dementia in developing countriesThough dementia is traditionally thought of as being prevalent only in the developed world, it is now occurring at higher rates in developing countries. Currently, 67% of people with dementia worldwide reside in low- and middle-income nations, and researchers predict that number will reach 75% by 2050 in tandem with these nations’ aging populations. Because health and social care services in these countries are already strained or non-existent, dementia in developing countries poses a unique set of challenges.

Dementia and Alzheimer’s

The most common cause of dementia is Alzheimer’s Disease. But as with nearly all forms of dementia, there is progressive brain cell death, so as its symptoms progress, cognitive functions become severely impaired. As early as the second stage of mild dementia, individuals may require intensive care and supervision from others with tasks in their daily life. However, healthcare systems are stretched thin in many developing countries. Often, their frontline providers may not be adequately trained in providing the long-term care needed for these conditions. Even when assisted-living arrangements in a medical facility are an option, people with dementia have limited autonomy over their care because there are few systems in place to monitor the quality of dementia care in poorer nations.

Treating Dementia in Developing Countries

Due to the lack of formal care, people with dementia in the developing world tend to rely upon systems of “informal” care by family, friends, or other community members. These support mechanisms are under great strain due to the economic, emotional and physical demands of unpaid, and often unsubsidized, caregiving. Caring for someone with dementia can demand up to 74 hours a week and cost around $4600 a year. Furthermore, symptoms associated with the later stages of dementia, such as aggression, depression and hallucinations can have distressful psychological effects for these caregivers. In fact, 45% of family caregivers report experiencing distress, and 39% have feelings of depression.

Social Stigmas Surrounding Dementia

The social stigma associated with mental health diagnoses as well as general health illiteracy and unfamiliarity with dementia also contributes to inequities within the quality of dementia care. A study conducted in India suggested that 90% of dementia cases in low and middle-income nations go undiagnosed. Even healthcare professionals may lack the awareness to identify early signs of dementia. The wide-spread myth that dementia is not a medical issue in developing countries can mislead providers to dismiss dementia’s symptoms as characteristics indicative of normal aging.

Furthermore, in some parts of Sub-Saharan Africa, such as rural Kenya and Namibia where knowledge of dementia is not widespread, people may associate dementia with witchcraft or punishment for previous wrongdoings. Such beliefs further entrench the stigma surrounding it into the broader culture, discouraging people with dementia from seeking an official diagnosis. Organizations like the Strengthening Responses to Dementia in Developing Countries (STRiDE) Project have worked specifically towards reducing this stigma.

Understanding Poverty and Dementia

The immense prevalence of undiagnosed cases is particularly detrimental, considering poverty may increase one’s risk of dementia. Poverty is linked with many risk factors for dementia — one of which is stressful experiences like financial insecurity and education difficulties. Incidence of dementia has also been linked to lower levels of education since early development of neural networks can help the brain combat damages to its pathology later in life. A study on the rural Chinese island of Kinmen, where the median level of education is one year, showed dementia rates rising as people turned 60. This trend is earlier than in developed nations, and implies that illiteracy and lack of education can bring on dementia sooner.

Looking Forward

It remains unclear whether there is a correlation or direct causation between education level and the likelihood of dementia later in life. But one thing, however, is clear — low education levels serve as a frequent marker for other socioeconomic issues that are more common in developing nations, such as poverty, malnutrition, and toxic environmental exposures. Furthermore, the most commonly recommended strategy for reducing the risk of Alzheimer’s is maintaining overall health, which is more difficult in poorer countries due to malnutrition and unequal access to health care.

Moving forward, we must expand the support available to informal care systems, while ensuring healthcare providers receive dementia-specific training and health literacy. Women often the ones left to provide the majority of dementia care, but their efforts largely go ignored by their governments. Incentives, like universal social pensions, disability benefits and carer’s allowances, could support family and friends who house and care for people with dementia. Still, formal health systems too need to be bolstered to supplement and eventually substitute the role of informal carers. Policy-makers worldwide need to prioritize and anticipate the growing number of people with dementia as it remains the only leading cause of death still on the rise.

– Christine Mui
Photo: Flickr

Fighting Dementia
In its most recent report, Alzheimer’s Disease International (ADI) observed that the majority of individuals fighting dementia or other related illnesses come from low-to-middle income countries. These findings draw interesting conclusions.

