Marathi Noi (Dementia/Senile Dementia)

MARATHI NOI (SENILE DEMENTIA/DEMENTIA)

INTRODUCTION

Senile dementia is a disease caused by degeneration of the brain cells.  It is different from normal senility in the elderly in that the patient's brain function will gradually deteriorate resulting in progressive loss of memory and mental abilities, and noticeable personality changes. Those affected may experience cognitive difficulties, personality changes, and behavioral problems. While these problems most often affect the elderly, they are not a normal part of aging.

Causes include:

•     Alzheimer's disease
•     Vascular dementia, the second most common cause of dementia, accounting for up to 20% of all                      dementias
•      Huntington disease, a progressive degenerative disease that causes dance-like movements and mental       deterioration
•      Atherosclerosis, or hardening of the arteries
•      Multiple sclerosis, a disorder of the sheath that lines the brain and spinal cord
•      HIV, the immunodeficiency disorder that leads to AIDS
•      Parkinson's disease, a degenerative disorder of part of the nervous system
•     Creutzfeldt-Jakob disease, a rapidly progressing degenerative disorder of the nervous system causing            problems with walking, talking, and the senses
•      Pick's disease, a disorder of the brain that causes slowly progressing dementia
•      Viral or bacterial encephalitis, an inflammation of the brain
•      Lewy body disease, a degenerative disease of the nervous system
•      Normal pressure hydrocephalus, or increased cerebrospinal fluid in the brain
•      Chronic subdural hematoma, or bleeding between the brain lining and brain tissue
•       Brain tumor
•       Wilson disease, a rare disease causing an accumulation of copper in the liver, brain,kidneys, and                     corneas
•       Neurosyphilis, an infection of the nervous system by the syphilis bacteria, which causes weakness and           mental deterioration
•       Progressive supranuclear palsy, also known as Steele-Richardson-Olszewski syndrome, a rare disorder        of late middle age that causes widespread neurological problems.

Certain abnormalities of a person's metabolism or hormones may also be responsible for the development of dementia, including the following:

·         Hypothyroidism, which means the thyroid gland is underactive

·         Hyperthyroidism, which means the thyroid gland is overactive

·         High-dose steroid abuse

·         Deficiency, or low body levels, of vitamin B12

·         Thiamine deficiency

·         Deficiency of niacin, or vitamin B3

·         Chronic alcohol abuse

·         Chronic exposure to metals, such as lead or mercury, and to dyes, such as aniline

·         Medication side-effects or drug interactions.

Symptoms at the early stage include the following:

• Forgetting recent events (distant memories also fade as the disease progresses)
• Experiencing difficulty in reasoning, calculation, and accepting new things
• Becoming confused over time, place and direction
• Impaired judgment
• Changes in personality
• Becoming passive and losing initiative.

Behavioural and psychological symptoms of dementia (BPSD)

Behavioural and psychological symptoms of dementia (BPSD) refer to the often distressing non-cognitive symptoms of dementia and include agitation and aggressive behaviour. BPSD have been defined as symptoms of disturbed perception, thought content, mood or behaviour, frequently occurring in patients with dementia. Other common terms in use for these symptoms include neuropsychiatric symptoms of dementia, behaviour that challenges or non-cognitive symptoms of dementia.

The spectrum of BPSD includes

• Aggression
• Agitation or restlessness; screaming
• Anxiety
• Depression
• Psychosis, delusions, hallucinations
• Repetitive vocalisation, cursing and swearing
• Sleep disturbance
• Shadowing (following the carer closely)
• Sundowning (behaviour worsens after 5pm)
• Wandering
• Non-specific behaviour disturbance e.g. hoarding

SIDDHA CONCEPT OF MANAGEMENT & PREVENTION

Siddha system of medicine relates an intricate technique known as Kaya Karpam method that is used for rejuvenation and the presumed immortalisation of the human body. Siddha medical science most distinctly emphasizes the practice of Kayakarpam to rejuvenate the body and mind that eventually slows down biological ageing. The kayakarpam therapy, which includes both pharmacological and non-pharmacological treatment approaches, is being followed for centuries in siddha practice. In the prevention and management of neuro psychiatry illnesses of elderly, especially senile dementia this approach is found to be much beneficial.

·         A siddhar called Theraiyar assures that daily intake of Inji then (Zingiber officinale rhizome after removing its outer skin, sliced and soaked with honey) will prevent senility, promotes good eyesight and strengthens the body. Studies have also shown potent memory enhancing action Zingiber Officinale rhizomes in scopolamine induced amnesia model study by significantly increasing whole brain acetyl cholinesterase inhibition.

