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Buddhi Stories Dementia Elders Featured Patient Stories

Bharadwaj – The Resurrection

Biography

Bharadwaj at 74 years was alert, active, enjoyed life as a whole and the company of his son, daughter, their spouses and their children. Born into an illustrious industrial house of Madras, he pursued his engineering studies abroad and came back to join, along with his 3 brothers, the industry founded by his father. In contrast to Jayaraman our other patient with dementia, here was Bharadwaj, with a huge extended family, all living close by, with him and his wife living with the son’s family, with a doting daughter and family next door. Socializing within this inner group, with true camaraderie and meeting over a meal on the multiple Indian festive occasions with exchange of gifts, and taking turns in singing south Indian classical music compositions solo or in groups was the traditional practice, a form of partial community living which could curb individuality, but did have its benefits for extended families that kept in close touch. There was  support through thick and thin from extended family, close family ties among large extended families being common till 3-4 decades ago. The advantages of such mutual support is slowly being eroded as families scatter and few of the younger generation, who migrate to greener pastures in the quest of employment and upward mobility, are left behind.

Exploring the Condition

Bharadwaj’s loss of cognitive ability was subtle and demonstrated itself as changes in mood and behavior. His family noticed several changes in him over time; he became progressively withdrawn socially, spoke very little, stopped watching TV or reading the newspaper. In stages, fatigued, depressed and lacking motivation, he confined himself to bed, and with less physical activity, he became a near recluse in the midst of the over-reaching social interaction around him. More worryingly, for the family, the gregarious family man became paranoid and prone to spells of aggression, a change that was both frightening and distressing. No amount of coaxing and cajoling from his son, daughter and other close family members could shake his resolve to slowly fade away. It is in this mood that he was brought to TriMed-Neurokrish, stubborn as a mule and refusing to co-operate for the comprehensive assessment and showing resistance to undergo therapy.

Bharadwaj was not diabetic or hypertensive. His lab reports were unremarkable. He had followed the middle path in his lifestyle, well-disciplined, with no excesses, and no smoking or drinking. He was, however, addicted to south Indian classical music, and would venture into complex pre-composed music, and sing along with his daughter in a state of joy and sheer abandon as the melody flowed in an unfettered cascade. Where had that music gone?

It was the gentle persuasion of the daughter and daughter-in-law on the one hand, and the professional prowess of the TriMed-Neurokrish team on the other, that saw the thawing of Bharadwaj‘s adamant early phase, and he entered the phase of acceptance of the assessment and integrated therapy, though rather grudgingly to start with. A diagnosis of Dementia, stage 2 was made, knocking threateningly at the doors of stage 3 if not intensively managed. His behavioural manifestations were those of apathy, irritability and aggression on the Neuropsychiatric Inventory (NPI).

Our Healing Approach

Bharadwaj was already on Admenta (memantine) and Cognix (piracetam) along with a mood elevator prescribed by a Neurology Consultant, who had seen him in early 2015. We added a small dose of an antipsychotic, Olanzapine. With strengthening of the lower limbs and gait training, Bharadwaj became less dependent as he walked with minimal support, and his low back pain, and body pain, which he had brought upon himself with poor physical activity, was under control. Abhyanga (Ayurvedic whole-body warm, herbal oil massage), Shirodhara (Ayurvedic therapy that involves gentle pouring of liquids over the forehead) and Acupressure ran parallel, as part of the intensive therapy. Reflexology was also introduced. It was a slow and tedious process that shook off the negative apathetic behaviour and veered Bharadwaj toward a more positive behaviour.

Reflexology

Reflexology is an ancient traditional massage form, involving particular areas of feet, hands and ears which are believed to represent specific human internal organs and body systems. These areas have been mapped elaborately especially to guide foot reflexology. The skilled massage can achieve positive changes in the function of these organs and systems and is also effective in neck, upper back, lower back, painful disorders of the spine, and knee pain. In the book “Relieving Pain At Home” authored by William H. Fitzgerald (1917), an ENT specialist, he observes “Humanity is awakening to the fact that sickness, in a large percentage of cases, is an error of body and mind”, echoing the modern concept of body-mind link in many chronic medical conditions. Reflexology as a discipline shares the common belief of the ancient therapies, in that of opening of any block in the energy channels of the body.

