By Jahanuma Tahir
IN her late sixties, Nusrat Mir is reliving her “sweet sixteen”.
The grandmother keeps revising her girlhood by strolling in her hometown meadow as a happy-go-lucky person.
But like her faint memory, the meadow she mentions has long faded in the city of Srinagar.
“It’s all in her mind,” says Nusrat’s teacher son, Showkat Mir.
“While she even fails to recognize me, she abruptly drifts to that distant phase of her life and talks about the meadow and her friends. Barring that phase of her life, she doesn’t remember anything else now. This forgetfulness has completely changed her. It’s quite a slog to bring her to senses.”
Nusrat was on medication for dementia before Covid came as a tormentor. She was badly bitten by the bug devouring her last bits of memory.
Her case has already alarmed medicos at a time when Kashmir’s healthcare system is bracing for the new variant—Omicron.
The ripple effect of the previous strain is already leaving a debilitating impact on many Covid survivors—experiencing poor concentration, memory difficulties and other cognitive issues.
“These are the signs of dementia which deprive us from all those attributes that make us human,” says Dr. Parvaiz Shah, a renowned neurologist of the valley.
“Dementia is a general term for the impaired ability to remember, think or make decisions that hinder a person’s daily life. The disease is progressive due to irreversible decline in brain function which slowly interferes with a person’s ability to carry out activities of normal daily living.”
Dr. Shah informs that this neuropsychiatric disorder manifests primarily as disturbance in thought, memory and intelligence followed by adverse impact on conduct which can be of sufficient severity to interfere with social and occupational functioning.
“COVID-19 could aggravate this process and hasten cognitive decline, and then dementia,” an anecdotal research notes. “If someone is destined to show dementia symptoms in his early 70s, and he already has these abnormal proteins and some issues going on with it, COVID-19 may come in and really fan these flames.”
To understand the link between the Covid-catalyzed fading mindscape of the valley and the pandemic, Kashmir Observer got in touch with Dr. Parvaiz Shah.
Dr. Sahab, Kashmiri households are silently struggling with the cases like Nusrat Mir—the lady losing her memory and everything she once fought for. Is Covid really messing up with our memories now?
Well, yes, it’s true that some of the Covid survivors may get the dementia-related changes earlier than expected. This is quite a departure from what we once know about dementia. As a neurodegenerative disorder, dementia is commonly seen above the age of 65 years.
But having said that, prevalence of dementia is still more in western hemisphere than in Asian countries.
But then doctors say that Kashmiris are now following and adopting western lifestyle and therefore matching their disease profiles as well. Is it true with dementia as well?
See, what’s certain is that the prevalence of the disease has increased manifold in Kashmir with time.
Back in 2006, our epidemiological study in Hazratbal block of Srinagar found the disease in 100.57/100000 population. This figure was a notch higher than that of Dr. Sushil Razdan et.al who reported dementia as an uncommon disease in early eighties.
But now, many lifestyle issues, like lack of exercise, excessive smoking, depression, poor educational status and alcohol intake are believed to predispose to dementia.
So, it’s clear that lifestyle change is robbing us of our memories now.
I mean, yes, dementia was once regarded as a rare disease in Kashmir. But now, it afflicts a sizable chunk of elderly population.
Even I come across on an average two to three such patients every week. This patient load can be attributed to the increased incidence of this disease as well as awareness about the disease both among the masses and healthcare professionals. Earlier, the patients with Alzheimer’s used to be overlooked and underdiagnosed due to lack of awareness about the disease as well as suboptimal medicare facilities.
But how’s dementia related to Alzheimer’s?
Well, only Alzheimer’s dementia accounts for 60-70 percent of all cases of dementia. In fact, Alzheimer’s is the most common form of dementia in western hemisphere with immense social impact.
Alzheimer’s is more common in females and sometimes it may be seen in more than one member of a family. The patient with this disease presents with memory disturbances. Forgetfulness especially for recent events is the major symptom. The patients tend to forget small day to day happenings. Questions are repeated again and again. Speech also may be affected. And while the patient suffers immensely, his family undergoes more psychosocial trauma while attending to such a patient.
Talking about the suffering part of it, the case of Nusrat Mir and others tell us that their family members have to grapple with forgetfulness for recent events, progressive visual disturbance, behavioral abnormalities followed by loss of control over urine and stool. How much traumatic—or tormenting—dementia can get?
See, with the passage of time, the patient suffering from dementia loses comprehension about his/her family members and fails to recognize them. These patients need sustained and comprehensive medical care under one roof from a team of medical personnel, including a well-trained nurse.
But since it’s impossible for the family to provide them adequate care at their respective homes, the need of the hour is to explore possibilities of institutional care to such patients which could to a large extent mitigate suffering of the family.
But can we somehow delay this disease?
Not definitely, however, the disease can be delayed if the people would get busy in intellectual pursuits like writing and mathematics. Dementia has been found to be less common in persons with such pursuits.
And what about Kashmir’s celebrated cultural composition and its resilience to fight this malaise? Can it come to the rescue of the patients?
Yes, since the disease is already showing an upward trend, our society needs to be sensitized to the fact that declining intellectual functioning with age is not always normal. At the moment medical curriculum has been regularly updated so as to make doctors and other healthcare professionals sensitive to dementia-related disorders. We also need to create skill base in manpower to help people age with dignity and honour and provide them with best possible health care.
Talking about the current scenario where Covid is only creating forgetfulness, how severe has this mind-fading become?
As you are aware, dementia has proved to be a socioeconomic burden with comorbid health issues. However, there’s no substantial scientific evidence in favor of Covid-19 infection predisposing to Alzheimer’s dementia though brain may get affected in Covid-19 infection.
Current estimate indicates that around 50 million people worldwide are living with dementia. This number will double by 2030 and triple by 2050.
In my experience, I have been coming across dementia patients very frequently as compared to two decades earlier.
So what’re some of the earlier signs of dementia?
Common presenting features of dementia include forgetfulness, decreased concentration, impaired judgement, misplacing of objects, hoarding, obsessive behavior, mood swings, confusion, language problems and occasionally hallucinations.
It’s common to come across sun downing behavior (due to disturbed internal body clock) in dementia patients. On the contrary symptoms of dementia may worsen by change of place. Dementia patients tend to be more comfortable at their familiar places.
Late in the course of illness, the patients forget how to use common objects and tools. Vocabulary becomes restricted and conversation virtually incomprehensible. Patients may face difficulty in walking and ultimately lose the ability to stand or walk. Being forced to lie inert in bed, the patient may pass urine in the clothes. Depression with insomnia and anorexia also occurs apart from delusions and psychotic behavior.
Given this harrowing experience, do we have any hope to salvage memories?
See, as on date there’s not much treatment for dementia. The patients need comprehensive care which is virtually impossible at home. A sizable number of cases need institutional care especially in advanced stages of the disease. Therefore, it’s important to decrease the impact of disease by reducing the aggravating factors. Of course the patients are helped by early detection of the disease, exercise, good diet, vitamins and other neuroprotective drugs.
And while dementia doesn’t cause death, it shortens life expectancy. The average lifespan of a dementia patient is 4-8 years but may go up to two decades.
But no matter what your age or stage of life is, you’ve power to change many variables that influences your brain health.
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