DEMENTIA has become a major problem the world over. In an interview to Frontline (May 21, 1999), Prof. Sid Gilman discussed Alzheimer's disease in detail. Many of the causes of dementia are reversible: for example, thyroid and Vitamin B-12 deficie ncy and some kinds of brain tumours and clots. However, one neglected area is vascular dementia. It was V. Hachinski and his colleagues who drew attention to this condition. However, even now, neurologists and physicians are a little sceptical about this term despite the fact that the term multi-infarct dementia is used rather freely.
The main risk factor in the case of vascular dementia is hypertension. Prof. H.M. Barnett, a pioneer in stroke research, describes four factors that contribute to stroke. They are: high blood pressure, smoking, accumulation of fats called lipids in the b lood cells and diabetes mellitus.
It is necessary for the physician to understand that the onset of this kind of dementia can be prevented by a systematic campaign which would include the launching of a nationwide campaign against smoking; measuring blood pressure periodically and keepin g it under control; controlling diabetes and keeping the blood sugar level within reasonable limits, especially in elderly people; and taking drugs called statins to lower lipids in the blood.
Unfortunately, in a country like India, very little is done towards prevention. If the guidelines mentioned above are followed, even heart disease can be prevented. Instead of spending money on treating these diseases, what is necessary is a public healt h campaign that uses the media to educate people about the risk factors and the preventive measures.
Why does vascular dementia occur? Generally, people associate a stroke with a major paralytic attack. However, strokes of lesser intensity, such as temporary paralysis or numbness of an arm, a leg or one side of the face, also occur. Without being unduly alarmed, people should recognise that these strokes, called transient ischaemic attacks, can be prevented and controlled. In international trials, a consensus was arrived at - that is, 75 mg of aspirin should be taken by individuals who come under the h igh-risk category and run the risk of having a minor stroke.
At present, Alzheimer's disease is given much more attention than vascular dementia. However, it is important that dementia is tackled at the national level.
A 10/66 Dementia group was formed recently. The K. Gopalakrishna Department of Neurology at the Voluntary Health Services and the T.S. Srinivasan Department of Clinical Neurology and Research at the Public Health Centre, both in Chennai, have been includ ed in this group.
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