Dementia is not one clinical entity. There are indeed several different types, some being the result of complications of other diseases. PHOTO | FILE
Last year, a good friend of mine disappeared for five days while on a business trip to Nakuru. Luckily, he was found alive, but disoriented. The doctor told us that he suffered from dementia.
Recently, his brother called me and told me that he fears that it could be a family trait, which I doubted. Does dementia run in families and what are the warning signs before it becomes worse?
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Over the years, I have learnt a number of things that continue to serve me well in clinical practice. One of those lessons relates to what on the surface seems to be simple clinical facts and, which the lay person accepts at face value.
When you tell us that a man disappeared in Nakuru while on a business trip, my clinical sense of suspicion is raised, because a man can disappear for many other reasons, and dementia is only one of the many possibilities.
If, for example your friend is aged 40, and vanished for five days, it is unlikely that this was as a result of dementia. A more likely explanation is that he took a girlfriend on a brief holiday somewhere near Nakuru! In the alternative, the young man could have been running away from debtors, an angry wife or girlfriend, but could also have gone on a drinking spree!
The point we are making here is that as appealing as they are, simple explanations can mislead one in the assessment of people who disappear. You tell us that the person was found alive but disoriented. Disorientation is an important word in your question, and it has both lay and technical meanings.
For example, one would like to know several things about disorientation. For example, was there any evidence of it before he went to Nakuru? If there was, why was he allowed by the family to go in the first place. If there was none, what could have made it make itself evident so suddenly in Nakuru? Was he, for example, hit on the head in his hotel room or even as he entered a car?
Some people with bleeding in the brain go to their doctors because of disorientation and confusion. In these cases, surgery leads to full recovery.
The other matter that would have to be looked into is alcohol and other drugs. While on business trips out of home base, many people tend to drink (and eat) more than is usual. For some, the sense of freedom can lead to indiscretions of all sorts. Was your friend perhaps one of these people?
Similar to the foregoing, but fundamentally different are those people on long-term medication for say, diabetes or high blood pressure, who either forget their medication at home, or more commonly forget to take their regular doses due to the pressure of work.
People with mental disorders who are otherwise well controlled under medication can deteriorate for similar reasons. Other things one would like to know about the disorientation include, whether it was accompanied by other symptoms, such as fever, shivering, sweating, headache, or even seizures. One would also like to know how your friend is now, several months after the initial disappearance.
If indeed your friend is in the right age bracket (60 years plus) and has continued to show signs of dementia (see below), then you might be right in your diagnosis.
If, on the other hand, the man has now fully recovered, you might have to find another more plausible explanation for what happened to him in Nakuru.
Before turning to dementia specifically, let me remind you that you are genetically the son of your mother and father. Obvious as this might sound, in practical reality it means that you have inherited all the “good” and “bad” that you have from one or the other parent.
Chances therefore are that you look like your parents, have the same range of intelligence quotient (IQ), and, by extension have higher chances of getting the same diseases as your parents.
In their first year of clinical training, medical students are taught how to take a family history. If a patient presents with say, diabetes or a bipolar disorder, or as in your case, dementia, the medical student (or doctor) would seek to establish if one or the other parent had a similar illness. One then moves to siblings, grandparents, aunts, uncles and other relatives including one’s children!
Just to make what seems like a simple matter more complex, let me remind you that dementia is not one clinical entity! There are indeed several different types, some being the result of complications of other diseases.
The so called vascular dementias are the result of long standing hypertension and diabetes. This type therefore would run in families indirectly, that is through the inheritance of diabetes and hypertension.
Alzheimer’s disease is the most commonly occurring type of dementia, and, again for simplicity, occurs more frequently in families.
The earliest signs that a person has dementia are often missed by the family. Subtle changes in memory can be attributed to tiredness or stress.
Some people have difficulties remembering appointments, where they kept keys, while others have problems finding words. Others show mood fluctuations including depression and anxiety.
Others become withdrawn and apathetic. As the condition gets worse, confusion and tendency to get lost soon set in. Some keep repeating the same story. Such a person tends to repeat the same joke over and over!
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