Our Focus

Cognitive retraining is a therapeutic strategy that seeks to improve or restore a specific person’s skills in the areas of paying attention, remembering, organizing, reasoning and understanding, problem-solving, decision making, and higher level cognitive abilities. The primary aim of this therapy is to train the patient to overcome the cognitive difficulties that interfere with day to day activity, towards gaining independence in activity.

Retraining usually begins with simpler cognitive skills like attention, short term memory and information processing and then proceeds to more complex skills like problem solving, and executive function. Each identified lost skill is retrained using graded practice of activities. Cognitive retraining involves repetitive practice that focuses on the skills of interest. Repetition is essential for the newly retrained skills to become automatic. Cognitive retraining requires a quiet room without distractions and the patient must be able to relax to receive optimum benefit from the retraining.

References

Alex Bahar-Fuchs A, Clare L, Wood  B Cognitive Training and Cognitive Rehabilitation for persons with mild to moderate dementia of the Alzheimer’s or vascular type: a review Alzheimers Res Ther. (2013) 5 (4): 35

Malhotra S,. Bhatia MS, Rajender G, Sharma V, Singh TB Current Update on Cognitive retraining in Neuropsychiatric disorders Review Article Delhi Psychiatry Journal (Oct. 2009) 12 ( 2 ): 213-218.

Looking Ahead

At the 6 month follow up, Bharadwaj is well overall, except for the occasional disturbances at night.

  • Aricep (donepezil) 10mg – 1-0-0
  • Admenta (memantine) 10mg – 0-0-2
  • Cognix Plus (piracetam + gingko biloba) 1-0-1
  • A to Z  1-0-0
  • Supracal A (calcium + D3) 1-0-0
  • Epitril 0.5 mg (clonazepam) was prescribed SOS at bedtime

He continues his therapies once a week. Bharadwaj walks with a little support within the house, is more independent in his self care, but needs help with soaping himself, and toweling after a bath. He socializes with immediate family members and language is more fluent and the content shows improvement. The lyrics of familiar songs are well recalled and musically expressed, as they go with the melody and the beat. Being able to sing puts him in a mood of elation. Perhaps most striking, he has islands of great clarity in thought and expression now. Recently, while watching a cricket match (another of his erstwhile passions) on the television, he regaled his family to their delight with comparisons, about the innings being played and another famous one from cricketing history. The family is pleased to see Bharadwaj enjoy some quality of life and never miss the once a week therapies.

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Adults Bipolar Disorder Elders Expert Blogs

From Elusive Cure to Enabling Comfort

We must consider quality of life and wellness as treatment outcomes and ask ourselves whether the treatment we opt for will help us achieve these outcomes.

