Lockdown does not help when the mind shuts down

Until March, when the Covid-19 lockdown began, Thangavel M’s dementia was showing signs of slow progression. For three years, his daily routine of walks in the park, time spent at the dementia day care centre engaged in cognitive tasks, and long drives seemed to help keep the 67-yearold’s cognitive mind active, giving his wife and son the strength to cope to a great extent. But then came the lockdown all of a sudden, and overnight, the clampdown on Thangavel’s routine. The day care centres were closed; and the walks outdoors and the long drives came to a grinding halt.

Since March 24, says Sasikumar, his father’s mental deterioration has been rapid. “He can no longer eat on his own, he has angry outbursts, he throws things, and no longer recognises my mother or me,” says Sasikumar. “I work from home now, but my father cannot understand what I am doing and so closes my laptop at whim, peers into conference calls, and shouts at those on screen.”

Doctors say Thangavel’s case isn’t isolated. “The lockdown has aggravated problems due to dementia in several elders,” says Dr Sridhar Vaitheswaran, consultant psychiatrist at the Chennai-based Schizophrenia Research Foundation (SCARF). He conducted a study on the needs of caregivers of people with dementia during Covid-19, which was published in the July issue of the American Journal of Geriatric Psychiatry.

The study shows that for people living with dementia, and their carers, Covid-19 is a double hit, says Dr Sridhar. “Something as small as cracked dentures can make life hell for a person with dementia and their carer. Through lockdown, carers found that one of the biggest problems was not being able to visit doctors in person. Also, most carers had to handle everything on their own as having support staff from outside was not safe,” says Dr Sridhar. Added to that because of the cognitive decline that accompanies the condition, people with dementia have difficulty remembering safeguard procedures, such as wearing masks or maintaining physical distancing.

A new environment or change in routine can lead to increased stress and therefore behavioural problems, say doctors. “Social isolation worsens brain aging and dementia,” says Dr Sridhar, “And unfortunately, that is a must during the pandemic.”

Sasikumar says he tried in vain during the lockdown to get his father out of the city to his native village near Trichy, so he could resume some of the outdoor activities. “The e-pass was rejected several times because dementia is not recognised as a condition that requires urgent medical care,” says Sasikumar, who finally got his father out of the city in late May. “But between March and May there was rapid worsening of his condition,” says Sasikumar.

Unfortunately, say doctors, dementia is often missed in the elderly population, its symptoms dismissed as side effects of aging. This despite the fact that worldwide there are 50 million people living with dementia, with a new case being detected every three seconds. In India, there are now an estimated 5.3 million people living with the condition and is expected to grow to 14.3 million in 30 years. In TN, it is estimated that we have between 4 to 5 lakh with dementia. “Basically, 5% of the population above the age of 65,” says Dr Sridhar. “We are living longer so the numbers are climbing.”

Now, while the rest of the country is in the unlock mode, for those with dementia, the lockdown continues. “Day care centres, which give people living with dementia a space to build on cognitive skills as well as their carers respite for a few hours, cannot be opened because the risk is too high,” says Dr Sridhar.

Although tele-counselling and video conferencing sessions are being conducted, doctors say engaging an elder with declining mental faculties over technology they cannot grasp is often a losing battle. “The mental pressure on a carer during the pandemic is overwhelming. You feel as isolated as the person living with dementia,” says Sasikumar.

Both SCARF and National Institute of Mental Health and Neuro Sciences (Nimhans), Bengaluru, have set up online support groups to connect carers. Scarf for instance is set to begin an eight-week online intervention program for carers to help them understand the various aspects of looking after someone with dementia and improving their cognitive skills. “Often it is the carer that needs counselling to prevent burnout. They are pushed to the wall as they need to bottle up their emotions. We offer them a vent. We also give them strategies on identifying triggers,” says Dr Keshav Kumar, professor of neuropsychology, Nimhans. Some of the techniques suggested are making the conversation simple, using post-it notes or placards to improve orientation to the environment, and encouraging physical exercise. Nimhans has also developed a Digital Cognitive Augmentation Programme. “It’s neuroscience gamified,” says Dr Keshav. “Every level works on a specific neural circuitry and can thereby help procrastinate imminent dementia.” The app, which can be downloaded on Android phones for free (carers need to write in to Nimhans), is designed to work on multiple levels like visual spatial functions, working memory, response inhibition and so on to enhance neural plasticity.