The true number of people with dementia in T&T is yet to be determined but it is estimated to be around 13,000, according to geriatric pyschiatrist Dr James Bratt.
Bratt is the only geriatric psychiatrist in the country who has completed an accredited training programme specifically in this area. He worked in Ireland, New York and London before returning to T&T in 2014 to set up his private practice in the same building where his father, Dr David Bratt, runs a private paediatric clinic in St James.
An old age psychiatrist, also known as a geriatric psychiatrist in the US, is a psychiatrist that has undergone extra training to treat the specific ways that older people, 65 years plus, with psychiatric and psychological conditions present, keeping in mind that many older people have chronic physical health conditions that complicate the picture.
Speaking to the Sunday Guardian, Bratt said about half of what he does was the diagnosis and treatment of mental health problems such as depression, anxiety, panic attacks, obsessive-compulsive disorder, bipolar disorder and schizophrenia, and the other half involved the diagnosis and treatment of people of any age with memory problems/ dementia.
On how prevalent Alzheimer’s was in T&T, Bratt said, “We do not yet know how many people have dementia in T&T, Alzheimer’s being the most common type of dementia.
“We are, though, extremely lucky to have a research group called Dartt (Dementia Awareness Research Group of T&T) based at UWI who are currently doing a prevalence study to answer this very question.
“We can, however, make rough estimates, according to the last population census from 2011 published by the Central Statistical Office, the population of T&T was 1.3 million people. Of that, 119,029 people were aged 65 and over, which represents nine per cent of the total population.
“It’s very hard to estimate accurately how many of these people have dementia. US figures indicate that 11 per cent of over 65s in the US have dementia, which would equate to about 13,000 people in T&T.”
He said this was a rough estimate, the figure may be more or less in reality.
Bratt said that was why hard figures were needed for T&T in order for the Ministry of Health to plan for the future treatment and care of people with dementia.
When asked if the trend in Alzheimer’s patients in T&T was fitting a similar pattern worldwide, he replied that he could only comment on his personal experience having worked as a doctor in three other countries.
Bratt said he was seeing the same numbers of dementia patients here as he did abroad.
He said what really surprised him coming back to Trinidad after many years was the number of people now living in senior citizens’ homes.
More women than men living with dementia, disease
affects rich and poor
Bratt said men and women were equally likely to develop dementia, however there were more women than men with dementia living today.
He said this can be explained by the fact that women lived longer than men.
Bratt said there was also the myth that dementia was a disease of rich countries, the World Health Organization (Who) in its report titled Statement of Intent on Global Action Against Dementia, which was adopted in Geneva more than a week ago, estimated that nearly 60 per cent of people with dementia live in low- and middle-income countries.
Bratt said there were differences in the numbers of people with dementia between different ethnicities, with Alzheimer’s being the most common type, but it was thought that genetic factors did not account for the large prevalence differences.
He said health conditions such as high blood pressure and diabetes were the likely culprits and were more common in certain groups such as people of African and Indian descent.
Bratt said these conditions themselves predispose people to developing dementia and especially vascular dementia, which is the second most common type of dementia.
RUN OVER PG 7
He said this was why practitioners in the field were constantly pushing the idea that a healthy heart equals a healthy brain.
Bratt said as more people were living longer, they were seeing more people with the disease.
He said age was the single biggest risk factor for developing dementia, the older one gets, the more likely one is going to develop dementia.
Bratt said nine per cent of the population in T&T today were over the age of 65, compared to 6.2 per cent in 1990.
He asked whether the country was prepared for an increase in the numbers of people with dementia.
Bratt said he did not see any figures to support that the disease was starting to affect a much younger demographic younger than 65 years.
He said there were many types of dementias and there were some that affected young people such as early-onset Alzheimer’s and Huntington’s Disease.
Bratt said these were genetic illnesses and these types of diseases tended to have stable numbers in the general population.