Quality of life is a relatively novel concept that dominates both medical science and health policy today and is widely accepted as the best indicator of outcome of treatment. The focus among practitioners of modern medicine, and indeed, in social consciousness, however, remains firmly on the elusive concept of “cure.” The adage among medical practitioners of yore: “to cure sometimes, control often; but comfort always,” hints at the importance of life quality, one that is forgotten, however, in the quest for miracle cures.That the majority of chronic conditions defy cure is something doctors know, but often choose to be agnostic of. Thus apart from infections, inflammations, metabolic disturbances and transient visitations of their ilk, that respond well to drugs designed to terminate them; and indeed abnormalities of structure (organs that have lost structural integrity) that are amenable to surgical intervention, the vast majority of medical conditions while potentially controllable, are not curable. Diabetes, hypertension, high cholesterol levels, ischaemic heart disease, stroke, epilepsy, dementia and a host of other conditions while “treatable” and/or “modifiable” (relief from clinical symptoms and attendant complications) are not “curable.” The promise of a “cure” for many chronic diseases thus remains wishful; that rainbow with its elusive pot of gold, at the end of the dark, illness cloud.There is no doubt we are living longer as a society, and this longevity is attributable, in great part, to advances in modern medicine; cardiac bypass procedures, joint replacements, organ transplants and such like. There is ample evidence to support our collective social longevity, the average Indian lifespan having increased by over a third, since the time of independence, the increase being greater in “advanced” societies like Japan. However, whether such longevity leads automatically to enhanced quality of life remains a conjecture. For example, the follow-up data after a cardiac bypass surgery, arguably the best known lifespan enhancing procedure, shows in many studies high rates of depression and cognitive dysfunction (memory and higher order brain function problems) 5-10 years after the procedure. It would be fallacious to blame the bypass procedure for these complications in the brain and mind; after all, had the person with ischaemic heart disease lived long enough, without the procedure, he might have developed these anyway. However, in evaluating the overall “success” of such procedures or advocating their widespread application through policy implementation, these factors must be considered carefully. In this instance, the question that begs our attention is: “while the procedure enhances lifespan, does it enhance the quality of life?” And if it does not for a select group, who constitutes the group? Why not for it? When does it enhance the quality of life, and when doesn’t it? What determines the outcome in a given individual? Where and how is this outcome determined? These questions need clear answers and we do not always have them.It is striking how both modern medicine and society are obsessed with the concept of “cure,” the quest for magic pills (or, indeed, magic procedures) that will help achieve the longevity goal, being never ending. The energy, enterprise and expense invested in this quest, by affected individuals, their families, and governments are, unfortunately, not always rewarded with a good quality of life after the procedure. Our obsession with “cure” probably comes from two very different directions. The first is idealistic; the tantalising possibility that we will, through advancements in science and technology, “fix” the vast majority of problems concerning the human body. When mankind has learnt to fly, build tunnels through mountains and under the sea, and transport itself into space at will, this aspiration of curing chronic diseases and enhancing longevity does not really seem that distant a frontier.The second, however, probably has more sinister origins that merit careful consideration. The business of curative medicine is enormously lucrative and demands the constant creation of markets that will utilise the goods and services it develops. What could interest the human race more than the possibility of a cure for illness and life-enhancement (with or without quality)? A degree of scepticism of novel, potentially curative treatments is, therefore, warranted in the modern social context, and we must examine carefully whether the promise of “a magic cure” for any chronic condition guarantees alongside an improvement in the quality of life. Thus, while we share a collective belief that people not only live longer due to advances in medical science but also live well, the presumption of a better quality of life, is sadly, in many instances, just that — a presumption!Scientifically viewed, the proof that many modern medical treatments enhance the life quality remains tenuous, to say the least. At a recent lecture in VHS, Chennai, Shah Ebrahim, Professor at the London School of Hygiene and Tropical Medicine and Chair of the South Asian Chronic Diseases Network, a renowned international expert on chronic disease epidemiology, rued our societal predilection for magic bullets (The Hindu, January 9, 2010). Talking about the “polypill” — a combination of aspirin (blood thinner), a Statin (to lower cholesterol levels), and antihypertensive agents (to lower blood pressure) — that is intended to enhance cardiovascular health, he pointed out that simple health promotion measures such as changing over to rock salt from processed salt (high in sodium) and using soya oil as opposed to palm oil (which strangely attracts a lower tax probably due to anomalies in trade policy) were just as likely to improve cardiovascular health. These are far cheaper for governments to implement, and relevant to developing nations.Prescribing the widespread use of the polypill for the middle-aged, as opposed to implementing these simple public health interventions through changes in policy, both health and trade, will be deleterious in many ways, he opined. It will be costly to the nation and poorly sustainable, will have low penetration in society and perhaps, most importantly, take away the responsibility for our health from us, placing it firmly in the hands of the pharmaceutical industry. Further, the former approach, of making people assume responsibility for their lifestyle and diet, alongside the implementation of a complementary government lead policy, is far more likely to enhance other desirable health behaviours in society and, indeed, global health outcomes.Why do we then as a society look to the “polypill” with such enthusiasm or consider it with such seriousness? The answer probably lies in our preference for “cure” as opposed to comfort and life quality. Happily for us, improved quality of life and “wellness,” a concept that has traditionally dominated eastern thought and traditional medical systems, is today receiving much global attention. Wellness encompasses both physical and mental well-being, the latter being a dynamic state of optimal functioning referring to the individual’s ability to develop his or her potential, work productively, build strong and positive relationships with others and contribute to the community. We must recognise that the prevention and management of diabetes extend far beyond the popular notion of blood sugar control; that cardiac health cannot be achieved merely by unblocking blood vessels and enhancing circulation through a stent or bypass; and indeed that the drugs for dementia available today do not even guarantee slowing of disease progression, let alone cure or reversal.Given this scenario, we as a nation and society must consider quality of life and wellness as treatment outcomes, quite seriously, and ask ourselves whether the treatments we are considering, however technologically advanced and seductive, will likely help us achieve these outcomes. We would also do well to examine closely the role of traditional and indigenous medical systems that have for centuries retained this focus on wellness and life quality through health promotion, prevention of illness, care and comfort for those affected with chronic illness; not merely curative treatments.

