NCDs a Major Risk Factor for Dementia

As the Ministry of Health and Wellness ramps up measures to prevent and manage non-communicable diseases (NCDs), psychiatrist at the Bellevue Hospital, Dr. Brian Kazaara, is highlighting the connection between chronic diseases and the neurodegenerative condition dementia.

He tells JIS News that while there has been an increase in cases of dementia locally due to the aging population, certain medical conditions like diabetes, high blood pressure, and stroke can increase risk by damaging the brain’s blood vessels and impairing its overall function.

NCDs like diabetes lead to high blood sugar, which harms blood vessels, while hypertension and high cholesterol also reduce blood flow to the brain. The impaired blood supply can result in reduced brain function and cognitive decline, ultimately increasing the risk of dementia.

“In Jamaica, we have very high rates of NCDs. Hypertension, diabetes – all of these are risk factors for dementia and if they are not adequately treated, they can lead to the progression of the disease in some cases, or just a reduction in the quality of life for the older adult as sometimes they may not remember to take their medication,” he says.

Dr. Kazaara points out that physical inactivity, smoking, and poor diet contribute to the risk of NCDs and the development of dementia.

“It becomes very important that you ensure that these NCDs are adequately treated,” he tells JIS News.

Primarily affecting the elderly, dementia is a general term for a decline in brain function caused by the progressive damage, loss of connections, and eventual death of nerve cells (neurons) in the brain.

It is a complex and multifaceted condition, encompassing a wide range of cognitive, behavioural and personality changes, rather than a single disease.

Memory loss, confusion, difficulty with familiar tasks, forgetting names, even of loved ones, are among the common signs of dementia.

The World Health Organization (WHO) states that dementia is the seventh leading cause of death and a major contributor to disability and dependency among older people globally.

The impact of the disease is significant, with far reaching consequences for individuals diagnosed, their loved ones, caregivers, and the wider society.

Dr. Kazaara, who is President of the Jamaica Psychiatric Association, tells JIS News that people with dementia have difficulty performing daily tasks.

“They have trouble with things like memory. They find it difficult to concentrate, they are no longer able to perceive their surroundings as they used to, or they are no longer able to plan and problem solve like they used to.

“It is therefore not surprising that they are no longer able to support themselves… bathing, using the toilet, being able to cook, being able to feed oneself. When someone has dementia, depending on the severity, their ability to do these tasks does decrease,” he says.

Dr. Kazaara notes that “some persons are on the milder end of the spectrum and they may still be able to do these things while others may require a much greater level of support and that can exert a burden on family systems, both emotionally and financially.”

In addition to NCDs, risk factors associated with dementia include advanced age, family history, and certain genetic mutations.

There are several types of dementia with Alzheimer’s disease, Vascular dementia, Lewy body dementia (LBD), and Frontotemporal dementia being the most common.

Alzheimer’s accounts for around 60 per cent to 70 per cent of cases of dementia, with the most common early symptom being difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, self-neglect, and behavioural, and withdrawal from family and society.

Vascular dementia is caused by reduced blood flow to the brain often due to a series of small strokes or changes in blood vessels, while LBD results from the abnormal buildup of alpha-synuclein protein (Lewy bodies) that damages nerve cells, causing cognitive issues like attention problems, visual hallucinations, and disorganised thinking.

Frontotemporal dementia is a group of diseases that affect the front and temporal lobes of the brain, leading to changes in personality, behaviour (increased irritability or aggression), and language.

People with dementia suffer from mood changes, becoming easily agitated, anxious and depressed. They experience a decline in key functions like language, attention, ability to perceive reality, and executive function (ability to plan and execute tasks, and problem solving), and social cognition, which is the ability to navigate their social environment.

“One of the most common symptoms we see in persons with dementia is memory loss. In a lot of cases, there is first a loss in short term memory – things that happen over the course of minutes or hours. So, persons may not remember where they put their keys for instance,” Dr. Kazaara points out.

He says that as the condition progresses there is a decrease in long-term memory.

“They may also have difficulty concentrating. They may not be able to focus on a particular task for an extended period in the way that they used to. They may also have difficulty with language, they may not be able to communicate as easily as they used to, and in social interactions, they may no longer be able to interact with others in the way they used to. It may be more notably awkward or different than it once was,” he points out.

Emphasising that dementia is not an inevitable consequence of aging, Dr. Kazaara says, “just because one ages doesn’t mean they are going to end up with dementia. It is not something that has to happen. Dementia is a disease process and some people live to be 70, 80 and don’t develop dementia.”

He says that timely diagnosis is crucial for effective management and care.

Non-pharmacological interventions such as cognitive training, physical activity and social engagement that support mental function and overall well-being, can help slow cognitive decline.

“Exercise is one of the best ways to address those conditions, but also, exercise has been shown to be beneficial for brain health. Exercise is something that persons of all ages should be doing, but it is beneficial for older adults and people with dementia.

“Because dementia is a brain disorder (a lot of people) may not think that physical activity is particularly important, but it is very important,” Dr. Kazaara notes.

For caregivers, he encourages a healthy diet, adequate hydration and social interaction for good brain health.

“By spending time with our older adults and allowing them to regularly engage in social activity, we can actually help them with their condition and improve their quality of life,” he says, further urging persons to ensure that dementia patients are aware of current events.

“They may not be entirely aware of the date or time or they may not remember the day of the week for example. What we encourage is to be patient, not to get frustrated, be gentle and remind them what month we are in and what year it is. That reorients them so they are more aware of these things,” Dr. Kazaara explains.

“Being gentle in your communication goes a long way in pacifying any situation,” he adds.

He also recommends that families seek the assistance of geriatric care givers or prescribed medication from a physician.

“Doctors can provide some kind of medication depending on the severity of the condition. When it becomes particularly severe, or dangerous, or where it appears that the older adult might be a threat to themselves or others, at that point, seeking professional assistance is an option that should be considered,” he advises.

Dr. Kazaara is encouraging persons to contact the Ministry of Health and Wellness, the Mona Aging and Wellness Centre, or the National Council for Senior Citizens (NCSC) to access resources and support for persons and families impacted by the disease.