Dementia – unpacking the decline

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The Global Burden of Disease (GBD) forecasts that the prevalence of dementia in South Africa is set to almost triple by 2050

Reflecting a 181% increase from 2019. Driven by a steadily ageing population and longer life expectancy, this rising burden of dementia highlights a need for greater awareness and earlier intervention to support both patients and caregivers.

Dr Harsha Patel, a Neurologist at Mediclinic Louis Leipoldt, says ageing is the biggest risk factor for developing dementia. As people age, their chances of developing dementia increase more than from any other known factor.

In addition to age, dementia can result from various diseases, injuries, or other medical conditions. “Dementia is caused by damage to or loss of nerve cells and their connections in the brain,” says Dr Patel. While genetics can play a role – particularly in early-onset dementia – most cases are not directly inherited. Certain gene mutations, Down syndrome, and conditions like diabetes, thyroid disorders and heart disease can all increase the risk of dementia. So too can lifestyle factors such as smoking, excessive alcohol use, physical inactivity, and social isolation.

“There are also various factors that affect what we call cognitive reserve – the brain’s ability to cope with damage or disease without showing noticeable cognitive decline,” says Dr Patel. “People who leave education early, don’t use a range of mental skills in their work, or who haven’t interacted much with others may have a smaller cognitive reserve,” she says. “But there are things people can do later in life to build this up, like staying mentally and socially active.”

Types of dementia

There are many types of dementia, each with different causes and characteristics. Alzheimer’s disease is the most common form, marked by the accumulation of amyloid plaques and neurofibrillary tangles that lead to brain cell death and shrinkage. Vascular dementia, the second most common type, results from reduced blood flow to the brain due to conditions like stroke or high blood pressure.

Other forms include Lewy body dementia, caused by abnormal deposits of a protein called alpha-synuclein; frontotemporal dementia, which affects the frontal and temporal lobes of the brain; and Parkinson’s disease dementia, which occurs in some patients with Parkinson’s at least a year after diagnosis.

“Many patients present with features of more than one type – which is what we call mixed dementia,” explains Dr Patel. “Because the boundaries between different types are not always clear, accurate diagnosis can be challenging but it is an important step for planning treatment.”

Treatment and support

While there is currently no cure for dementia, a combination of medication, therapy and lifestyle management can help to ease symptoms and improve quality of life.

“Treatment depends on the type and stage of dementia, but medications can help to manage and sometimes slow the progression of symptoms,” says Dr Patel. “They do not reverse the underlying disease, but they can make a meaningful difference in daily function for some patients.”

Dementia treatment should be individualised according to the patient’s needs. Providers of care may include a neurologist, psychiatrist, neuropsychologist, physician, physiotherapist, occupational therapist, speech therapist, dietician and nurse.

Neurologists are important in diagnosing dementia and may manage related neurological symptoms. Geriatricians and/or physicians focus on the health of older adults, including diagnosis and management of dementia. Psychiatrists are able to diagnose, treat and manage the mental and emotional health of dementia patients. Neuropsychologists assess cognitive and behavioural functions through standardised tests which can help determine the type and extent of cognitive impairment in dementia. Nurses provide direct patient care, administer medications and educate patients and families about dementia care.

Non-pharmacological interventions are just as important. Physiotherapy helps to maintain physical abilities and independence in daily activities and is important in preventing falls. Occupational therapy can introduce memory aids, visual cues, and adaptive tools to support independence. Speech therapists help address communication and swallowing difficulties that can occur in patients with dementia. A healthy diet, regular physical activity and continued social engagement all play a role in preserving function for as long as possible.

Family and caregivers are essential members of the care team, providing important information, support and care for the individual with dementia. Caregivers also need support. “Families are on the front lines of care, and it can be an emotionally and physically taxing role,” says Dr Patel. “Caregiver education, respite care and support networks are critical to maintaining everyone’s wellbeing.”

Dr Patel encourages individuals who are concerned about memory loss – either in themselves or a loved one – to seek medical guidance as early as possible. Some conditions that mimic dementia symptoms, such as vitamin B12 deficiency or thyroid disorders, may be treatable. “Early diagnosis allows us to rule out reversible causes, plan appropriate care, and support the patient and family right from the start,” she concludes.