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Dementia Dementia & Memory Loss Elders Expert Blogs Featured

Dementia: A Looming Threat

Photo Credit: The Hindu: N Sridharan

A low level of awareness about dementia is most often why diagnosis is delayed and public health consciousness remains poor.

World Alzheimer’s Day (September 21) was marked this year, in India, by the release of a comprehensive Dementia India Report. Prepared by national experts, converging under the Alzheimer’s and Related Disorders Society of India (ARDSI) umbrella, it estimates that there are 3.7 million elderly currently living with dementia in India, each spending Rs. 43,000 per annum on medical care. Dementia mainly affects older people, although about two per cent of cases start before the age of 65 years. After this, the prevalence doubles every five years with over a third of all people aged 90+ years being affected. With the exponential increase in the population of the elderly (60+ years) in India, an estimated 100 million today, expected to rise 198 million in 2030 and 326 million in 2050, dementia poses a looming public health challenge, the enormity of which cannot be underscored. The report thus addresses a felt need among professionals, policy makers, dementia sufferers and their families.

What it is ?

Dementia is a neuropsychiatric disorder in which memory and other cognitive functions like thought, comprehension, language, arithmetic, judgment and insight deteriorate progressively.

While it increases in prevalence with advancing age, it is not a normal feature of ageing, a common misconception. Further, dementia is a clinical syndrome, one with many underlying causes, some potentially treatable. Of the many conditions that cause dementia, Alzheimer’s disease (AD) associated with neuro-chemical decline and waste product accumulation in the brain; vascular dementia (VaD) associated with strokes; dementia with Lewy bodies (DLB), a condition associated with Parkinson’s disease; and frontotemporal dementia (FTD), are most common.

The treatable conditions that cause dementia include infections such as syphilis, HIV and tuberculosis; hypothyroidism and other endocrinal problems; vitamin B12 and folic acid deficiency; toxic conditions of various kinds and so on. As they are potentially reversible they need to be addressed swiftly.

What the report highlights ?

The report highlights two areas of great import for dementia sufferers and their families: activities of daily living (ADL) an important measure of the human condition, and behavioural and psychological symptoms associated with dementia (BPSD), an important predictor of health related quality of life (HRQoL). Problem behaviours in dementia include agitation, aggression, calling out repeatedly, sleep disturbance, wandering and apathy.

Common psychological symptoms include anxiety, depression, delusions and hallucinations. BPSD occur most commonly in the middle stage of dementia and are an important cause of caregiver strain. They appear to be just as common in low and middle income countries as in developed ones.

