Women, indigents doubly burdened by dementia, ADHD, epilepsy – doctors’ panel

Dementia, attention-deficit/hyperactivity disorder (ADHD), and epilepsy are already disruptive on their own, but women and indigents face greater burdens having these conditions—or caring for patients with them.

A panel of female doctors elaborated on these difficulties in a media forum held by Novartis on Tuesday in celebration of Women's Month.

More stressful than cancer care

Dementia describes a wide variety of symptoms associated with a decline in mental ability that affects memory, thinking, and social abilities, said Dr. Socorro Martinez, chair of the Dementia Council of the Philippine Neurological Association.

It is often mistaken as a normal part of aging due to its effect on memory and other cognitive abilities in patients aged 65 and above, but people younger than 50 can also suffer from forms of early onset dementia.

"Dementia is not a part of proper aging. However, because of the stigma that has been attached to dementia, most of the family members won't like to accept the diagnosis that the individual is really suffering from dementia," Martinez said.

The devastating symptoms of dementia also affect caregivers, who are found to be more stressed than caregivers of patients with cancer.

"It has stated that approximately 60 percent of caregivers for individuals suffering from Alzheimer's disease are females and it is usually the eldest daughter that takes care of the individual with the Alzheimer's disease," Martinez explained.

"In most cases, they have found out that the stress of caring for patients with Alzheimer's disease is approximately 3.5 to 4 times greater than when you are taking care of patients with cancer," she continued.

New technologies such as specialized brain scans and blood tests may be able to predict Alzheimer's a decade before symptoms occur.

Hard to diagnose, hard to medicate

Accurately predicting ADHD in children, on the other hand, is more difficult due to their age and known symptoms, said Batangas Medical Center Pediatrics chairman Dr. Elizabeth Palines.

Dr. Elizabeth Palines, pediatric neurologist, says it is mostly women who bear the burden of caring for others (1/2) pic.twitter.com/jLyohEhkGl

— Rie Takumi (@rie_takumi) March 28, 2017

"Hindi [sila] KSP; hindi lang talaga nila matiis to move about," she explained. "The thing is, normal yun sa four-year-old. Two- to four-year-olds normal yan, kaya yan yung sinasabi kong the terrible age."

"But it's not appropriate after six or seven. Kaya as early as four years old kapag nag-daycare, dun mo na malalaman kung may tendency," she continued.

Apart from suffering from severe inattention, hyperactivity, and impulsivity that interfere with their daily life, people with ADHD are also more prone to comorbidities such as depression, anxiety, and substance abuse.

"They can easily get addicted, they like that adrenaline rush. They're the ones who get into accidents... and they can be the ones who hurt people because pagkatapos nilang gawin yun, saka lang nila naiisip na mali yun. If they cannot fit into society, kawawa naman," Palines said.

Medication means purchasing drugs that are often hard to access, due to laws limiting their sale to patients with special prescriptions from doctors and to pharmacies with specific permissions.

Because their medication must be taken every day, persons with ADHD must spend between P100 to P300 daily, depending on the dosage and type, to keep their condition in check.

"P100, P300 a day. And mind you, you have to take this continually. The recommendation is to take it a whole year. It used to be we could give them drug holidays... to minimize the cost," Palines said.

"[It must] be given continuously. But sometimes, dahil mahal, maybe during the long summer break, take it off. Two weeks before school starts, start it again because the effects [are] not immediate. It takes time for you to see the effect of the medication," she continued.

Side effects better than no meds

Women with epilepsy also face economic and reproductive repercussions.

Having the chronic, neurological condition can stop some women from pursuing certain careers due to stress being a trigger for seizures.

Stress-triggered seizures, certain anti-epilepsy drugs' (AED) having an effect on breast milk, and the possibility of passing on disease also discourages some from raising families.

"As a general rule: if you are a person who gets pregnant, you're not sick, you're perfectly normal, the chances of you having a congenital malformation is two to three percent," Cabral said.

"If you are a person with epilepsy with anti-epileptic drugs, that rises to two to three times, or four to six percent," she continued. "We have data from the [Philippine Health Research] Registry spelling some of the drugs are related to the baseline rate."

While it was common to stop AEDs during pregnancy in the past, current research shows that women should continue taking AEDs while with child as they risk the safety of their children more by stopping.

Dr. Leonor Cabral-Lim, country expert on epilepsy, says women w/ epilepsy have 95% chance of bearing normal children;they CAN have families. pic.twitter.com/bE4ptT60pA

— Rie Takumi (@rie_takumi) March 28, 2017

"Most pregnancies of women with epilepsy are going to be successful. Majority of them, in fact, as high as 95 percent can have normal children and they can raise families," Cabral said.

"There are certain types where we can say that inheritance could range from two to eight percent. But I still tell my patients, that means even though you're [going to be a] mother or father, there's a 92 to 98 percent chance that it's not going to be inherited," she emphasized.

Mental health bill, training, and the Three R's

Cabral is one of the hundreds of health professionals who are pushing for the approval of the National Mental Health Act, which covers the psychiatric, psychosocial, and neurologic health needs of Filipinos.

Under Section 8 of the Mental Health Act, PhilHealth will provide patients with mental disorders insurance packages that will cover their considerable medical needs.

Rural and urban health workers will also be trained to identify disorders and provide better mental health care in hard-to-reach locales.

"We will train [them)]in primary care so it doesn't only include epilepsy. Actually, the bigger part is psychiatry, mental health, depression," Cabral said. "They are given a medication package of three months. And after that, they list down the patients and they ask the DOH for a supply."

"What I know is the government is looking [for] money for 2017. We hope this continues," she continued. "I would like to encourage all of you to support the mental health bill."

For caregivers, the greatest help they could seek is to find support from caregiver networks such as the ADHD Society of the Philippines, family, and friends.

They must also remember the three R's : respect, repetition, and reassurance.

Respect the capabilities of patients w/ dementia;
Repetition is part of their lives;
Reassure patients that they can still do things.

— Rie Takumi (@rie_takumi) March 28, 2017

"Alzheimer's disease may destroy the body and the mind of a patient, but it can never destroy the anima, the soul, where love emanates," Martinez advised. "They know how to communicate when they feel that they are loved." — BM, GMA News