·         Nell ma nei, which is paddy rice (Oryza sativa) flour mixed with cow‘s ghee is advised to be taken daily. Brown rice is said to contain high levels of neurotransmitter nutrients that can prevent Alzheimer‘s disease to a considerable extent.

·          Ponnanganni (Alternenthera sessilis) cooked with ghee, pepper and salt made as curry and taken with daily food to slow down ageing.

·         Tender leaves of vembu (Azardiracta indica) are ground and added with omam (Tachyspermum ammi) and salt .This therapy is especially started on the day of rohini nakshathra and continued for 40 days. Recent scientific studies also suggest that neem possess antioxidant and cognition-enhancing actions.

·         Intake of Katrazhai (Aloe vera L) as dry or cooked form, gives mental wellness as if the person consumes regular fruit and mercurial drugs.

·         When manathakkali keerai (Solanum nigrum) taken either as curry or dried fruit or decoction yields extraordinary physical and mental wellness. Studies also indicate that S. nigrum extract could serve as a dietary supplement to combat various neurodegenerative diseases.

·         Withania sominifera (Amukara) root powder mixed with ghee or milk taken twice a day improves fertility and reduces nervous debility. A double-blind, randomized, placebo controlled study of the effects of Amukkara on stress found that it reduced symptoms of stress and inability to concentrate and reversed forgetfulness in a dose-dependent manner, and 500 mg/day was more effective.

·         Dry powder of Kaiyaan (Eclipta prostrata) should be taken with tender coconut water for one month and then one month with honey. This strengthens the body and avoids premature aging. Further, it has enzymatic and non-enzymatic antioxidants such as ascorbic acid and rutin. Eclipta prostrata has been used as a traditional medicinal plant to prevent dementia and to enhance memory in Asia.

·          Kadukkai-gall nut (Terminalia chebula) powder taken for 48 days with water in the evening time relieves jaundice, ascites and mental disorders like delusions.

·         Decoction or food item prepared from thettran kottai and nellikai (Strychnos potatorum and Phyllanthes embelica) is also advised for mental and physical health.

·         Vallarai (Centella asiatica) leaf can be prepared as curry and taken daily. It can also be taken along with common salt for 40 days. It enhances memory, intelligence and strengthens the body. It is found to be beneficial for cognitive and nervous illnesses as well as cerebro-vascular complications. Its effect in preventing cognitive deficits is proven.

·         Intake of a green called sirukeerai (Amaranthus gangeticus) salt, pepper and ghee provides mental sharpness.

·         Lemon juice or salted lemon taken daily for 6 months regularly with strict adherence to karpam regimen is said to prevent greying of hair and insanity. It also rejuvenates the body.

·         The oil prepared with Thulasi (Ocimum sanctum) known as Holy basil used in medicated oil bath, helps to cure pittha-accompanied diseases. This plant extract has been shown to possess anti-inflammatory, antioxidant and cognition-enhancing properties.

·         Practicing special regimens like pranayama, yoga and meditation is also found to be beneficial in managing this disease.

·         Thokkanam, a special therapy in Siddha system is also found to be helpful. This therapy includes applying medicated oils with specified pressure on the surface of the body to stimulate varma points and regulate the accumulated praana vayu (vital force) in the affected part of the body.   Pathartha guna chinthaamani and Theran tharu are some of the texts that deal with the techniques of this therapy. Strong body, relief from pain radiant skin and sound sleep are some benefits of this therapy mentioned in these texts. This method has many positive influences on the nervous system. It has also been reported from studies that tactile massage brings changes in cognitive function and BPSD in the everyday life of elderly patients with severe dementia through a 6-week course of tactile hand massage.

References:

                                 http://www.diagnose-me.com

                                 http://www.bpac.org.nz

1.Dr.B.Chitra et al. An overview on the role of Siddha practices in the prevention and management of age related neurodegenerative disorders with special reference to Senile dementia. Indo American Journal of Pharm Research.2015:5(04).

2.ka.su.Utthamarayan. Thotra kirama aaraitchiyum Siddha maruthuva varalarum, 3rd ed. Department of Indian medicine and Homeopathy publishers; 2003.

3.Dr.S.P.Thiagarajan. Sirappu Maruthuvam.1st ed. Department of Indian Medicine and Homeopathy Publishers; 1998.