Dementia is a complex condition that affects millions of people worldwide. It is not a single disease, but a term used to describe a range of symptoms associated with different diseases, one of which is Alzheimer’s Disease in which there is a decline in cognitive functions mainly memory, and changes in behavior and personality which are severe enough to interfere with daily life. Some of the symptoms of dementia include memory loss, being unaware of where the person is or who around him are (disorientation), personality changes, agitation and restlessness, hallucinations or delusions, difficulty with coordination and balance, issues with communication and others. These symptoms may show up in not only in Alzheimer’s disease but also other diseases such as vascular dementia, Parkinson’s disease dementia, Huntington’s disease, Creutzfeldt-Jakob Disease among many other conditions which are broadly clumped under the term “dementia”. This article focuses on dementia in Nepal exploring it’s meaning, types, causes, and preventive measures. Dementia in Nepal becomes more imperative on the backdrop of World Health Organization (WHO) urgent call for Alzheimer’s and dementia in Nepal and other Low-and-Middle-Income Countries (LMIC) in South-East Asia on the Alzheimer’s Day.  “Time to Act on Dementia, Time to Act on Alzheimer’s” was the theme and highlighted in the importance of early detection, and intervention, challenges in diagnosis and care, and the need for a national strategy. According to Alzheimer’s Disease International, an organization representing Alzheimer associations worldwide, approximately 78,000 people in Nepal are currently living with dementia. This number is predicted to grow significantly, reaching 134,000 by the year 2030¹. It is estimated that over 50% of population over age of 60 years have some form of memory-related problems². Mental health in Nepal, has various challenges with huge human resource deficit, lack of government budget and a will, and rapid urbanization and social separation and disintegration all of which have to be looked into and taken care of in handling the burden from mental health issues it faces at present and in the future as well the challenges in meeting the SDG goals that have been set.

The word “Dementia” is derived from Latin term “demens or dement” meaning “out of one’s mind”.

There is another broad term “neurodegenerative diseases” (contrast it with neurodevelopmental disorders), in which, usually with age there are degenerative changes in the brain resulting in neuronal loss and loss of volume of different areas of the brain. Most of the neurodegenerative diseases, due to decreased number of neurons, are progressive in nature, the symptoms getting worse over time causing decline in cognitive functions such as memory loss, having difficulty with reasoning and problem solving, being oriented to time, place and person, and personality and behavioral changes which are hallmark of most of the neurodegenerative diseases such as Alzheimer’s disease. Most people at a later stage develop difficulties moving around, lose control over their bladder and bowls, have trouble eating and drinking, become more aggressive. Many go out and have difficulty finding the place they live and thus necessitating a 24-hour care.  In most cases of dementia, the cognitive functions are occasionally preceded by changes in mood, emotional control, behavioral and motivation.

According to World Health Organization (WHO) 57 million people had dementia worldwide, over 60% of whom lived in Low-and-Middle-Income-Countries (LMIC) such as Nepal. Alzheimer’s disease is the most common form accounting for 60-70% of all cases suffering from dementia. Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older people globally.

Very importantly Alzheimer’s disease is not the only one condition under the umbrella term dementia but there are various other conditions in addition to Alzheimer’s disease which are broadly known as dementia which are listed below under the section “Types of Dementia”. Since Alzheimer’s is the most common form of dementia and famous people have suffered from it such as the past president of USA Ronald Regan, dementia in Nepal is taken as a synonymous for Alzheimer’s Disease.

Some famous individuals who suffered from dementia are

• Ronald Reagan, 40th President of USA (1911-2004)
• Margaret Thatcher, prime minister of the United Kingdom (1925-2013)
• Harold Wilson, prime minster of the United Kingdom (1916-1995)
• Charles Bronson, actor (1921-2003)
• Arthur O’Connell, actor (1908-1981)
• Glen Campbell, country music star (1936-2017)

Importance of Dementia in Nepal

A huge and dauting task looms over Nepal, as also indicated by World Health Organization, that Dementia in Nepal requires a timely and urgent focus by all concerned. Nepal is a land locked country with a population of 31.12 million people. Life expectancy has increased to 72.4 years. The geriatric (old, aged people) population is increasing as the health care and other factors become better in Nepal. With the increase in old age population the number of people suffering from dementia will also surge. It is estimated that individuals suffering from dementia will probably surge above 132,000 in next 20 year’s time. Nepal has to embrace itself and timely preparation is an urgency. According to the latest WHO data published in 2020 Alzheimer’s and Dementia Deaths in Nepal reached 2,022 or 1.26% of total deaths.

