereavement.
Dementia is a slow death, with mental deterioration causing inability for self-care and burdening family members with the heavy responsibility of caring for their loved ones who gradually lose cognitive function and no longer recognize them. In effect, they are no longer the same people we know and love, but just a shell of their previous selves.
In developed countries, dementia patients are cared for in institutions which entail heavy costs. In the UK, the cost is US$8.2 billion a year, or 0.6 percent of the UK gross domestic product. We can’t afford that kind of expenditure in the Philippines, so many are cared for at home by family members.
The family members who care for their loved ones with dementia experience substantial psychological, practical, and economic strain, often necessitating cutting back on work, which they need to support themselves and the patient. Dementia care is intensive and expensive.
In this age when blood pressure devices are readily available and relatively cheap, and blood pressure medications are also priced low, and in fact, are distributed for free in many cities and towns, people still neglect their vascular health.
So, why are people not concerned about their blood pressure? Hypertension is often asymptomatic, and people mistake the lack of symptoms as something to ignore. Many are too busy eking out a livelihood to support their families, neglecting their own health. Hypertension affects two-thirds of people aged 60 years and above. Obese persons also tend to be hypertensive, due to the heavy burden on their hearts to supply blood to a large body mass. Some have hereditary factors predisposing to early development of hypertension.
For those in mid-life (40-64 years old), it is very important to control their blood pressure so as not to suffer the ill-effects of hypertension in their later years. Do take the time to check your blood pressure, and if it is elevated, consult a doctor who can prescribe anti-hypertensive medications. Religiously take your medications and check your blood pressure daily or twice a day. Keep a record and refer it to your doctor when you go for a consult.
While you’re at it, check your blood sugar. Diabetes mellitus is a risk factor for developing dementia. The same goes for high cholesterol levels, so check for this as well.
Do this for your own health, but more importantly, for your loved ones, who may have to suffer the burden of caring for you if you develop dementia.