The report outlines the current evidence based pharmacological treatments for dementia, especially AD and VaD: cholinesterase inhibitors (donepezil, rivastigmine, galantamine); NMDA agonists (memantine); drugs for BPSD (SSRI’s for depression and anxiety; new antipsychotics for psychotic symptoms like agitation, aggression, hallucinations; antiepileptic drugs that serve as mood stabilising agents); addressing also their cost-benefit in low-middle income countries. It also lays stress on the importance of structured caregiver interventions as part of standard treatment including psycho-educational interventions for dementia; psychological therapies such as cognitive behaviour therapy, cognitive retraining and family and caregiver counselling; as also caregiver support and respite care. Highlighting that caregiver interventions have been conclusively shown to delay institutionalisation of the person with dementia in the developed world; it observes that many new treatments in advanced stages of research hold promise for persons with dementia and their families.

The report differentiates risk factors into those that are non-modifiable (genetic factors for example) and those that are potentially modifiable. It highlights the extensive and evolving medical literature on the role of lifestyle diseases: diabetes and insulin resistance; high cholesterol levels; high blood pressure; increased fat intake and obesity; together the so-called metabolic syndrome as a modifiable risk factor for dementia. It is important that policy makers recognise these factors as targets for both primary (early) and secondary (after the onset) risk factor prevention. It points to the low level of awareness about dementia as an important reason why diagnosis is delayed and public health consciousness remains poor.

Worryingly, it observes that the lack of awareness extends to health professionals, formal training in dementia diagnosis and care not being a part of most medical, nursing and paramedical curricula; a matter of great concern needing immediate remediation. That stigmatisation of persons with dementia is rampant and that there is a need for raising awareness about the condition across segments of society is explicitly stated.

In India…

Assuming incremental life expectancy and a stable incidence of dementia, the report attempts to estimate the future burden of dementia both nationally and State-wise.

A twofold increase in dementia prevalence to 7.6 million by 2030 and a threefold increase to over 14 million by 2050 are thus estimated. Interestingly in the State-wise estimation, Delhi, Bihar and Jharkhand are all estimated to witness a 200 per cent or greater increment in dementia cases.

These figures have of course been calculated based on certain assumptions. When one factors in the significant disability that dementia confers on the affected person, estimated as being greater than any other health condition except severe developmental disability, the impact of this exponential rise in prevalence, even put mildly, is staggering. The report addresses the need for services to be developed: memory clinics, day care, residential care, support groups and helplines, pointing out the paucity that currently exists. Also highlighted is the severe paucity of human resources for dementia care.

A number of short-term and long-term focus goals, to improve resources; as well as scope, scale and quality of care are proposed.The report concludes with several key recommendations. The most important of these are:

  • Make dementia a national priority
  • Increase funding for dementia research
  • Increase awareness about dementia
  • Improve dementia identification and care skills
  • Develop community support mechanisms
  • Guarantee caregiver support packages
  • Develop comprehensive dementia care models
  • Develop new national policies and legislation for people with dementia

While these recommendations do address the need for dementia to be integrated into the National Policy for Older Persons (NPOP), they predominantly highlight the specific needs of dementia as a disabling and common condition among the elderly; one that can and will challenge Indian public health systems. However, the report acknowledges that dementia must be viewed in the context of other elder health problems, and within the framework of the NPOP.

Sets a gold-standard

Perhaps the greatest contribution of this Dementia India Report is in its setting a gold-standard for other disorders of ageing: quantifying the prevalence and burden of the condition; its impact on the sufferer, caregiver and society as a whole; the framework of services required in order to give succour and solace to sufferers and their families; the causes, risk factors, treatments and management models; and the State-wise national impact.

One fervently hopes that it will facilitate a powerful and futuristic policy response from the powers that be. In a country where the average age of the parliamentarian clearly falls in the “elder” category, one can only hope that it will be welcomed and adopted with the enthusiasm it richly deserves.Acknowledgements: Dr. K Jacob Roy, National Chairman of Alzheimer’s and Related Disorders Society of India (ARDSI) for permission to present this summary of the report and the use of figures.

