Nirmal Mehra, was 70, and principal of a well-known school in Delhi when signs of dementia began to show up. Mehra, an army officer’s wife and highly popular among her social group, started getting confused about directions and people. As her disease became more severe, Mehra began losing memory of recent events and even stopped identifying her own family members. ”She remembered her brothers and parents and longed to go back to them,” recalls her daughter Poonam Natarajan, who is chairperson of National Trust under the Ministry of Social Justice and Empowerment which works for the welfare of people with autism, cerebral palsy, and other mental problems.
“She was very active and social, and did not want to stop her work. But with dementia, she could not have held her position as the principal, and we had to force her to quit,” Natarajan said with moist eyes, recalling her mother at a workshop organised by Helpage India. A portrait of Mehra placed on the table showed her as a beautiful woman in the prime of health, making one wonder if such illness can strike people so active. Mehra died last year at age 80 after suffering with dementia for 12 years. Her story is one of the many stories of suffering due to the disease which erases memory and takes away the ability to do day to day work.
Healthy ageing has been taken up as the theme by WHO for World Health Day this year. India will have around 10 million patients of dementia, a disease related to aging, by 2020, according to a recent report. With increasing proportions of the greying population, dementia cases are on rapid increase. The Dementia India Report 2010 also says social cost of the disease, which was almost Rs.14,700 crore in 2010 is likely to triple by 2030. Manjari Tripathi, additional professor of neurology at All India Institute of Medical Sciences (AIIMS), terms the increasing cases of mental and neurological disorders like Alzheimer’s and dementia as a “silent tsunami” engulfing the nation, which is set to have the world’s second largest population of senior citizens by 2020.
“We had around 4 million patients of dementia in 2010, the numbers will increase with the increasing number of greying population,” Tripathi told IANS. “As the population ages, the problem will increase. “India had over 90 million elderly (above 60 years) in 2010. By 2050, the number is expected to go above 324 million, making almost 20 percent of the total population. ”The biggest problem is that the patients don’t even know that they are ill,” she said. ”Almost one-third of all patients coming for any kind of treatment have been found to be suffering from mental problems,” adds Rajesh Sagar, additional professor at department of psychiatry at AIIMS. Atul Prasad, senior consultant of Neurology at Fortis Hospital in Delhi’s Vasant Kunj, says that patients of dementia should not be stigmatised by calling it a mental disorder, as it is a neurological disorder.
“Forgetting is normal, we all forget things at times… but for those suffering from dementia, the problem is related to degeneration of the brain,” he told IANS. ”While degeneration with age is a normal process… as the human brain tends to shrink with age, but in dementia patients the process becomes faster, making them lose their ability to do basic things,” he said. The doctor said that the process starts with memory loss, gradually the patient stops identifying people. At a later stage, patients tend to walk away unknowingly, they can pass stool and urine anytime and lose control over their body functions, or they may start taking clothes off in public or become violent.
The biggest role in this illness is that of the caregivers, says the doctor. ”Caregivers have the most important role, and mostly the counselling is for caregivers as they themselves suffer great stress. As the patients do not realise their illness, it’s ever so more difficult,” he says. Sagar said that often the caregivers, who are mostly family members and often a female family member, suffer from depression themselves becoming the “hidden patients”. ”It has been seen that 50 percent of the caregivers suffer from depression themselves, the problem is emotionally taxing for the family which has lost the relation (with the patient),” says Sagar. The factors behind the diseases are not well established, but counting the possible reasons triggering the disease, Tripathi says deficiency of vitamin B12, thyroid deficiency, high stress, and factors like smoking and alcohol contribute to the problem.
Prasad added that while increasing number of elderly people, owing to increased life expectancy is one reason, other reason could be lifestyle related. ”Physically and mentally active people have lesser chances of developing dementia,” he adds. While medicines cannot treat dementia, Prasad said that diagnosed at the right time, the process can be slowed. ”Also, the manifestations of the disease can be controlled by medicines,” he said.