By Oluwasola Samuel, Freelance Health writer. With medical review by the DLHA Team.
An elderly African man. Age is a risk factor for Dementia. Image credit: Freepik.
Dementia is an umbrella term used to describe decline in higher order brain function like memory, language, problem-solving, and other thinking abilities. This decline is severe enough to affect your behaviour, relationship, or daily life.
Dementia is not just a disease, but a symptom that's shown as a result of several diseases or conditions affecting the brain, like Alzheimer's disease.
Alzheimer's disease is the main cause of dementia in older people. This condition is common in older people because age is one of the major risk factors. [1] As you age, your brain goes through changes that can lead to mental decline.
In Africa, many have little to no knowledge about dementia. It's widely misunderstood, and it's a topic avoided by many. Dementia in Africa is becoming an unavoidable reality due to a growing and ageing population.
In this article, you will learn about dementia from the following viewpoints:
Dementia is a term for several brain conditions that affect your memory, the way you think, and your ability to carry out everyday activities. It happens when brain cells are damaged, which disrupts communication within your brain, making it difficult to remember things, plan, or make decisions. Imagine someone who once remembered everyone’s birthdays now struggling to recall family members' names.
There are different types of dementia, with Alzheimer’s being the most common among them. As dementia progresses, you might forget familiar routes, need help with dressing, or even struggle to recognize your loved ones. This condition can also affect the way you move, speak, or control your emotions.
Dementia can take an emotional and physical toll on you, your loved ones, and your caregiver if not properly managed.
Dementia is a growing concern worldwide, and Africa is not left out. In Africa, experts have projected a significant increase in the coming decades. Understanding the prevalence of dementia in Africa is crucial to preparing for the future and ensuring those affected are well cared for.
In Africa, dementia affects people who are 65 years and older, similar to other parts of the world. [1] Studies show dementia affects between 2.3% and 20% of people depending on the location in Africa. [2] Even though dementia may be rising in Africa, it's still lower than in many parts of the world. This may be because of fewer studies and fewer diagnoses carried out in Africa.
In Sub-Saharan Africa, the annual rate of new dementia cases is approximately 13.26 per 1,000 people, resulting in an estimated 367,698 new cases each year. [2] This region shows a rapid increase in dementia incidence with age, nearly doubling every 7.7 years as people grow older.
In Northern Africa, particularly Egypt, research shows an incidence rate of around 27 per 1,000 people over a 20-year period. Overall, Africa tends to report lower dementia incidence rates than Europe or North America.
Despite these projected figures for Africa, it's important to note that many people with dementia go undiagnosed. Hence, the need for more research and awareness in Africa for a clearer view of the prevalence of this condition.
Dementia comes in different forms, and each type of dementia affects the brain in its own unique way.
To understand the different types of dementia well, it is best to classify the condition first.
Dementia can be broadly grouped into three as follows (see figure 1);
Figure 1: Classification of Dementia. Click on image to enlarge.
This occurs as a result of damage to brain cells that can be arrested and improved if the cause is identified and treated early. Examples; head trauma, alcohol, or infections.
This is caused by slow onset and progressive brain cells damage.
Irreversible dementia can be further subdivided into primary and secondary.
For primary irreversible dementia, these are a group of brain conditions where the damage is permanent and cannot be cured. These diseases affect your brain directly, leading to a gradual decline in memory, thinking, and everyday abilities. Conditions like Alzheimer's disease, Parkinson's disease dementia, Frontotemporal dementia, Lewy Body dementia are classified as primary irreversible dementia.
On the other hand, secondary irreversible dementia include conditions like hypertension, high cholesterol, and atherosclerosis that increase your risk of vascular dementia. These conditions affect blood flow to your brain, which can cause blood vessels to narrow or become blocked, which can lead to strokes or brain cell damage over time.
Vascular dementia may be prevented when its risk factors are controlled early.