Facts: 

  • There are 3.7 million elderly currently living with dementia in India, each spending Rs. 43,000 per annum on medical care
  • A twofold increase in dementia prevalence to 7.6 million by 2030 and a threefold increase to over 14 million by 2050 are thus estimated
  • Many new treatments in advanced stages of research hold promise for persons with dementia and their families

With the exponential increase in the population of the elderly in India, the disorder poses a challenge to public health systems.

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Dementia Dementia & Memory Loss Elders Expert Blogs Memory Problems

Perspectives in Dementia Care and Health Policy

A health policy for dementia should be comprehensive, especially spelling out the role of family, community and government.A brainstorming session on future perspectives in dementia care and health policy, at the National Dementia Summit held recently in New Delhi, is most insightful. The key prompts for this interactive session are simple and follow a 5W1H management model — who, what, why, when, where and how, in Rudyard Kipling’s “six friendly men” mould. We begin by asking who should take part in developing public policy. The large number of stakeholders becomes apparent: apart from Government, civil society agencies, medical, nursing, paramedical and other professionals, university faculty and researchers and those engaged in the care of dementia; the person affected (if able), their caregivers and families, clearly should all have a say in health policy development. Other stakeholders include the insurance sector, private care providers and agencies rendering dementia related services — pharmaceutical, nutraceutical, medical instrumentation industries; hospitals, hospices and homes. There is unanimity on whom health policy should target; everyone affected by the condition regardless of their economic or social

Photo Credit: The Hindu : N. Sridharan

circumstances.Prevention of Risk FactorsWhen should dementia health policy become operational (at what point of time in the lifespan) we ask. The discussion among experts is animated. They point out that primary prevention i.e. the prevention of risk factors that increase the likelihood of dementia development: hypertension, obesity, high lipid factor levels and diabetes; smoking and alcohol consumption; should begin young, perhaps even in teenaged years. These being the risk factors for many chronic and lifestyle diseases, the benefits of such primary prevention will undoubtedly go far beyond dementia, to a host of other chronic and lifestyle diseases. Secondary prevention, the optimal management of risk factors once they have developed, usually begins in middle age, when risk factors surface and are first detected in individuals. Tertiary prevention, early diagnosis of dementia, even in the mild cognitive impairment stage, often mistaken to be part of normal ageing; the early treatment with drugs that can slow down the disease; and supportive interventions for the caregiver, is universally believed to be mandatory. The group is unanimous that the time for a well defined national health policy is now, when there are an estimated 100 million elders in India, 3.7 million of whom are believed to have dementia.Participants believe that a health policy for dementia should be comprehensive and cover standards for diagnosis, treatment, clinical management; spelling out clearly the role of the family, community and government. Aside from this, dementia requires considerable care, which goes far beyond cure: rehabilitation care, respite care and palliative care, all of which must be clearly outlined. Dementia is a condition with many ethical, legal and financial implications that need to be addressed; and is also the focus of much research. Participants feel strongly that such health policy development should be inclusive and bottom-up, assimilating inclusively the views of all stakeholders; not top-down, based on the views of a minority who have access to the corridors of power. International delegates point out that there is evidence today that the bottom up approach to policy making is far more likely to work that the top down one. In this context participants express their regret that much of health policy development in India remains top down, with stakeholders being seldom consulted.Discussing the focus of a health policy, there is general agreement that all essential domains of dementia care need to be addressed: thus the person, family especially the principal caregiver and community health resources all need importance. However, given dementia’s inherent nature, a disabling condition with complex medical and social needs, secondary care, even tertiary care, cannot be avoided at times of diagnosis; for management, both drugs and non-drug therapies; and complications. At the same time rehabilitation care, both in-patient and out-patient, needs emphasis. When asked to choose between these different domains of care, putting focus on one, participating experts and stakeholders are unanimous; the person, his family and the community resources they can leverage upon are a paramount focus of health policy development.We proceed to ask “who should do what?” for the person with dementia. Interestingly, the need for co-operation and partnership between government, civil society, private providers and affected families becomes immediately apparent. The government clearly has to lead on making dementia a national priority, guaranteeing support for the caregiver and developing new dementia policy and legislation, all of which need immediate and timely action. On the other hand civil society support groups and care providers clearly have their work cut out for them taking ownership for tasks like increasing awareness in the community, improving dementia identification and care skills, and developing community support systems. The development of comprehensive care-giving models will require the involvement of experts: universities and tertiary facilities, working in tandem with affected families. Research is seen as one area where all parties need to take part. The government must increase funding for dementia research; pharmaceutical agencies and industry must contribute their mite; as must universities and other academic agencies; civil society supporting and enhancing the process; families participating with enthusiasm and altruism.The development of dementia health policy, as it has unfolded here, is by no means unique to that condition. The majority of chronic diseases, a rising burden in India today, will require a similar approach: paradigms that address long term care (when cure is not an option); participation and co-operation among a range of agencies, often as different from one another as chalk is from cheese; and inclusive, bottom up health policy development. While a nodal national agency charged with this responsibility will probably be part of the answer, this discussion on dementia brings to the fore, an urgent felt need in this country, for health policy paradigms that will address the emerging epidemic of chronic and lifestyle diseases. Isn’t it time our policy makers and Kipling’s six friendly men, met?

