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"Non - cognitive symptoms of dementia"in developing countries
- K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), N.Edirisinghe MD, Senior Registrar, University Psychiatry Unit, North Colombo Teaching Hospital,Ragama, Sri Lanka (18 June 2009)
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K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Professor of Psychiatry Faculty of Medicine,University of Kelaniya,Ragama,Sri Lanka, N.Edirisinghe MD, Senior Registrar, University Psychiatry Unit, North Colombo Teaching Hospital,Ragama, Sri Lanka
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lalithkuruppu{at}lycos.com K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), et al.
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The editorial “ Another nail in the coffin of the cognitive paradigm of dementia ’’ by Alistair Burns(BJP.2009) has been read with much interest. Cognitive problems have been the main area of interest in research and the therapeutic interventions for people with dementia conventionally. It is becoming increasingly evident that several common non- cognitive symptoms give rise to problems not only to the persons with dementia and carers ,but also in relation to clinical management (Douglas et al 2004). Non- cognitive symptoms have been grouped together under the term ‘ Behavioral and Psychological Symptoms of Dementia ’ (BPSD) by the Internatoinal Psychogeriatric Association. This has a global relevance particularly for developing countries like Sri Lanka because of increasing elderly population and increasing number of dementing people . Despite the cultural variations , their neuropsychiatric manifestation is more or less the same when compared with that of developed countries.Therefore, most clinicians tend to use the same neuropsychiatric batteries adapted in western countries , may be after validation or making minor modifications. In fact , the safe and effective management of psychiatric and behavioral symptoms of Alzeihmer’s dementia can be considered as one of the greatest challenges the clinicians face(Overshott et al 2004). Caring for patents with dementia is extremely stressful. However, the burden of caring for patients with dementia mainly falls on the family in countries like Sri Lanka . Further , change in the supportive closely-knit family structure mainly due to increase in number of females seeking employment will cause problems in the traditional care. Other important factor noteworthy is insufficient state support, which will further increase the care giver burden. These factors were already highlighted (Kuruppuarachchi & Lawrence 2006) The importance of incorporating non-pharmacological options in the management of dementia, in the initial phase , has been emphasized. This is particularly relevant for developing countries even though there is some evidence in favor of effectiveness of pharmacological interventions in reducing care giver burden. Less costly non-pharmacological interventions may be considered on its own or as an adjunct to chemotherapeutic interventions in our part of the world. Therefore, it is high time for us to do more research work in this area in our countries keeping in mind the changes occurring in the traditional family as well. Rating scales which can be used cross –culturally may be developed in order to facilitate the early identification of “Neuro- psychiatric’’ sequel of dementia across the globe. References Burns A . Another nail in the coffin of the cognitive paradigm of dementia . The British Journal of Psychiatry 2009 ; 194 : 199-200 Douglas S , James I , Billard C . Non- pharmacological interventions in dementia. Advances in Psychiatric Treatment 2004; 10 :171-179 Overshott R, Byrne J , Burns A . Non-pharmacological and pharmacological interventions for symptoms in Alzheimer’s disease. Expert Review of Neurotherapeutics 2004; 4,No 5: 809-821 Kuruppuarachchi K A L A ,Lawrence T S. Carer burden in dementia. Ceylon Medical Journal 2006;51(1):44 |
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