Plans to help dementia sufferers in the community

Malta lacks a community-based service and a holistic approach for dementia suffers, according to neuropsychiatrist Mark Xuereb.

He is in the process of setting up the first Malta Dementia Society, which is likely to be welcomed with a sigh of relief by carers of dementia patients.

"Dementia cuts right through society, affecting so many people, and cannot be overlooked," Dr Xuereb said. "I remember coming across a half-naked elderly man, walking in the middle of the road to the drydocks to get his 'ration', under the impression that he was still living in World War II. The family was also distraught - such is the extent of the danger of dementia," he recalled.

Malta may still have strong family and Church ties, which are to its advantage in terms of tackling dementia, but it is lacking an "assertive outreach" in the community, he continued, although plans to adopt a community-based service, based on the established UK model, are in the pipeline.

The service would require teams, consisting of a physician, a general practitioner, a neoropsychiatrist, community nurses, social workers, occupational therapists and physiotherapists, for particular geographical areas. They would be of immense benefit to patients, who would be able to remain in their natural surroundings, avoiding the trauma of being moved around and preventing unnecessary and premature institutionalisation, Dr Xuereb pointed out.

Despite the existence of wards for people suffering from dementia in St Vincent de Paul, Mount Carmel Hospital and Zammit Clapp, which offer sterling work, the service is considered to be "incomplete".

Malta lacks a specific support group, or centre, specialising in management of patients and providing consistent advice for carers, whose role is heavily burdensome.

The Malta Dementia Society, the first of its kind, is being based on the Alzheimer's Disease International (ADI) template and is considered to be an important step ahead for Malta and for dementia.

Eventually, a helpline would be set up, meetings organised and funds raised, Dr Xuereb, its founder, envisaged. He was surprised that, in 2004, no such dedicated carer support group is in place in Malta, given its aging population, and that the service is only provided in an indirect manner.

"Of course, the society cannot embark on a utopic mission and has to be realistic but it can support carers and let them know they are not alone; that there is help for them out there. Carers carry out invaluable work, which is often unacknowledged by the family and the state," he said.

Dementia is, as yet, a poorly understood condition by the public. Its definition, according to the World Health Organisation classification is: an acquired progressive disorder of cognitive function which is chronic and not always reversible.

The International Classification of Diseases stipulates that it implies at least two or more deficits of cognitive function out of the following eight: memory, personality, abstraction, praxis (following and executing a coordinated movement), language, judgment, social conduct and visuo-perceptual skills (knowing yourself in relation to the environment).

Dementia, therefore, does not only affect memory, as is commonly understood, Dr Xuereb explained.

Often considered to be Alzheimer's, today it is an established fact that dementia is divided into a number of ramifications, which must be classified because each requires specific attention and affects management options.

Carers should be encouraged to ask professionals exactly what their patients are suffering from to be able to handle the situation appropriately.

A wrong diagnosis, which is often the case in dementia, can lead to crucial management problems and distress for patients and carers.

Another major misconception is that dementia is only related to the elderly. In reality, it can also occur in the young, primarily due to syphilis and HIV, which are both on the rise, as well as drugs and alcohol.

Research on dementia is ongoing and reclassification is constant, said Dr Xuereb, who is based at Oxford University, a frontrunner in the field.

The school of thought from Oxford is that the most common type of dementia is a mixed form: Alzheimer's, together with vascular dementia, the narrowing of arteries in the brain, meaning less blood and, therefore, memory loss - a primary feature of dementia. These are the preliminary findings of the nationwide Optima project, carried out at the Radcliffe Infirmary in Oxford.

Despite the amount of research, there is no miracle cure, or pharmacological treatment for a number of dementia as yet, although psychological therapies for patients and carers are also a mainstay of treatment.

What can be achieved, however, is an improvement in the quality of life and dignity of patients, as well as support and education of carers, who often feel lonely, isolated and powerless, Dr Xuereb said.

Among the risk factors, dementia can run in the family, although it is not an automatic certainty. Others include a history of Down's Syndrome, smoking, high blood pressure, being overweight, high cholesterol levels and untreated hypothyroidism.

But experts advocate that there are ways to either prevent, or delay the onset of dementia. They recommend adopting a healthy lifestyle, a healthy diet and remaining active, both physically and mentally.

It is for this reason that Dr Xuereb praises the University of the Third Age and encourages people to continue reading, going to social clubs and "doing crossword puzzles!"

Anyone interested in joining and contributing to the MDS can e-mail the society on maltadementiasociety@gov.mt.