Mumbai’s memory clinic hopes to slow the progression of dementia in patients
The first such clinic in a public hospital in the city offers comprehensive management including cognitive rehabilitation and caregiver support for persons with dementia
Mumbai: In December 2020, the family of a stockbroker from Vile Parle began to notice some odd signs in his behaviour. He struggled to find words. He couldn’t write in straight lines. As the chief executive officer of a stockbroking firm he had founded two decades ago, he was required to sign cheques and documents every day; now, his signatures weren’t the same. However, one of the most alarming changes they noticed was that the 52-year-old could not understand directions anymore. This prompted them to seek help and the man was eventually diagnosed with early onset of dementia caused by Alzheimer’s disease. The stockbroker is among the six patients to regularly visit the memory clinic at the civic-run KEM Hospital — the first such clinic in a public hospital in the city — which offers comprehensive management including cognitive rehabilitation and caregiver support for persons with dementia.
The one-room clinic, which opened in September 2021, is housed in the KEM Hospital’s outpatient department (OPD) building. It is stacked with puzzles, colour books, and charts that detail cognitive exercises, which help improve attention, organisation, planning and remembering.
Dementia is an umbrella term used for impaired ability to remember, think, or make decisions that interfere with everyday activities. Alzheimer’s disease — a progressive neurologic disorder that causes the brain to shrink and brain cells to die — is the most common type of dementia. Other causes include ageing, hypertension, diabetes, high cholesterol among others. Some reversible causes include side effects of medicines, vitamin deficiencies and thyroid hormone imbalance. Dementia is common in people over 65 years but is also seen in younger people, and is then referred to as early-onset.
In his first session in September, the stockbroker was asked to draw a picture of a 3D box and a star. He wasn’t able to draw either. His wife and 21-year-old son who watched him from a corner of the room were shocked. “I couldn’t hold back my tears. I have always known him as a bright, sharp person who took tough decisions every day. Now, he couldn’t draw a star,” his son said.
“The doctors have told us that his condition cannot be cured but only its progression can be slowed down,” he said.
According to a 2020 report by the Alzheimer’s and Related Disorders Society of India (ARDSI), an estimated 5.3 million people above the age of 60 have dementia in the country. It translates to one in 27 people above the age of 60. Dementia requires a bunch of interventions including medicines, management of neuropsychiatric and behavioural problems, cognitive rehabilitation and caregiver support. While some private facilities may offer such comprehensive services, the public sector lacks such facilities, leaving a large pool of patients to deteriorate faster. Patients who fall into this gap could become completely inactive, increasingly irritable or violent.
Psychiatrist Dr BN Gangadhar who is also a former director of the National Institute of Mental Health and Neurosciences (NIMHANS) said that there is a tendency to trivialise memory problems among the elderly. “People should know that not all memory problems are natural, some could be linked to unnatural causes like Alzheimer’s disease or vascular dementia. The first part of the solution is to raise awareness and then make facilities accessible to such population,” he said.
“In dementia, the last things you forget are the old memories and the recent memories are the ones that start fading away quickly,” said Dr Mayuri Kalika, a neuropsychologist at the KEM Hospital who is a part of the multidisciplinary team that operates the memory clinic.
“Thus, family members of an undiagnosed patient sometimes misunderstand his or her forgetfulness as fake or laziness. Relatives often tell us how the patient vividly remembers his stories from childhood but can’t remember simple things like turning off the tap or other basic daily chores,” she said.
Cognitive rehabilitation
“In India, we have a tendency to not let senior citizens take up work, even basic household chores,” said Dr Urvashi Shah, an honorary neuropsychologist at KEM Hospital. “Most children do this because they want their old parents to relax and take rest. But this may actually have a negative impact. Allowing seniors to continue their basic chores is important to stimulate the brain. They must be encouraged to take up newer activities to challenge the brain,” said Shah.
The patients coming to the memory clinic are challenged in a similar manner. Patients like the Vile Parle stockbroker who have been highly functional before the onset of dementia are challenged with sudoku puzzles, word games and maze tests, while others who have not been very active start with colouring, reading picture stories or such simple activities.
The doctors at the clinic describe these cognitive exercises as attempts to reach into the brain and save dying neurons. Engaging in basic activities like cooking, cleaning, praying or taking up hobbies like craft and drawing can offer the necessary stimulation to the brain.
Before the clinic opened, patients visiting the OPD were evaluated and put on medication, but doctors could only advise caregivers to try puzzles or games and make timetables for patients. Now, they get them to actively do these things.
Cognitively stimulating activities like games and puzzles are known to improve brain health. In dementia patients, these activities not just improve brain function but also play a therapeutic role by improving interactions with fellows and through a sense of accomplishment by completing certain tasks. The human brain has millions of nerve cells called neurons. Degenerative diseases like Alzheimer’s cause the death of the neurons gradually that leads to deterioration of functions like memory, speech, movement etc. Doctors said that when patients are put through well-planned activities in rehabilitation clinics, the degeneration of neurons slows down.
“We need more such clinics in the public sector. It is the need of the hour,” said Dr Sangeeta Ravat, head of neurology at KEM Hospital, who helms the memory clinic. “Patients coming to a public hospital like ours mostly come from lower socio-economic backgrounds. The caregivers sometimes can’t afford to get them to the clinic if the sessions are scheduled more often. So, we have to space the sessions depending on the willingness, affordability and condition of the patient. If we have more such clinics, patients can get services closer home,” she said.
According to Dr PP Ashok, head of the neurology department at the PD Hinduja Hospital, in addition to more such dedicated clinics, day-care centres for people with dementia are also essential. “There are plenty of such centres in the US. A bus picks up such individuals, drives them to the centres where they undertake several activities designed for them, and they are dropped back home in the evening when their family members return from work. We need such centres in India,” he said.
“We have a lot of hopes from the memory clinic,” said the stockbroker’s son. “It is difficult to gauge any difference in him so far, but hopefully, we will see some changes in the coming days,” he said adding that his father had to stop going to work soon after his diagnosis in December 2020. Recently, they initiated the procedure to relieve him from the CEO’s position. “Because of his condition, the members of the firm thought it was the right thing to do,” he said.