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Jakarta Post

In Indonesia, a looming gray crisis

  • Christian Razukas

    The Jakarta Post

Jakarta   /   Wed, September 11, 2013   /  12:50 pm

DY Surhaya said that when she returned to Indonesia in 2002, her mother was angry. And confused.

'€œMy mom was very combative, arguing about little things '€” very small things,'€ the former CNN journalist said at a recent discussion on dementia at the @america cultural center in Jakarta. '€œIf the ironing wasn'€™t perfect she'€™d get furious at the maid.'€

The problem was eventually diagnosed as Alzheimer'€™s disease.

'€œIf I knew my mom had these symptoms 10 years ago, I would have dragged her to a psychiatrist, made her eat better, exercise more,'€ DY said of any of the things that might have helped stop the dementia, which currently affects more than one million people in Indonesia.

Dementia is a non-communicable disease and no one is sure exactly how it develops. Scientists think that Alzheimer'€™s, which accounts for up to 80 percent of all dementia cases, is connected to protein tangles and deposits in the brain.

'€œAlzheimer'€™s is in a continuum, where people move over a period of decades from an asymptomatic to a pre-clinical state,'€ US Alzheimer'€™s policy specialist Michael Splaine said over the Internet at the talk. '€œThis is a 20 to 30 to 35 year process.'€

Dementia is not part of normal aging, Martina Nasrun, one of the nation'€™s few geriatric psychiatrists, said. '€œThis is an illness that worsens over time. Slowly, it robs people of their cognitive ability, leaving them with holes in their memories.'€

People with Alzheimer'€™s or dementia passed through several stages, including apathy, agitation, depression, aggression and psychosis, Martina said. Eventually, it kills them.

It'€™s not a problem limited to Indonesia. '€œIf you have problems imagining yourself at 85, we'€™re all having problems imagine millions of 85-year-old people,'€ Splaine, who has advised US officials and lawmakers, said. '€œDementia is a reality.'€

Albert Maramis, a psychiatrist and mental health expert working for the World Health Organization (WHO), said that the problem was quickly getting worse in low and middle income countries (LIMC) such as Indonesia, where the graying population has been increasing at a faster rate.

'€œWe can see that the population pyramid is changing. Years ago, the base [the elderly] was very wide and the peak was very small. Life expectancies are increasing from 55 to 65 and 68,'€ Albert said. '€œWe cannot be quiet. We have a need. The family structure is changing, and we need to change with those needs.'€

Martina said that there were many causes of dementia, including old age and genetic predisposition. People suffering from high blood pressure, high cholesterol, diabetes and obesity were also at increased risk.

Having a poor education and old age also increased the chances of developing the disease, as did being female, although Martina said that might be connected to women'€™s longer average life spans.

'€œThere are no medications that can stop Alzheimer'€™s, but there are medicines that can improve certain aspects of the disease or can temporarily stabilize a patient,'€ Martina said. '€œMedicine must be combined with a management strategy.'€

Managing the disease, however, will be difficult. In the Asia-Pacific region alone, the number of dementia cases is expected to jump from 13.7 million to 64.6 million, with more than 3 million cases in Indonesia, by 2050, Martina said.

Treatment requires geriatric psychiatrists and specialist physicians, who are rare in Jakarta and rarer even still at the district or regency level. In one bright spot, Albert says that the WHO developed standards currently used by the Health Ministry at the Puskesmas community clinic level to screen for dementia.

He said that while dementia currently has a price tag of US$604 billion across the globe, the indirect costs of treating the disease, such as lost wages for family caregivers, were more important for LIMCs like Indonesia.

'€œAlzheimer'€™s is like a rock thrown into a pond,'€ Splaine said. '€œThe ripples affect the family and eventually national development.'€ He was also concerned about families losing grandparents. '€œWe think about a '€˜second'€™ patient. There is a real financial hardship when people become isolated or incapable of raising the next generation.'€

Meanwhile, DY doubted that the WHO standards would be enough.

Practitioners, she said, '€œhave these lists of all these other higher priorities related to the MDGs [Millennium Development Goals] for 2014. It'€™s not on their agenda or their key performance indicators. Their KPI is to make sure that maternal deaths are slowing down.'€

'€œWe'€™re pushing for a national plan. But SBY [President Yuhoyono] hasn'€™t done anything yet. A decree has been at the Ministry of Health for three years. But it'€™s not dengue fever or malnutrition or stunting. It'€™s not HIV/AIDS or tuberculosis.'€ DY said. '€œIt'€™s not sexy.'€

'€œThis is going to be a major problem.'€

Alzheimer'€™s Indonesia is planning a '€œMemory Walk'€ as part of car-free Sunday on Sept. 15, meeting by Grand Indonesia and will offer free screenings for the disease. Visit or @alzi_indonesia for information and to watch the talk.

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