World Mental Health Day: How loneliness is fueling dementia in Kashmir

Srinagar: At the Out Patient Department of Institute of Mental Health and Neuro Sciences, Kashmir (IMHANS), a consultant psychiatrist noticed something unusual for weeks together.

A 70-year-old patient, Riyaz Ahmad (name-changed) diagnosed with dementia who was often the first one to show up at the OPD and yet he ended up availing his turn at last.

“I saw him deliberately choosing to wait and seek treatment at last. In the meantime, he animatedly engaged and talked to almost all patients waiting there. On one of his follow ups, I asked him, why does he do this? He finally opened up and said he along with wife had been feeling terribly lonely. They sent their only son abroad to pursue studies and he got settled there. Their loneliness and the need to connect with others felt more at this age. Talking to others helped him lessen the gloominess that always seemed to weigh him down,” he said.

Ahmad’s dementia became noticeable when his wife observed that he was off his game. “I would show him where I kept his things in the closet multiple times — or remind him his friend made a call and he has to call him back or he has to buy something on the way home from the mosque. And next day he would say, ‘What are you talking about? You never said this.’ His behavior had undergone a major change. From being calm and composed, he became a short-tempered and impatient person. This is when she thought he should seek medical help,” the psychiatrist said.

Dementia is a neurodegenerative disease, most common in people over the age of 65, and can majorly impact the quality of life of the person affected.  It is noticed when an elderly person starts misplacing things, forgetting about recent events, conversations, and common places. A person close to the patient may start noticing these changes. Alzheimer’s disease is the most common type of dementia.

Although it typically happens in older people, it is not an inevitable part of aging. The brain naturally deteriorates as people grow older, but this deterioration occurs more quickly in people with dementia. Questions like “Mein kathe chu ghare” (Where is my home?), bathroom kathe chu? (They lose the way to the bathroom within their own home), “Che neyeth mei poanche choore? (Accusing a family member of stealing their money), daare neish chu khabar kus? (There is someone standing near the window who might harm them) are often asked by patients suffering with dementia. The family members should not be dismissing this behavior as just “problems related with old age”, Dr. Insha Rauf, Psychiatrist at district hospital, Budgam explained.

The doctor said that the disease progresses over time and at later stages, a person may lose the ability to speak and walk. While the onset of Alzheimer’s disease is not before the age of 65 or so, in some cases it may begin at an early age also.

Further, Rauf added, the Kashmiri population currently has a very high burden of vascular risk factors, such as diabetes, hypertension, and obesity, which can adversely impact the onset and progression of dementia.

A 2022 study titled, “Loneliness, Social Isolation, Traumatic Life Events, and Risk of Alzheimer’s Dementia: A Case–Control Study” was conducted by IMHANS, Kashmir. It was published in the Indian Journal of Social Psychiatry.

The research was aimed to find out if loneliness, social isolation, and traumatic life events are risk factors for Alzheimer’s dementia (AD). A sample size of 100 patients were evaluated using a case–control study over a period of two years (2018–2019).

“It was found that “Loneliness” is a robust risk factor for dementia in Kashmir and as such more research needs to focus on it so that suitable cognitive behavioral interventions may be developed and refined to help the vulnerable population,” the study said.

Rauf who is also a co-author of the study said the treatment approach to tackling the disease has to be multi-dimensional. From the awareness level, where people understand what dementia is, a good number of people are missing out on the diagnosis of dementia at earlier stages due to a lack of awareness.

“There is poor awareness of dementia in society as well as among health care professionals. Also, there is a low specialist or trained human resource capacity for the care of those with dementia, and lack of public health priority for dementia is responsible for late referral to hospitals,” he said.

Dr Arshid Hussain, Professor of Psychiatry at IMHANS, Kashmir told The Kashmir Monitor that dementia affects families physically, socially, economically and psychologically as well.

“The focus of our healthcare system is still communicable diseases, maternal and child health as we have a lot to do in these priority areas, but we cannot be oblivious to the changing realities of health,” Hussain said.

He stressed that aging society and its mental health consequences are reality. Therefore, we need to refocus our health agendas to fit in the needs of changing society. “From lessening loneliness to preventing elderly abuse to early detection to diagnosis of depression to dementia, the tasks are many. All stakeholders need to be involved and a public health approach is the only way forward to improve care and quality of elderly population,” Hussain said.

Rauf said besides upgrading the health infrastructure for the geriatric population, a long-term approach is key, where not only pharmacological treatment is provided but non-pharmacological treatment is also considered.

“Medication, Reminiscence therapy, cognitive stimulation therapy, reality-oriented training along with lifestyle changes are the treatment approaches for patients with dementia,” Rauf said.