This occurs when brain cells are damaged but with evidence of mixed symptoms and signs of different types of primary irreversible dementias.
The three most common types of primary dementia include:
This is the most common type of dementia. Alzheimer's disease causes a slow but progressive degeneration of your brain cells. The affected degenerating brain cells die, and it causes memory loss, confusion, and inability to carry out daily tasks.
It's a condition that affects the way your brain sends signals to your body, especially those that control movement. Parkinson's disease occurs when neurotransmitters (a chemical messenger released by neurons) like dopamine start to die off gradually; this causes communication to break down, leading to movement problems. This disease is progressive, and it isn't curable. However, there are treatment options to help improve symptoms.
LBD is caused by abnormal deposits of a protein called alpha-synuclein in brain cells. This abnormal protein deposit causes damage to the cells and leads to memory problems, difficulty moving, and sometimes hallucinations.
The most common type of secondary dementia is:
This type of dementia is common in stroke victims as well as those with unrecognized micro-bleeds in the brain. Vascular dementia may occur as a reduced blood flow to an affected are of the brain, which in turn causes damage to brain cells to affect such brain functions like thinking, decision-making, and concentration.
Other uncommon types of dementia (primary and secondary) include:
Dementia happens as a result of damage to your brain cells. The brain controls the way you think, act, or move. When dementia affects any part of your brain, it also affects its ability to communicate and carry out the function assigned to that part of the brain. For instance, when the part of the brain that controls thinking is affected by dementia, you will find it difficult to think or concentrate.
Although the exact cause of primary dementia is unknown, researchers have found that genetics could play a significant role in the cause of dementia. [3] For instance, if your parent or sibling is living with Alzheimer's disease, a common type of dementia, it's highly likely you will have Alzheimer's disease at some point in your life.
Some causes of secondary dementia include environmental factors like:
There are some things that put you at risk of dementia. Some of these risk factors can be controlled, while others cannot be controlled.
These include:
As you age, your risk of developing dementia increases. This cannot be controlled because humans age naturally. Most people with dementia are 65 years and older. [1]
If dementia runs in your family, you have a higher risk of having it later in life. The reason for this is because every person has a gene connected, and that can be traced through their family history. [3] When it comes to dementia, genetics plays a vital role in determining if you are at risk of having dementia at one point in your life.
These include:
Health conditions like heart disease, high blood pressure, diabetes, and stroke are some of the medical conditions that put you at a higher risk of developing dementia.
If you had a serious head injury, it may also increase your risk of developing dementia later in life. When it comes to head injuries, it's important to conduct thorough and constant checkups because it can affect the brain and reduce your brain function.
If you indulge in unhealthy habits like smoking, poor diet, and excessive alcohol, your risk of dementia increases over time. You can reduce your risk by exercising, eating healthy, and stopping smoking and excessive alcohol.
The symptoms of dementia are gradual but progressive in nature. It starts gradually or mildly and becomes worse over time.
The symptoms of dementia can be classified into two, namely:
People with dementia often exhibit early signs that may or may not be recognised.
Dementia symptoms are still early if you begin to experience:
When dementia symptoms become severe, you may experience:
There is no one specific test known to determine if you have dementia. To be sure, a skilled healthcare professional could carry out different tests on you. These tests are to help the healthcare professional know if you have dementia and which type of dementia you have.
Before any test is done, your healthcare professional would:
In order to determine the type and progression of dementia, your healthcare professional could carry out any of the following tests:
The neuropsychological test is carried out to check how good your mental status is. It involves checks of several high order brain functions conducted by a neuropsychologist (a skilled healthcare professional who has a vast knowledge of how brain conditions affect behaviors and cognitive function).
Neuropsychological tests assess:
These tests can help your healthcare provider:
Two of the most common neuropsychological tests that your provider may perform on you include:
This examination is a brief test carried out by your healthcare professional to check the level of your cognitive impairment. The test involves questions asked to see if you have a problem communicating, following instructions, or an inability to remember things.
