Elderly and Dementia in Nepal / 国際保健医療

<b>Background</b><BR>  Dementia is defined as a decline in cognition or behavior in one or more of the following areas: memory, social-interpersonal behaviors etc. It is regarded differently depending on the society of each country. To compare the effect that it has on Japanese society, we started research in Nepal.<BR><b>Methods</b><BR>  We asked Medical doctors and nurses in remote areas and the capital city in Nepal about their awareness of dementia. We also examined the elderly in communities and hospitals, using the Mini-Mental State Examination (MMSE) and Hasegawa Dementia Scale Revised (HDS-R), and asked family members about the elderly’s daily life and checked Clinical Dementia Rating (CDR).<BR><b>Results</b><BR>  Three out of six medical staff members in remote areas did not know the word “dementia.” However, most medical staff had seen cases of suspected dementia. The averages and deviations of MMSE and HDS-R in 6 elderly in community were 16±4.2 and 17±5.0, respectively. The average of CDR was 0.9.<BR><b>Conclusions</b><BR>  There was a lack of awareness about dementia in remote areas. Nepali society was found to be tolerant of aging and dementia.

Current status of epilepsy surgery in Nepal

Epilepsy surgery could not be started in Nepal till recently because we lacked know-how on epileptic zone localization. With the guidance of Prof. K Arita and Prof. T Hori we could start this surgery from 2002. Now we are performing surgery on our own but still have limitation in regards to case selection. At present Kathmandu Model Hospital is the only institute providing surgery for non-lesional cases. We have operated on 11 cases of non-lesional epilepsy of which 9 were temporal lobe epilepsy and 2 were drop attacks. Engel class I result could be achieved in 7 and class II in 2 cases. Both of the drop attack cases underwent complete corpus callosotomy and had no further atonic seizure. One patient had transient hemiparesis and there was no mortality or permanent morbidity. Achieving good result especially in the initial phase is important to convince the medical community to accept this treatment modality. Initial failure will lead to lack of enthusiasm, referral and even restriction on the program. In this regards we have been able to prepare groundwork for future development of epilepsy surgery. Epilepsy surgery can be an acceptable and cost-effective method of treatment for intractable seizure in countries having similar socio-economic scenario.