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The term dementia covers all causes of this condition in which, as you know, there is progressive decline in memory and cognition, other aspects of brain function, and associated behaviour changes with inability to carry out the usual activities of daily living.
Most persons are familiar with Alzheimer's dementia and indeed this is the commonest form, but there are vascular and mixed dementias as well as those related to Parkinson's disease, past repeated head trauma, drugs and toxins. Some dementias are treatable, medically. For example, those due to vitamin deficiencies such as Vitamin B12, folate or thiamine, or surgically, for example, a resectable brain tumour.
I have been conducting a clinic for persons with dementia for the last five years. The clinic, however, actually started in 2001. To my knowledge, this is the only such special clinic in the island, though private practitioners also treat these persons. I am thus in a unique position to see not only the effects of the dementia on the patients, but also how the caregivers try to cope with the changes in their loved ones. Our population has undergone both an epidemiologic and a demographic transition. We have seen the decline and disappearance of the acute infectious diseases such as gastroenteritis, and the burgeoning of chronic diseases such as diabetes, hypertension and cancers and a variety of stress-related conditions.
Medical research has not stood still though and there have been continuing developments of general and specific preventive measures such as immunisation, improved management of common medical conditions and development of life-enhancing lifestyles by populations. Persons are thus living longer. In Jamaica, currently, the percentage of persons aged 60 years and older is about 10 per cent of the total population. According to the Statistical Institute, by the year 2050, this percentage will be 25 per cent! Dementia is associated with ageing. We are likely to see a huge increase in persons with this condition and we should have in place the requisite management tools and personnel.
Let me illustrate some of the issues. The University Hospital of the West Indies has been conducting a dementia clinic weekly since 2001. During this time, many patients have been seen, usually with symptoms varying from mild to the more severe forms of dementia. These patients are from across the island, varying in age from the mid-50s into the 90s and are from all socio-economic strata. Most are being cared for by their spouses and/or children, while a few are cared by helpers, practical nurses or are in nursing homes. A study of 75 patients seen in the clinic over the period 2001-2005 revealed a roughly equal gender distribution (49 per cent women and 51 per cent men), a mean age of 77 (standard deviation of +/- 9.53 and range 54-94 years). Patients were assessed using the Mini Mental State Examination and the functional activities scale. There was observ-able improvement in 40 per cent of the patients treated with the drugs under discussion. Additional information on this study is available.
Yet, in the present, there is tremendous suffering and tremen-dous costs. The costs associated with a dementia of the Alzheimer's type may include the following:
Initiation and maintenance of anti-dementia medication, that is, cholinesterase inhibitors rivasti-gmine, galantamine or donepezil.
Initiation and maintenance of antipsychotic, anti-depressant or anti-anxiety medications, such as haloperidol, risperdal, escitalopram, lorazepam.
Initiation or maintenance of medication for general medical conditions which may have preceded or coincided with the onset of dementia, such as diabetes, hypertension, arthritis.
Retro-fitting of the home via increasing the safety of bath-rooms, kitchens, changing locks, adding padlocks or grilling to prevent wandering.
Hiring of helpers, practical nurses to assist with care of the demented person.
Nursing home placement.
Caregiver burnout necessitating treatment with medication, hospitalisation or both.
According to Dr Maurice Redden in his presentation at the meeting of the American Psychiatric Association held in San Francisco from May 16-21, 2009, "the aims of patient care management are to delay disease progression, delay functional decline, improve quality of life, support dignity, control symptoms and provide comfort at all stages of Alzheimer's disease".
Our current management falls short of that because the caregivers cannot afford to give the drugs in the correct amount. The drug companies have tried to assist, via giving a 20 per cent discount at designated pharmacies in the case of Rivastigmine (developed by Novartis), provision of samples by the Galantamine (Reminyl) developed by Janssen-Cilag and Donepezil (Aricept) developed by Pfizer. In this regard, I attach for your information, a bill for one fortnight's supply of medication. The total is over $10,000 and the drug company had given a card guaranteeing a 20 per cent reduction in the cost. The NHF can do a lot to positively influence the quality of care by adding these drugs to the approved list and by being open to other drugs as the research continues for better and more definitive treatment and preventive measures of dementias.
This is the extraction from a letter written to the National Health Fund (NHF) on May 25, 2009, by Dr Loraine Barnaby while she was consultant psychiatrist in the Dementia Clinic at the University Hospital of the West Indies. ...http://www.jamaica-gleaner.com/gleaner/20090810/cleisure/cleisure3.html
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Your Alzheimer's donation will help billions live without it. Donate online now
The term dementia covers all causes of this condition in which, as you know, there is progressive decline in memory and cognition, other aspects of brain function, and associated behaviour changes with inability to carry out the usual activities of daily living.
