“The prevalence of dementia in persons [in Jamaica] who are 60 and older is somewhere around 9%, and that is likely an underestimate. What that works out to be is that approximately 45,000 persons 60 and older are probably living with some type of dementia, but these figures are from 2018, and that's before COVID”, explained Dr. Ishtar Govia, research and Clinical Psychologist and Senior Lecturer in Epidemiology at the Caribbean Institute for Health Research (CAIHR), UWI Mona in Jamaica.
Adding that COVID-19 does indeed affect long term cognitive function, Dr. Govia further explained that the underestimate is also impacted by “the poor diagnostic services and pathway in the country, and because people tend to present so late.”
Ageing Population
These statistics are important based on the fact that Jamaica is seeing a rapidly ageing population, the highest growth rate being among those 80 years and older, with the over 60s projected to be approximately 18% of the population by the year 2050. This data, according to a study co-authored by Dr. Govia in 2021, “signals the importance of robust and sustainable long-term care services and systems.”
Trinidadian-born Govia is the program lead at CAIHR as well as heading the multi-country dementia care improvement study dubbed Strengthening Responses to Dementia in Developing Countries (STRiDE), which works with public and private practices to inform policy to support people living with dementia and their caretakers.
She is Managing Director on the Board of the Jamaica Mental Health Advocacy Network and a founding member of the Caribbean Alliance of National Psychological Associations. The doctor is also on the board of the Bellevue Psychiatric Hospital in Jamaica, the country’s major mental health center, an institution that has been associated with the stigma surrounding mental health in the country.
Dr. Govia noted that the stigma is based on lack of knowledge and understanding, but was quick to point out that, using Jamaica as a case study, there has been much progress over the past two decades with billboards, social media, helplines offering support, resources, and opening up the conversation.
“But, there does tend to be a generational divide. Older persons still associate mental health with mental illness, and a particular type of mental illness as in schizoaffective disorders that have people on the street and homeless,” said Dr. Govia.
She added that the issues related to dementia are further behind the general conversation of mental health because the age group that it tends to focus on are very concerned about image and presentation. So, by the time their condition is verbalized, it is late in the progression of the dementia.
Based on these misconceptions and stigma around mental health, the clinical psychologist wants to make it perfectly clear that there is a difference between mental illness and cognitive illness or impairment.
Neurocognitive Disorders
“Dementia is in a category called neurocognitive disorders, and that's different from psychiatric disorders… Progressive dementias, for example, typically are highly correlated with age. Persons who are 80 and older tend to be the age group that we see most cases of dementia, and your risk for dementia increases as you get older. Age is the strongest risk factor.”
Mental illnesses, on the other hand, could affect anyone across all different age groups. These psychiatric disorders are things like schizoaffective disorder, bipolar disorder, major depressive disorder, generalized anxiety disorder, specific types of anxieties, post traumatic stress disorder.
Asked if there are any effective treatments for dementia, Dr. Govia noted that the therapeutics and medications that exist to date, for example to treat Alzheimer's disease, tend to address symptom presentation particularly if the condition is identified in its early to mid stages. Two of the main anti-dementia medications are Aricept and Namenda.
Said Dr. Govia: “Namenda is not pervasively available in the Caribbean, definitely not in Jamaica. And so the therapeutics aren't at the point yet of actually slowing down the progression. They really aren't at the point of stopping the progression, preventing the progression or reversing it. There is a lot of work being done.”
She explained that there has been controversy around aducanumab, a drug that was approved by the Food and Drug Administration in 2021 for the treatment of Alzheimer’s disease. The clinical trials focused mainly on European American populations excluding other ethnic and racial communities. And, according to the wider medical fraternity, further studies are needed to test the drug’s effectiveness. But, Dr. Govia is hopeful as another recent medication, lecanemab, in trials now, is showing peaks of potential.
There are other things that can be done in terms of care management said Dr. Govia. She talked about actions such as reducing your risk factors including poor sleep or nutrition, low physical activity, hearing impairment, which a lot of people don't recognize is a risk factor for dementia, and pollution.
The next step is to put in support structures, if necessary, depending on the disease progression. In some ways it may be better to age-in-place, which would mean retrofitting one’s living space.
“It’s really about how do you put things in place so that you can ensure that you have a good quality of life and that you can live as independently as possible, for as long as possible, while gradually building in more supports for progressive dementia. The reality is that you do become dependent in the final stages, so it’s really just preparing for that.”
