Eldemire Shearer: Dementia is nothing to be ashamed of

After last week’s public acknowledgement that former Prime Minister Portia Simpson Miller has been suffering from dementia, Professor of Public Health and Ageing Denise Eldemire Shearer says there should be no shame associated with the condition which mostly impacts the elderly.

Eldemire Shearer, Jamaica’s pre-eminent ageing specialist, told The Gleaner that though the elderly are mostly at risk for dementia, not all older persons have the condition, which worsen over time and for which there is no cure – yet.

According to her, cultural taboos aside, there is global focus on the condition which will, hopefully, lead to more discussion locally.

In addition, she noted that while individuals have a right to the privacy of their medical information, the condition is nothing to be ashamed of.

“Definitely not. And I am not sure that we are as ashamed of it as we are accepting of it. Because from I was little, and I’m now one of these older persons, we always heard that this relative or that relative was senile. They had dementia. So, it was unfortunately accepted as part of getting older. It is in the last 20-25 years - because of the work of organisations like Alzheimer’s Association - that it is coming more and more to the fore, that it is not a normal part of ageing, but that it’s an illness. There’s more and more attention in the last five years to something called brain health,” Eldemire Shearer told The Gleaner.

While there might be a level of embarrassment among some relatives caring for individuals with the disease, with more experts now focused on brain health, that sense of shame can be reduced through a better understanding of the condition.

Unique to each person

According to Eldemire Shearer, several years ago, when the term ‘dementia’ was not widely known, the condition was known as ‘senility’, but it was always understood by medical experts.

“It was very clear to us, even in those days, that there was a difference between different people. Dementia in older people is very unique to each person. We know that there’s memory loss, there’s thinking loss, et cetera. But depending on which part of the brain is affected, you’re going to have different manifestations. So, for the frontal lobe, you are going to have behavioural problems, emotional problems. If it’s in the balance centre, you’re going to have balance issues,” she said.

Continuing, she added: “The thing about dementia is you have Alzheimer’s, which, as I said, is a disease entity in its own. However, we also have vascular dementia. Now, vascular dementia has with it, as is implied, a blood vessel component. Therefore, you have additional concerns. You have strokes, you have high cholesterol, those sort of things, which have their own symptoms, which are going to be superimposed on the memory problems, the thinking problems. So, for people, it’s very important to get the diagnosis.

“Whereas there is more dementia in old age, there is also early onset. So it is not purely a disease of old age. It is more common because you have lived that much longer, just like lung cancer. If you smoke for 40 years and 50 years versus 10 and 20, you are more likely to get it. So the age comes in by virtue of exposure to the risk factors. And because we know that Alzheimer’s, which is one of the dementias, only one, does have its origins in enzyme deficiencies, etc, they take a while to develop.”

According to her, the common thread among individuals with dementia is memory loss, which interferes with thinking, judgement and reasoning, and one’s ability to perform the tasks of life.

“Memory loss alone is not dementia. It may be an indicator to the family that something is wrong, but it does not make the diagnosis. So there are tests; commonly there is the Montreal Cognitive Test, there is the Mini Mental, which most of us still use, where you ask the person questions. The questions are divided into straight memory, but also into thinking. And there are questions in the preliminary tests that can test your ability to reason. So you do subtraction, you do drawing of triangles, you do drawing of clocks,” Eldemire Shearer explained.

According to her, general practitioners play an important role in the early stages.

“So the preliminary test that’s done, usually by the general practitioner, usually in the family doctor’s office, indicates to the family, should this be further investigated?

Critical to this is that the family does not accept that memory is part of, or memory loss is part of ageing. The recognition of dementia starts at the family level,” she said.

Most families, she added, know that as their relatives age there may be shortcomings, but for the most part no one wants to think that something is wrong with their relatives.

“Therefore, we accept the fact that they forget things and say, ‘They’re getting old, let us support them.’ But it’s not. If it is to the point of disrupting life, then you need to have that discussion with your family doctor and take it from there,” she said.

Risk factors for dementia

In Jamaica’s population, 72 per cent of persons over 60 suffer from high blood pressure, which is a risk factor for vascular dementia. For Eldemire Shearer, Jamaicans should practise early prevention management and not just focus on the elderly.

“We’re talking about managing middle age, and adults in general. Because if there is high blood pressure, then you want to think about the exercise, the overweight, the smoking, the cholesterol. Because in managing those problems, you are going to reduce the risk factors. Therefore, you are going to reduce the likelihood of developing dementia,” she cautioned.

erica.virtue@gleanerjm.com