What can be done
to prevent dementia
When asked if people can do anything to prevent or stave off the disease, he said lifestyle factors were extremely important in reducing the risk of dementia. Bratt said the current recommendation was to eat healthily—low salt, low sugar, low cholesterol, also exercise regularly, don’t smoke, drink only in moderation or not at all.
He said to also partake in mentally challenging exercises such as learning a new language or musical instrument, play Sudoku, crossword puzzles and to enjoy social activities, as loneliness was the untold scourge of modern day life.
Bratt said a very interesting study from Finland was published recently in the medical journal Lancet showing real evidence that modifying several risk factors for dementia at the same time physical exercise, brain training, social activities, and dietary intervention showed improvements in the brain function of older at-risk people.
Bratt said that there was no evidence that alternative treatments such as coconut oil, turmeric or other supplements prevented dementia or slowed down the rate of deterioration.
When asked if there was a large market for what he was doing in T&T, Bratt replied that many people had asked him that question and he asked himself the same thing when he moved back home last year.
He said there was far too much work for one old age psychiatrist.
Bratt said luckily there were many general psychiatrists, neurologists and general practitioners in T&T who played a vital role in the diagnosis and management of dementia.
Responding to the question that he was a second-generation doctor, the son of Dr David Bratt, if he ever felt that he had to come out of his father's shadow, James joked that he prefered to think that he was making his own shadow.
Bratt said his main motivation to become a psychiatrist was that he found the interaction with people fascinating and he felt very drawn to the specialty from the first day he started working in it. He said his main motivation to become a geriatric psychiatrist was because he enjoyed the company of older people.
Bratt said he also enjoyed the interplay between psychiatry and physical illness and working as a psychiatrist in general hospitals was something he always enjoyed.
He said doing home visits is very often necessary in his field due to the physical frailty of some patients and visiting a person’s home is something he enjoys very much and gives him key insights into the social situation.
No cure on the horizon
Bratt said that there were many research projects around the world attempting to find a cure but he didn’t think there was a cure around the corner. He said at the moment the most important thing was prevention and public awareness.
When asked his opinion on cloning or stem cell research for a possible cure for Alzheimer’s, Bratt said that it was a contentious topic with lots of ethical considerations, however these do represent real possibilities of finding new treatments in the future.
He said discussions needed to start on complex issues such as this and others such as physician-assisted death, euthanasia, and dying with dignity.
Bratt said no matter what your opinion was, these issues were real and families faced them on a daily basis.
Bratt stressed that early diagnosis and treatment were vital to stave off the progression of the disease for as long as possible in order to give a person as many years of good quality living as possible.
He said there was a lot of misinformation out there that “the medicines do nothing” or that “nothing can be done for dementia” and this was incorrect.
Bratt said it had been shown in many studies that there were real long-term benefits to taking medications licenced for dementia, and even more so when taken early, and that many interventions, be it from psychologists, occupational therapists, dementia nurses, dieticians, social workers or dementia advisers were extremely effective.
He said serious discussions on the economic and social impact of dementia needed to start in the country.
Bratt said a health economics study was needed to show hard figures on what the Government spends on dementia care and what it should be spending.
He said the financial burden on families was enormous, so too the caregiver stress burden and families were struggling to cope.
Bratt said the GAPP (Geriatric Adolescent Partnership Programme), which was a wonderful idea, was struggling to cope.
He said The Alzheimer’s Association, of which he was the vice-president was underfunded and underdeveloped despite the kindness of the people who give of their free time and it needed citizens' help.
Dr James Bratt Biography
Dr James Bratt attended medical school for six years at the Royal College of Surgeons in Ireland. After a two-year internship in internal medicine/infectious diseases, surgery and paediatrics in both Dublin and New York, he then started a seven-year training programme in psychiatry in London, UK.
Bratt trained for three years in general psychiatry and then four years specifically in old age psychiatry and received his Certificate of Completion of Training (CCT), without which he would not be considered a specialist in the UK. Bratt also holds a Masters in Public Health from King’s College London.