Most persons are familiar with Alzheimer's dementia and indeed this is the commonest form, but there are vascular and mixed dementias as well as those related to Parkinson's disease, past repeated head trauma, drugs and toxins. Some dementias are treatable, medically. For example, those due to vitamin deficiencies such as Vitamin B12, folate or thiamine, or surgically, for example, a resectable brain tumour.
I have been conducting a clinic for persons with dementia for the last five years. The clinic, however, actually started in 2001. To my knowledge, this is the only such special clinic in the island, though private practitioners also treat these persons. I am thus in a unique position to see not only the effects of the dementia on the patients, but also how the caregivers try to cope with the changes in their loved ones. Our population has undergone both an epidemiologic and a demographic transition. We have seen the decline and disappearance of the acute infectious diseases such as gastroenteritis, and the burgeoning of chronic diseases such as diabetes, hypertension and cancers and a variety of stress-related conditions.
Medical research has not stood still though and there have been continuing developments of general and specific preventive measures such as immunisation, improved management of common medical conditions and development of life-enhancing lifestyles by populations. Persons are thus living longer. In Jamaica, currently, the percentage of persons aged 60 years and older is about 10 per cent of the total population. According to the Statistical Institute, by the year 2050, this percentage will be 25 per cent! Dementia is associated with ageing. We are likely to see a huge increase in persons with this condition and we should have in place the requisite management tools and personnel.
Let me illustrate some of the issues. The University Hospital of the West Indies has been conducting a dementia clinic weekly since 2001. During this time, many patients have been seen, usually with symptoms varying from mild to the more severe forms of dementia. These patients are from across the island, varying in age from the mid-50s into the 90s and are from all socio-economic strata. Most are being cared for by their spouses and/or children, while a few are cared by helpers, practical nurses or are in nursing homes. A study of 75 patients seen in the clinic over the period 2001-2005 revealed a roughly equal gender distribution (49 per cent women and 51 per cent men), a mean age of 77 (standard deviation of +/- 9.53 and range 54-94 years). Patients were assessed using the Mini Mental State Examination and the functional activities scale. There was observ-able improvement in 40 per cent of the patients treated with the drugs under discussion. Additional information on this study is available.
Yet, in the present, there is tremendous suffering and tremen-dous costs. The costs associated with a dementia of the Alzheimer's type may include the following:
Initiation and maintenance of anti-dementia medication, that is, cholinesterase inhibitors rivasti-gmine, galantamine or donepezil.
Initiation and maintenance of antipsychotic, anti-depressant or anti-anxiety medications, such as haloperidol, risperdal, escitalopram, lorazepam.
Initiation or maintenance of medication for general medical conditions which may have preceded or coincided with the onset of dementia, such as diabetes, hypertension, arthritis.
Retro-fitting of the home via increasing the safety of bath-rooms, kitchens, changing locks, adding padlocks or grilling to prevent wandering.
Hiring of helpers, practical nurses to assist with care of the demented person.
Nursing home placement.
Caregiver burnout necessitating treatment with medication, hospitalisation or both.
According to Dr Maurice Redden in his presentation at the meeting of the American Psychiatric Association held in San Francisco from May 16-21, 2009, "the aims of patient care management are to delay disease progression, delay functional decline, improve quality of life, support dignity, control symptoms and provide comfort at all stages of Alzheimer's disease".
Our current management falls short of that because the caregivers cannot afford to give the drugs in the correct amount. The drug companies have tried to assist, via giving a 20 per cent discount at designated pharmacies in the case of Rivastigmine (developed by Novartis), provision of samples by the Galantamine (Reminyl) developed by Janssen-Cilag and Donepezil (Aricept) developed by Pfizer. In this regard, I attach for your information, a bill for one fortnight's supply of medication. The total is over $10,000 and the drug company had given a card guaranteeing a 20 per cent reduction in the cost. The NHF can do a lot to positively influence the quality of care by adding these drugs to the approved list and by being open to other drugs as the research continues for better and more definitive treatment and preventive measures of dementias.
This is the extraction from a letter written to the National Health Fund (NHF) on May 25, 2009, by Dr Loraine Barnaby while she was consultant psychiatrist in the Dementia Clinic at the University Hospital of the West Indies. ...http://www.jamaica-gleaner.com/gleaner/20090810/cleisure/cleisure3.html
Omega-3 fish oils linked to better semen quality
Infertile men have lower levels of omega-3 fatty acids in their sperm than fertile men, suggests new research that opens up the possibility for supplements to boost sperm quality. ...http://www.nutraingredients.com
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