This test helps to assess how severe dementia is and track severity over time. This test has a total score of 30. Any score from 25 and above is considered normal, but a score below 25 is considered cognitive impairment.
This test is an updated and more sensitive version of the MMSE. It also contains 30 questions and procedures that are performed to help detect mild cognitive impairment (MCI)/decline and early signs of dementia.
The test is carried out to see if a person with suspected MCI dementia has problems with thinking, verbal and image communication, following instructions, paying attention, remembering things, or making decisions. A score of above 25 is considered good, but a score below 25 is considered cognitive impairment.
Other neuropsychological tests that could be carried out for a more detailed assessment of your mental condition include:
Your healthcare provider could carry out blood tests to help eliminate or rule out other conditions whose symptoms are closely related to dementia.
This test will check for:
Other general blood tests may include a Complete Blood Count.
3. Brain Imaging
The brain imaging test is used to scan your brain and identify any suspected cause of dementia. There are several brain imaging tests that can be carried out to identify changes in the structure and function of your brain.
The most common brain scans are:
Magnetic resonance imaging is often requested by your healthcare provider because it provides images of your brain to check for abnormalities such as tumours, strokes, or changes to the blood vessels in your brain that can cause dementia.
When conducting this imaging test, your healthcare provider uses a special X-ray machine to picture your brain. This picture gives your healthcare provider a well-detailed look inside your brain to see if there is any damage or unusual changes.
This scan is used to detect abnormal patterns of brain activity and changes in glucose metabolism, oxygen metabolism, and blood flow in and around your brain that are often present in Alzheimer's disease for example.
This test measures electrical activity in your brain. It's conducted if your healthcare professional suspects you have seizures, which occur in some form of dementia. To carry out this test, electrodes are placed on your scalp over several parts of your head. This helps to detect and record electrical activity, patterns, and any abnormalities.
4. Lumbar puncture (spinal tap)
This test involves the use of a needle that is inserted between the bones in your spine to collect cerebrospinal fluid from a space within the coverings of your spinal cord in your lower back. This fluid usually flows around your spinal cord and your brain to cushion and nourish the structures. This fluid can provide information and reflect what's happening in your brain.
5. Genetic Testing
The genetic testing is carried out to confirm if there is a strong family history of dementia. This will help to understand the level of your risk of dementia.
All of these tests are often conducted in combination to help healthcare professionals determine whether you have dementia, to understand the type of dementia that you have, and how it progresses. This helps in adopting appropriate care and the right treatment plan.
Unfortunately, there is no cure for dementia. [5] However, the good news is that there are ways to manage the symptoms of dementia to improve your wellbeing over time. The type of management approach to be used depends on the cause and severity of your dementia.
Below are the management and treatment options available if you have dementia:
The medications that can be administered to you by your healthcare professional include:
Drugs like donepezil, rivastigmine, and galantamine are medications that can be administered to you by your healthcare professional if you have dementia. The cholinesterase inhibitors help to boost a chemical in your brain called acetylcholine.
Acetylcholine helps the nerve in your brain to communicate effectively. This communication assists your brain to function better (memory and thinking).
Memantine is also known as an N-methyl-D-aspartate (NMDA) receptor antagonist. NMDA helps to regulate your brain chemical glutamate. Glutamate is involved in the memory and learning processes of the brain. NMDA is often administered to people with moderate to severe dementia. Think of NMDA as adding a protective layer or cover to your brain to keep it from overstimulating.
People with dementia often experience sudden changes in mood and behaviour. They also experience anxiety and depression and feel agitated. As a result, your healthcare provider may prescribe antidepressants (a prescription medication for treating depression), anti-anxiety drugs (a medication used to reduce symptoms of anxiety), or antipsychotic medications (medications used to treat mental disorders) to help with the symptoms. Think of these drugs as a pair of glasses that helps get your sight back into focus when they become blurry or distorted.
