Transcultural perspectives of dementia

Abstract

There was a time when knowledge from the East was considered only in exotic tales, hazily referred to in mystical tones. Today, however, we feel encouraged to take into account different opinions and practices to those that prevail in the West. This shift in recognition is particularly noteworthy in the dementia field, since fast rates of population ageing are taking place in developing countries, where a challenging epidemic of dementia could occur in the near future. To face that epidemic properly, we should be prepared with reliable data about this new “old problem”. Dementia: A Global Approach intends to fill this gap. The book collates an extensive amount of knowledge, mostly from non-western societies. It is divided into 11 sections and covers important topics in dementia with a cross-cultural perspective. The book addresses assessment, psychosocial factors, service delivery, and management in patients with dementia, touring the clinical approach to dementia in different cultures around the world. It also highlights the contribution of the 10/66 Dementia Research Group on cross-cultural research and concludes with a plea for increased global awareness of the disease. The first chapter poses the cultural dimension of being an elderly individual in Asia and portrays the challenges of treatment of elderly patients in a developing country. Although the focus shifts in the next few chapters to more general topics in dementia research (mild and vascular cognitive impairment), most of the book then resumes discussion on cross-cultural themes. There is much debate about nature versus nurture and the different contribution of genetics versus the environment on the causation and manifestation of dementia. Although some forms of dementia seem to be highly dependent on genetics, others seem to be more affected by environmental factors such as lifestyle and food habits. This book touches on this debate many times when discussing variations in dementia prevalence according to different societies with diverse cultural backgrounds. In chapter 4B, for instance, there is an interesting debate between opposing views on the existence (or not) of different prevalence rates of vascular dementia around the world. Obviously, a book of 202 pages is not intended to be encyclopaedic; therefore, some topics are not addressed thoroughly. The laudable intention of providing a global view of the problem of dementia in all major regions of the world is hence not fully achieved. In section 9, for instance, when considering the clinical approach to individuals with dementia, the editors seem to have randomly picked countries that supposedly represent a whole continent. Peru, for example, was selected to represent South America at the expense of Brazil, which accounts for half the continent's population, with different ethnic groups, language, and customs from Peru. But can a continent be properly represented regarding the complex multifactorial disorders that make up the dementias? This question remains a challenge not only for the editors of this book, but also for every clinician and researcher in the dementia field. In recent years, research on the topic of ethnic and racial issues in dementias has increased dramatically. At the same time, the need for cultural competence in all of geriatric care, including dementia care, is increasingly being acknowledged. Researchers and providers are beginning to recognise the impending so-called ethnogeriatric imperative, as the number of elderly people from diverse ethnic and cultural backgrounds continues to rise.