Our ageing brains: Concentrating on dementia
- Tamsin Oxford
Strong social networks can go a long way to assist people living with forms of dementia, such as Alzheimer's.
The passage of time, the genetic lottery and illness can affect an older person’s emotions, moods and behaviours – changing how they engage with others and experience life. Advancing years can cause problems with cognition and memory that can manifest in mood changes that influence their relationships and lives.
Diseases such as Alzheimer’s erode a person’s sense of self-awareness and cognitive ability and put immense pressure on caregivers and partners as they watch the person they knew slowly disappear.
According to the National Center for Biotechnology Information (NCBI), around 46.8 million people worldwide are living with Alzheimer’s and other dementias, of which about 187 000 are in SA. This number is expected to increase to 250 000 by 2030 making it increasingly important to find ways to help people experiencing dementia.
“As we age, so does our brain, the centre of the body that controls so much of who we are and what we do each day,” explains Dr Ryan Wagner of the MRC/Wits Agincourt Research Unit at Wits.
“Certain parts of our brain shrink in size and this can impact our memory, learning and decision-making. Our ageing brains are also more likely to be affected by conditions such as stroke and dementia.”
Dementia is an umbrella term used to describe a number of different conditions that result in decreased cognitive ability, such as Alzheimer’s. Many of these conditions are progressive and often have a drastic effect on a person’s ability to carry out daily activities.
There is still a lot to be learned about what causes dementia, which is essentially damage to brain cells and can be caused by strokes or ‘small strokes’ that are more common in older people. Wagner points out that another condition that affects mood, behaviour and emotions in older people is depression.
“It is common but often under-diagnosed in older people,” he says. “We know that higher levels of depression are seen in people with dementia and after experiencing a stroke, but older people without dementia or stroke experience depression as well. With generally more health issues, a possible reduction in physical function, changing relational dynamics, maybe the loss of a partner or close friends and thoughts of mortality – getting older can be stressful and lead to depression.”
The brain is the epicentre of the individual. It’s the central computer that manages memory, decision-making, mood, movement and speech. Conditions that affect the brain tend to manifest in different ways as they affect different areas. Depression and dementia can develop slowly.
Cognitive impairment can start with forgetfulness – where are the house keys, who is that person?
With dementia, this will progress over time and other brain functions may be affected – I can’t remember how to speak, I’m not sure how to respond. This can lead to changes in mood due to frustration and anger. Often, dementia is accompanied by severe mood swings, aggressive behaviour, and what can seem like illogical decision making. People affected by the illness are frustrated by the limitations of their thought processes and their moods are troubled by confusion, loss and sorrow.
“For many people, experiencing dementia or cognitive decline, it is more important to conduct normal activities at home and in the community than it is to put a label on whether their condition is Parkinson’s or dementia,” explains Professor Stephen Tollman from the MRC/Wits Agincourt Research Unit at Wits.
“We still don’t have a lot of data for the relative rates of various conditions but insights and research will help us to manage treatments and interventions that are more effective. One area that can be plotted with real accuracy is the ways in which social networks change over time as cognition declines. Social networks play an important role and these can shrink as dementia increases.”
The resilience of social networks plays a powerful role in helping people with evolving dementia. A solid and supportive network has a positive effect, especially in areas where medical and healthcare resources are limited and often unavailable. As Tollman points out, “I think we know very little and it’s important we gain a deeper understanding, particularly in the rural context. Older people play a critical role in South Africa and their importance to the youth and future of the country is clear.”
Dementia is a burden felt heavily in rural and poorer areas and the changes in mood that accompany the decline are complex and challenging, but there have been some remarkable shifts in approach and potential management of the condition.
In 2018, Wits Professor Stefan Weiss revealed a ground-breaking nasal spray that could potentially transform the lives of people with Alzheimer’s. The spray, currently undergoing clinical trials, has shown success in slowing down the progression of the disease by targeting the protein aggregation that accompanies it.
“While we still don’t have an effective treatment to reverse or cure Alzheimer’s, there are medications that temporarily improve some of the symptoms,” concludes Wagner. “Globally there’s a huge effort underway to better understand the causes of dementia. The hope is that if we better understand the causes, we can develop effective treatment. But the best we can do right now is to try and prevent it. Eating healthily, getting adequate exercise, quitting smoking and keeping the brain active are the best ways to lower the chances of developing dementia.”
- Tamsin Oxford is a freelance writer.
- This article first appeared in Curiosity, a research magazine produced by Wits Communications and the Research Office.
- Read more in the 10th issue, themed: #Mood how our mental health and wellbeing are impacted by the socio-economic, political, psychological, legal, ethical, cultural and technological interpretations of our world.