Non-Medication Management
People with dementia often exhibit or have bad or destructive thoughts. These destructive thoughts impact their behaviour or mood or both. Cognitive behavioural therapy (CBT) - a type of talk therapy - is used to help people with dementia learn, identify, and replace bad or destructive thoughts with good, positive, or more realistic thoughts.
To achieve behaviour change, your healthcare provider uses a modified form of CBT to:
This therapy aims at stimulating or improving memory, problem solving, and language abilities. Your healthcare professional sets up activities that help you task and work your brain (think). These activities would include word puzzles, creative exercises, question and answer games, etc.
An occupational therapist (a healthcare professional who helps people regain independence in their daily activities after illness, injury, or disability) is needed for this therapy. The occupational therapist helps people with dementia or brain-related conditions to relearn how to carry out and manage familiar daily tasks. This task includes dressing, cooking, brushing, bathing, eating, etc. The aim of the occupational therapist is to make you self-independent and make everyday life easier and safer.
Healthy habits like eating a nutritious diet and exercising regularly can help slow down symptoms of dementia and improve brain function over time. When it comes to eating nutritious meals, a dietitian (a nutrition expert who helps people make healthy food choices and manage dietary conditions), will be in the best position to guide you and structure a meal plan that will enhance and fuel your brain’s function.
Engaging in regular exercise helps to improve blood flow to the brain. As a result, you will need a gym instructor to help structure exercise routines that will help improve brain health.
People with dementia and their families/caregivers often need support in dealing with the emotional stress that comes with caring for and managing dementia.
Counselling support groups provide a safe haven to talk about your feelings and learn new coping strategies to improve dementia symptoms and stress. Think of this as finding a supportive friend who helps you navigate through rough or tough times.
Each management or treatment option mentioned aims at helping you manage dementia symptoms and improve and maintain quality of life. This makes each day a little easier and more comfortable for both a person with dementia, their family members, and or their caregivers.
Treating dementia in Africa comes with its own unique challenges.
Below are some of the major challenges:
Public awareness about dementia is still low in various parts of Africa. Both those in the rural and urban areas don't fully understand what dementia is. Even those with some form of understanding of the condition see the symptoms of dementia as a normal part of aging. As a result, people ignore these signs, which leads to delays in diagnosis and treatment.
The healthcare system in many African countries is still underdeveloped, unequipped, and inadequate to cater for the health needs of the people. Hospitals and clinics may not have the right equipment or specialists (neurologists and geriatricians) crucial for treating dementia.
For many people living in rural areas, travelling to the nearest equipped hospital can be expensive and time consuming. As a result, they seek other treatment alternatives, which most times are ineffective.
Dementia could take a longer period to treat, especially when symptoms take longer to improve. For many families in Africa, it can be financially frustrating. This is because treatment requires regular doctor visits, medications, and long-term care, which can be quite expensive.
Also, most people in Africa don't have access to health insurance schemes that can act as shock absorbers to reduce their financial burden. As a result, most families are often left to bear the full financial burden.
In some African communities, people with dementia are often referred to as “crazy” or "cursed." People with dementia are often neglected and stigmatized. As a result, family members hide a person with dementia away from the public eye instead of helping them to socialise with people and their environment. The truth is that hiding them away only further complicates the issue and worsens the condition and mental health.
Africa has a shortage of well-trained and qualified healthcare workers that specialise in treatment of dementia. Many of these trained and qualified healthcare professionals prefer to travel out of the country for greener pastures. As a result, family members are left to provide care without the right guidance or training. Over time, this may lead to burnout, which can impact the physical and mental health of caregivers.
While there are medications available for treating dementia symptoms, accessing these medications is a difficult task in many parts of Africa.
