Dementia

Alzheimer’s disease is a type of brain disease, just as coronary artery disease is a type of heart disease. It is also a degenerative disease, meaning that it becomes worse with time. Alzheimer’s disease is thought to begin 20 years or more before symptoms arise,1-6 with changes in the brain that are unnoticeable to the person affected. Only after years of brain changes do individuals experience noticeable symptoms such as memory loss and language problems. 

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Dementia is a public health priority\cite{world2012dementia}. 

Just like coronary artery disease is a sort of heart disease, Dementia disease is a type of brain disease. It's also a degenerative disease, which means it'll get worse over time\cite{dementia_2020}. 

Over 35 million people live with Dementia in the world and it will double by 2030\cite{world2012dementia}. The disease's high cost will make it difficult for health-care systems to cope with the disease's expected future rise in prevalence. The current expenses are estimated to be US\$ 604 billion a year, and they are expected to rise even faster than the prevalence\cite{world2012dementia}. In addition, Dementia is overwhelming for the caregivers and adequate support is required for them for their mental and physical health. Providing care to a person with dementia can put a lot of strain on them. Even more, the stressors are physical, emotional, and economic\cite{world2012dementia}. Family and other informal support structures in the community provide the majority of care, and the majority of caregivers are women. Every year, 7.7 million new instances of dementia are diagnosed, meaning that a new case of dementia is diagnosed every four seconds somewhere on the planet. The rising incidence of dementia call for rapid action, particularly in LMICs with limited resources\cite{world2012dementia}. Dementia is a phenomenon caused by a brain disorder, typically chronic or progressive, in which many higher cortical functions, such as memory, thinking, direction, understanding, computation, learning capacity, language, and judgment, are disrupted\cite{world2012dementia}. It involves deterioration in emotional control, social behaviour, or motivation. Alzheimer's disease is the most common kind of dementia, accounting for 60–70\% of all cases{world2012dementia}. Alzheimer's disease is affecting an increasing number of our country's senior citizens and their families, and it's critical that we address the public health threat it poses\cite{obama_2011}. Although multiple potential therapies are being examined in various stages of clinical trials, there are presently no medications available to cure or even change the progressive course of dementia\cite{obama_2011}. Dementia starts with some forgetfulness, getting lost in space and time, and undergo mood swings. But as it worsens, the patient would be unable to recognize anyone, cannot eat without assistance, need assisted self-care, may have bladder and bowel incontinence, unable to walk, and unable to reach back home\cite{world2012dementia}. In addition, the patient may exhibit extreme aggression towards the caregiver including physical violence\cite{world2012dementia}. Therefore, the caregivers get extremely stressed in the due care. Dementia has a detrimental impact on those who are responsible for their care. In time, the caregivers may become inattentive due to physical and emotional stress brought by about by intense care to patient. 

 

“...Alzheimer’s disease burdens an increasing number of our nation’s elders and their families, and it is essential that we Confront the ChallenGe it poses to our publiC health...” President Barack Obama, United States of America, 2011\cite{obama_2011}. 

 

The loss of independence, social limits and interpersonal disengagement, and personality and/or behavior changes that emerge from cognitive, behavioral, and effective impairments in functioning are all problematic aspects of dementia\cite{moritz1989health}. Problem behaviors, such as wandering, yelling, and destroying property, are usually the result of the patient's cognitive functioning deteriorating and the severity of the illness escalating. Caregiver depression was predicted by evidence of similar maladaptive behaviors in the patient\cite{schulz1995psychiatric}. In family caregivers of Dementia patients, and strong links were found between burden, particularly isolation, disappointment, and emotional engagement, and reported health and sense of coherence, when age and relationship were taken into account. Caregivers with a lower burden reported better health and a higher mean sense of coherence than caregivers with a greater burden\cite{andren2008relationship}. The caregiver's loneliness and despair increased as a result of the relationship's lack of closeness owing to the patient's cognitive impairments. They discovered that caregivers who experienced higher degrees of loneliness and despair also had higher levels of relational depravity and dissatisfaction with the existing relationship's poorer quality\cite{beeson2000loneliness}. Female spouse caregivers reported higher levels of relational degradation, loneliness, and depression than male spouse caregivers\cite{beeson2000loneliness}. 

 

It is estimated that 8.5 million people care for a dementia patient at home\cite{gallicchio2002gender}. In the previous 12 months, 34.2 million adults in the United States were caregivers to an adult aged 50 or older (roughly 14.3 percent of all American adults are a caregiver to someone age 50 or older)\cite{anderson2018characteristics}. When demented elderly are cared for at home, their families face a significant financial burden. Families pay for 60 percent of formal services provided to patients in nursing homes or in the community out of pocket. Out-of-pocket expenditures for families of dementia averages \$18,256 per year without reimbursements\cite{dunkin1998dementia}. In 2019, almost 16 million family members and friends contributed 18.6 billion hours of unpaid care to people with Alzheimer's disease and other dementia's, totaling \$244 billion in value\cite{dementia_2020}. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older\cite{dementia_2020}. Fatalities from stroke, HIV, and heart disease declined between 2000 and 2018, whereas reported deaths from Alzheimer's disease surged 146.2 percent\cite{dementia_2020}. Total spending for health care, long-term care, and hospice services for dementia patients aged 65 and older are estimated to be \$305 billion in 2020. All of this elevated the likelihood of emotional discomfort and negative mental and physical health consequences for family caregivers\cite{dementia_2020}. These issues are worsened by a dearth of dementia care experts, which puts an increasing strain on primary care physicians to provide care for dementia patients\cite{dementia_2020}. This further shifts the load to family caregivers.