I posed four questions on Alzheimer's disease in Jamaica, to Dr. Albert Chen, a medial doctor and a consultant clinical gerontologist. He is also the chairman of the Alzheimer's Disease Outreach Programme. Here are the edited responses.

Eulalee Thompson: You say that about 27,000 Jamaicans (about one per cent, I think you stated) have Alzheimer's type dementia. Could you speak about the health and social systems that need to be put in place for the country to properly manage the disease?

Albert Chen: The number 27,000 would cover the total cases of dementia in Jamaica. This would therefore cover dementia cases due to Alzheimer's disease, but also those due to strokes and other vascular diseases, Parkinson's disease, and other less common types of dementia (such as HIV and Prion diseases).

Most dementia patients are cared for at home by family members, especially spouses and daughters, but increasingly by daughters-in-law and sons. Persons with severe dementia, which is accompanied by persistent behaviour problems, are commonly placed in institutional residential facilities for professional care.

The first focus should be on educating the public about dementia, so that persons may be properly diagnosed early in the disease, and appropriate treatment initiated. There is treatment available for most cases of dementia, though there is no cure on the immediate horizon.

The second focus should be to improve the skills level of persons caring for those with dementia. This begins with the neurologists, psychiatrists and gerontologists/geriatricians (at the specialist level) and ends with the family caregivers.

Institutionalisation of dementia patients should be the very last resort, therefore family physicians and family members and caregivers should be properly trained to manage the day-to-day affairs of such patients.

Alzheimer's disease is a chronic disease, such as hypertension and diabetes, and should get the equivalent attention. We must consider, at the state level, including drugs for dementia on the JADEP/NHF programmes, and retraining community mental health officers to better monitor persons with dementia at their homes, and also to increase the number of such community workers (especially as we decentralise the mental health system.)

The main message is that there is no dementia due to age and there is no longer an entity called Senile Dementia. All cases of dementia have a specific cause, which can usually be identified and treated, and this is never chronologic age.

Is it projected that we will have far more cases in the near future?

While age does not cause dementia, the prevalence increases with age. By 2011, a large number of Jamaican baby boomers (born between 1946 and 1964) will reach 65, and with this their risk of dementia will increase. For every five additional years after age 65, the prevalence of dementia will approximately double. By 2050, it is reasonable to expect over 40,000 Jamaicans to have dementia. With increasing longevity of the older population in general, and also of those persons diagnosed with dementia, these projections are not unreasonable.

We should also consider reverse migration of older Jamaicans who are returning from abroad. Increasingly, the cost of nursing home care in North America is forcing oversees Jamaicans with severe dementia to seek residential care in Jamaica. This is a trend which may intensify in the future.

Is adequate treatment available here in Jamaica? If not, how could we improve it?

We have well trained professionals, who are very qualified in the management of Alzheimer's disease and other forms of dementia. The challenge is to increase the level of expertise of primary care personnel, such as family physicians and professional and family caregivers. The drugs needed to manage dementia are largely available, though not inexpensive.

Adding certain drugs for dementia to those approved for the JDEP/NHF programmes would significantly revolutionise the treatment of dementia in Jamaica, and greatly improve the quality of life of persons with dementia and their caregivers. This may also result in delayed institutionalisation and tremendous savings to the families.

What about stigma and ignorance, are these issues affecting Alzheimer's? You could discuss.

Yes! Jamaicans respect the elderly, in general. Therefore, the stereotyping of persons with senility is a compassionate one. However, this very compassionate linking of dementia with age is also the main reason why many such persons are not referred for medical attention. The point is, if the problem is due to age, and there is no cure for age, why waste money going to the doctor. In fact, the correct message is that all cases of severe memory and mental decline in the elderly are due to identifiable causes. And these causes can in most cases be treated.

Please send feedback to eulalee.thompson@gleanerjm.com