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Bipolar Disorder Dementia Elders Expert Blogs Featured

Food for Thought

A healthy diet and lifestyle can stave off memory loss.Dementia is a disorder of brain aging caused by a range of factors: degeneration of chemical systems in the brain; accumulation of waste products; diminishing blood perfusion leading to many small areas of damage (microvascular infarction); and several other causative factors.Prevention assumes great significance in this era of chronic and lifestyle diseases; with hypertension, obesity, lipid disorders (high cholesterol) and diabetes (HOLD) being rampant in society. Nutrition underpins both HOLD and dementia.It is well known that sub-clinical deficiency in essential nutrients can lead to dementia. Research has shown memory deficits in people with low plasma levels of vitamin B 12, folic acid, lycopene, a-carotene, b-carotene, total carotene, b-cryptoxanthin, a-tocopherol etc.

There is mounting evidence for the Mediterranean diet — high consumption of olive oil and fish, hence elevated intakes of monounsaturated fatty acids and v–3 polyunsaturated fatty acids — being protective against age-related cognitive decline. The antioxidant compounds in olive oil (tocopherols and polyphenols), and fatty acids may help maintain the structural integrity of nerve membranes. The naturopathy food pyramid is a good indicator of what we should eat in order to remain healthy and prevent dementia.There is no doubt that red wine consumed in moderation may be beneficial, reducing bad cholesterol, preventing blood clots and protecting the heart. The protection may come from the constituents of red wine made from tannin grapes, which include procyanidins, a class of flavonoids also found in plants, fruits and cocoa beans. Thus moderate red wine consumption maybe good, but only when accompanied by a “healthy” lifestyle.There is growing evidence that vitamin supplementation has a significant role to play in lowering the risk of dementia. Evidence for vit C, E, B12 and folic acid — as supplements in higher doses — is particularly strong. Indeed, the US FDA has recommended folic acid fortification of foods, for example flour and bread. High vitamin levels due to inappropriate supplementation can, however, be problematic and must be guarded against.It has long been known that certain plant formulations — Brahmi (Bacopa Monnieri), Tulsi (Basil), Ashwagandha (Withania Somnifera), Curcumin (in turmeric), extra virgin coconut oil — may enhance memory function and these are subjects of active research. Evidence to support over-the-counter plant formulations is, however, not available.A well-preserved memory is the cornerstone of a good life; good nutrition and a healthy lifestyle will help us achieve this milestone. To paraphrase the great bard, do we not desire to avoid or at least postpone our “sans everything” years?

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