Some of the medications may not be available at local healthcare centres or neighbourhood pharmacies. Also, in situations where the drugs are available, adulterated drugs are the ones sold to unsuspecting victims. Without reliable and constant access to authentic medications, managing dementia may become more challenging.
Many African countries lack national strategies, political will, and policies aimed at addressing dementia. Addressing this condition will require coordinated and deliberate effort towards making effective policies and implementing them. Also, the government should provide funding to train professionals and for research purposes.
If most of these challenges are addressed, the quality of life of many Africans living with this condition will improve. This will require deliberate and conscious effort on the part of the government, healthcare professionals, and caregivers.
Dementia usually affects older people, and the risk of this condition increases as you age. Most dementia cases become evident at about age 65 and above, but that does not mean the condition starts at that age. It is believed that the start of dementia may be as early as 15 - 20 years before the condition is diagnosed. Dementia can also affect younger people between the ages of 30-64. [6] The type of dementia that affects younger people is rare and it’s called “younger-onset” or “early-onset dementia."
The sad truth is that dementia cannot be permanently cured at the moment. [5] However, treatment and management methods are available to help you manage the symptoms and improve your wellbeing over time. Also, researchers are exploring and looking for ways to slow dementia progression.
The duration of dementia symptoms depends on its stage and progression. On average, people with dementia may live as long as 4 and 10 years after diagnosis. [7] However, some people may live with the condition for a much longer period.
The awareness level of a person with dementia depends on the level of severity. In the early stage of dementia, a person with the condition may recognise something is wrong but may not fully understand what's happening. As dementia progresses, the person’s awareness begins to reduce, and they may no longer recognise or realise they have the condition.
Caring for a loved one with dementia can be challenging. However, there are tips and methods you can adopt to help improve their quality of life.
Below are some of those tips:
Summary
Dementia is a complex condition that affects memory, thinking, and behaviour, which often impact the daily lives of people living with this condition. It's becoming a growing concern across Africa as more people are living longer. With dementia on the rise, it's important for you to understand what it is and how it affects both you and your loved ones.
There is no cure for this condition. However, there are management methods that can improve symptoms over time. There are some challenges in caring for people with dementia in low resource settings like in sub-Saharan Africa. These include low public awareness of the condition, cultural stigma, few trained health personnel for the population served, inadequate infrastructure, medication stock-out, etc.
Managing dementia and helping people understand this condition requires a lot of effort from governmental agencies and other healthcare stakeholders. With improvement in these challenges, sub-Saharan Africans will understand how to lower their risk for dementia as well as how the condition can be managed with compassion and care.
1. World Health Organization. Dementia [Internet] 2023 March 15. [Cited 2024 Oct 27]. Available from here.
2. Akinyemi RO, Yaria J, Ojagbemi A, Guerchet M, Okubadejo N, Njamnshi AK, et al. African Dementia Consortium (AfDC). Dementia in Africa: Current evidence, knowledge gaps, and future directions. Alzheimers Dement. 2022 Apr;18(4):790-809. doi: 10.1002/alz.12432. Available from here.
3. National Institute of Aging. Alzheimer’s disease genetics fact sheet [Internet]. Last reviewed 2023 March 1. [Cited 2024 Oct 27]. Available from here.
4. Alzheimer's Association Press Release. Alzheimer’s risk factors may be measurable in adolescents and young adults. [Internet] 2020 July 30. [Cited 2024 Oct 27]. Available from here.
5. NHS UK. Is there a cure for dementia? [Internet]. Last reviewed 2024 April 19. [Cited 2024 Oct 27]. Available from here.
6. Mayo Clinic. When Alzheimer’s symptoms start before age 65 [Internet]. 2024 April 19. . [Cited 2024 Oct 27]. Available from here.
7. Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. Heterogeneity in reports of dementia disease duration and severity: A review of the literature. J Alzheimers Dis. 2021;84(4):1515-1522. doi: 10.3233/JAD-210544. Available here.
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Published: November 1, 2024
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