Prevention and treatment of Dementia require multi-domain intervention

Chennai, 23August 2015: “Dementia is a silent epidemic in India and other Asian countries whose population is rapidly aging. It is a major public health issue in these countries. Identification of high-risk groups, better understanding of pathophysiology, well-diagnosed trials should form the effective prevention and treatment strategy of dementia. It also requires a multi-domain intervention,” urged Dr Christopher Chen, Director, Memory Aging & Cognition Centre, National University of Singapore.

Delivering the 13th MV Arunachalam Endowment Oration titled “A Double Whammy: The Combined Impact of Stroke and Dementia in Asian Patients”, organized here today by Neurokrish and Trimed here, Dr Chen said that there should be a right balance between prevention and treatment strategies. “We should use primary intervention (risk reduction), secondary and tertiary intervention that represent early detection and treatment respectively to get better medical outcomes.”

MV Arunachalam

Dr Chen said that unfortunately dementia is often unrecognised or misdiagnosed in early stages in Asian countries. It is mistakenly viewed as inevitable consequence of ageing by patients, family members as well as health care professionals.

On better ways to diagnose dementia, Dr Chen said that though vascular dementia is the most common cause of early onset of dementia, the contributors are mostly a combination of multiple pathologies such as vascular dementia, and Alzheimer’s disease. Vascular conditions such as hypertension and diabetes and cerebrovascular conditions such as small strokes (microinfarcts), silent brain infarcts, and microbleeds, are being understood as significant contributors to cognitive impairment and dementia.

Extending the logic of Thomas Sydenham that “a man is as old as his arteries”, Dr Chen said that “a man’s brain is as old as his heart”. He pointed out that people with sub optimal cardiac functions are likely to develop dementia. “For instance, the level of N-terminal Protein Brain Natriuretic Peptide (NT-proBNP), which shows volume overload and ventricular wall stress, can be a sensitive marker not only for impaired cardiac function but also for cognitive function,” he explained.

Dr Chen emphasized that at-risk elderly people should go for multi-domain intervention involving diet, exercise, cognitive training, vascular risk monitoring to avoid dementia. He said that physical training for muscular strength and aerobic exercises are particularly useful. They improve the neuro-psychological score in terms of processing speed, memory and executive functioning of brain.

In Asia, there is an explosion of dementia because of age factor, calorie intake in food, hypertension, and diabetes, among others. However, there is a decrease in the prevalence of dementia in Western Europe because of better life style, better education, better nutrition and food, he observed.

Mr A Vellayan, Trustee, Vellayan Chettiar Trust and Director, Murugappa Group presided over the function, and Dr E S Krishnamurthy, Founder, Neurokrish and Trimed, welcomed the gathering and later moderated the open-house Q & A session.