Though there is no known cure for the infirmity, one respected method for fighting dementia is education. However, poorer countries often struggle to provide education to their citizens.

Professor Carol Brayne of the University of Cambridge recently led a study to analyze the relationship between the level of one’s education and the probability of developing forms of dementia.

She and her team discovered from a sizeable sample that for every additional year of exposure to education, an individual reduces his or her probability of developing dementia by 11 percent.

The researchers surmised that an educated person’s brain can better handle changes than one who is not as educated.

The brain’s pathology does not seem to change between educated and uneducated people. Instead, it merely affects their ability to cope with the onset of dementia’s effects.

This discovery provides hope for many, but it also presents a problem. Individuals who grow up in lower income countries often struggle to acquire a primary education and basic literacy.

One recent statistic states that in developing nations, one in four adolescents have trouble reading or even spelling their name in their native tongue.

The reality of illiteracy provides an ongoing series of issues for an individual during his or her lifetime. Unfortunately, the severity of these issues augments as the body begins to grow old.

In addition to the loss of physical strength and a weakening immune system, these individuals may also have a higher chance of developing dementia.

Mere decades ago, this issue was not as prevalent due to relatively low life expectancies. However, with advances in treatments for transferable diseases and an increase in government subsidies for the elderly, individuals are living longer.

As a result, longer lifespans have sparked a rapid growth in the elderly demographic. This growth parallels the rising number of dementia cases.

In addition to being a horribly debilitating disease, fighting dementia is expensive.

ADI projects that by 2018, dementia will have an annual global cost of $1 trillion. By 2030, it will be double that figure.

A growing majority of individuals with dementia live in areas of the world lacking in easily accessible health care. Thus, a sizable proportion of the financial burden will fall on the depleted social services of their developing country.

By providing for those who have acquired the disease, developing countries will likely have to cut back on other forms of public funding. Ironically, one of those cuts could be in public education, one of the keys to preventing dementia’s development.

With this in mind, the ADI recommends that countries find more economically efficient ways to provide for dementia patients. Nations should also ramp up their already stellar efforts to provide education for all.

Professor Brayne summarized her study simply: “Education is known to be good for population health and equity. This study provides strong support for investment in early life factors which should have an impact on society and the whole lifespan. This is hugely relevant to policy decisions about the importance of resource allocation between health and education.”

Preston Rust

Photo: Pixabay

When grandparents and parents of developed countries begin to lose lucidity, families put them in nursing homes and hope for modern medicine to ease their lives. The circumstances are different in the developing world, where dementia cases are on the rise and there is an increasing need to address the problem.

Dementia affects 44.4 million people in the world, two-thirds of whom are living in the developing world. This spread can largely be accounted for by the slow transition these countries are making toward increased economic stability. Diets high in animal fat have been noted as a cause of dementia, and as countries are developing, their diets have begun to incorporate more Western traditions. With this change in diet, dementia is reaching even more people.

Tobacco use has also been linked to dementia, and during the transition period in developing countries, tobacco companies have begun to target these regions of the world to expand their market. To add insult to injury, these areas are typically less educated about the risks of smoking and are therefore much more susceptible to smoke.

Low rates of education are also having a troubling effect on the rates of dementia in the developing world. Illiteracy and low educational achievement are two risk factors linked to dementia, and in impoverished areas around the globe, education is one area that is lacking. Often children forgo school completely to help support their families, or else they are not provided with the encouragement and support needed to succeed in school. Either case leaves them less educated and potentially more likely to develop dementia later in life.

Although increased life expectancy is a positive change for developing countries, it also leaves them more exposed to the risk of dementia. Denis Evans, who works at Rush University in Chicago, explains that, “Age is the biggest known driver of dementia.” With populations living longer, they begin to experience the ailments of old age. Because this transition toward longer life spans is relatively recent for many countries, they are currently ill equipped to deal with new medical concerns. Thus, they have begun an expensive game of catch-up.

As studies continue and the developing world gains exposure to the signs and symptoms of dementia, prevalence may not decline but the cases will be easier to handle. Increasing education in general, and more specifically to the risks of smoking and the benefits of a balanced diet, could also potentially lower the rates of dementia. We look hopefully to a brighter future where these countries will be able to address dementia and drastically improve lives.

– Magdalen Mae Wagner

Sources: Alzheimer’s Disease International, Physician’s Committee, NCBI, Alzforum