A study based published in The Lancet indicates that in 2019, 57.4 million individuals were thought to be suffering from dementia and with growing geriatric population it will increase reaching staggering 152.8 million by 2050. This will equally be applicable to Nepal as well¹.

Centers for care of Dementia in Nepal

The author has not visited or tied to any of the below lists of centers offering care for dementia in Nepal. The author thus cannot verify the authenticity and quality of services provided by these centers. These are just listed on the basis of internet search for the term “centers offering care for dementia in Nepal”.

Hope Hermitage

Senior Citizens, Home, Club & Day Care Center – The Home Hermitage

Best Caring for Dementia | Alzheimer’s Patients in the Nursing Home in Kathmandu, Nepal – Arogin Care Home

Nepal – Dementia Care International

Nepal Senior Care

Dementia Care – Orchid Care Home

NIAH Nepal – National Institute on Ageing and Health

Diagnosis

Diagnosis of dementia is based on the clinical symptoms and brain imaging such as MRI scan. Dementia is currently the seventh leading cause of death worldwide and has 10 million new cases reported every year which comes to nearly one every three seconds.

The picture in the right demonstrates the way brain undergoes neuronal death, called atrophy, which causes the various cognitive, behavioral and personality changes.

With age the neuronal deaths are very normal but in dementia there is either untimely or early neuronal deaths (atrophy) leading to symptoms that would otherwise appear very late in life.

There is no cure for dementia however, there are certain drugs which can slow down the progressive course of the condition.

Types of Dementia

Types of Dementia differ in terms of which brain area is affected most. Because different areas of the brain are involved in different functions, the symptoms also vary depending on the location of severity of damage in different areas of the brain.

1. Alzheimer’s Disease
   Alzheimer’s disease is the most common form of dementia, accounting for 60-80% of cases. It is characterized by the accumulation of amyloid plaques and tau tangles (proteins which hinder the communication between the neurons and also cause inflammation and oxidative stress which further damages brain cells). Abnormal and rapid buildup of Beta amyloid proteins and Tau tangles are hallmarks of Alzheimer’s disease and differentiate it from other types. Together they are believed to be responsible in progressive neuronal death, shrinkage of the brain and onset of cognitive and other symptoms.

   1. Hallmark Symptoms in Alzheimer’s Disease

      • Gradual memory loss, especially short-term memory.
      • Difficulty with problem-solving and completing familiar tasks.
      • Confusion about time and place.
      • Personality changes and withdrawal from social activities.

2. Vascular Dementia
   This type is caused by reduced blood flow to the brain, often due to strokes or other vascular conditions. High levels of cholesterols and other fatty acids make the vessels reaching different areas of the brain narrower and blocked resulting in loss of blood to various areas resulting in death and atrophy of the brain tissues. Symptoms include impaired judgment, difficulty planning, and slowed thinking.

   Hallmark Symptoms in Alzheimer’s Disease

   • Gradual memory loss, especially short-term memory.
   • Difficulty with problem-solving and completing familiar tasks.
   • Confusion about time and place.
   • Personality changes and withdrawal from social activities.
   2. Dementia with Lewy Bodies
      This form involves abnormal protein deposits called Lewy bodies in the brain. It shares symptoms with Parkinson’s disease, such as movement difficulties, along with cognitive decline.

   3. Frontotemporal Dementia
      This type primarily affects the frontal and temporal lobes of the brain, leading to changes in personality, behavior, and language skills. It is more common in younger individuals.

   4. Mixed Dementia Some individuals may have a combination of two or more types of dementia, such as Alzheimer’s and vascular dementia, which complicates diagnosis and treatment.

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Reference

1. GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105-e125. doi: 10.1016/S2468-2667(21)00249-8. Epub 2022 Jan 6. PMID: 34998485; PMCID: PMC8810394.
2. Jha, A., & Sapkota, N. (2013). Dementia Assessment and Management Protocol for Doctors in Nepal. Journal of Nepal Medical Association, 52(189), 292–298. https://doi.org/10.31729/jnma.567