I-Dementia Ingavinjwa? Okushiwo Ucwaningo

Uma nikhathalele umuntu one-dementia, noma nibone umzali ephila nayo, kungenzeka nizibuze ukuthi ngabe yayingavinjwa yini, nokuthi ningayivimba yini ukuthi ingenzeki kinina. Leli khasi lichaza ngolimi olulula lokho ucwaningo olukushoyo ngempela. Impendulo emfushane: akekho ongathembisa ukuvimbela i-dementia, kodwa ucwaningo luphakamisa ukuthi ezinye izingozi zingehliswa, nokuthi ukuzehlisa phakathi kwabantu abaningi kungase kusho ukuthi abantu abambalwa bathola i-dementia noma bayithola kamuva.

Lolu ulwazi olujwayelekile, hhayi iseluleko sezokwelapha. Sicela nifunde isitatimende sethu sezokwelapha futhi nikhulume nodokotela ngempilo yenu.

I-dementia ingavinjwa?

Akukho ndlela eboniswe ukuthi isebenza yokuvimbela i-dementia komuntu oyedwa. I-National Institute on Aging (NIA) ithi nakuba kungekho okuboniswe okwamanje ukuthi kuvimbela i-Alzheimer’s, abacwaningi bathole amasu anethemba futhi bayafunda ukuthi yini engase isebenze nokuthi yini engase ingasebenzi.

Okukhonjiswa ucwaningo ukuthi izimo zempilo nemikhuba ethile kuhlobene nethuba eliphezulu le-dementia. Lapho lezo zingozi zingaphansi phakathi kwabantu bonke, abantu abambalwa bangase bathole i-dementia, noma bayithole kamuva ekuphileni. Lokho kuhluke kakhulu esiqinisekisweni.

Uphawu olunethemba: i-Lancet Commission yango-2024 yabika ukuthi kwamanye amazwe anemali ephezulu, kufaka phakathi i-US ne-UK, inani labantu abadala abane-dementia lehlile. Ababhali bacabanga ukuthi lokhu kungenxa, ngokwengxenye, yemfundo engcono, ukunakekelwa kwezempilo okungcono nokulimala okuncane kwemithambo yegazi phakathi nokuphila, ngokusho kwesifinyezo se-University College London sombiko.

Yini etholwe yi-Lancet Commission yango-2024?

I-Lancet Commission ye-dementia prevention, intervention and care iliqembu labacwaningi be-dementia abangu-27 abahlola ubufakazi njalo eminyakeni embalwa. Umbiko wabo wango-2024 waqamba izinto eziyi-14 ezikhulisa ingozi ezingase zishintshwe, futhi wakhulisa ukuthi ndawonye zibalelwa cishe uhhafu (cishe ama-45%) ezehlakalo ze-dementia emhlabeni wonke. Ngamazwi ababhali, lezi zehlakalo zingase ngokombono zivinjwe noma zibambezelwe uma izingozi zisuswa (umbiko we-Lancet Commission wango-2024).

Izinto eziyi-14, ezihlukaniswe ngesigaba sokuphila lapho ubufakazi bunamandla kakhulu:

• Ebuntwaneni nasebusheni: imfundo encane.
• Maphakathi nokuphila (cishe eminyakeni engu-40 kuya ku-65): ukulahlekelwa ukuzwa, i-cholesterol ye-LDL ephezulu (“embi”), ukucindezeleka, ukulimala ekhanda, ukungenzi umsebenzi womzimba, ushukela, ukubhema, umfutho wegazi ophakeme, ukukhuluphala ngokweqile, nokuphuza utshwala ngokweqile.
• Ekuphileni kwakamuva: ukuhlukaniswa nabantu, ukungcola komoya, nokulahlekelwa ukubona okungalashwanga.

Ezimbili ezintsha kakhulu ezengezwe ngo-2024 kwaba i-cholesterol ye-LDL ephezulu nokulahlekelwa ukubona okungalashwanga. Izinto ezihlobene nesabelo esikhulu kakhulu sezehlakalo kwaba ukulahlekelwa ukuzwa ne-cholesterol ye-LDL ephezulu (cishe ama-7% ngayinye), kulandelwa imfundo encane nokuhlukaniswa nabantu (cishe ama-5% ngayinye).

Umhlahlandlela wethu wezinto ezikhulisa ingozi uhlola zonke eziyi-14 ethebuleni, nalokho ucwaningo olukuhlobanisayo nalokho enikwazi ukukwenza.

Lokho okungasho inani lama-45%

Kulula ukuliqonda kabi leli nani, ngakho kuyasiza ukucaca:

• Isilinganiso sabantu bonke. Sichaza izehlakalo ze-dementia emhlabeni wonke, hhayi amathuba enu noma amathuba omzali wenu.
• Sithatha ukuthi kunembangela nomphumela. Ababhali bathi bafaka kuphela izinto ezikhulisa ingozi ezinobufakazi obuncikayo, kodwa ukuthi ezinye izixhumanisi zingase zibe ngokwengxenye kuphela ukubangela. Isibonelo, ukucindezeleka ekuphileni kwakamuva kungase ngezinye izikhathi kube uphawu lokuqala lwe-dementia kunokuba kube yimbangela.
• Asiqinisekisi lutho komuntu oyedwa. Isifinyezo se-UCL siphawula ukuthi ukwehlisa ingozi kusebenza ezingeni labantu bonke futhi akuqinisekisi ukuthi noma yimuphi umuntu uzogwema i-dementia.
• Elinye ihhafu alichazwa yilezi zinto. Iminyaka, izakhi zofuzo nezimbangela ososayensi abangakaziqondi okwamanje yiyona eyakha okusele.

Umehluko phakathi kokuthi “ukwehlisa ingozi” nokuthi “ukuvimbela” ungowuphi?

Ukwehlisa ingozi kusho ukwehlisa amathuba. Uma iqembu elikhulu labantu lehlisa umfutho wegazi, abambalwa kubo bangase bathole i-dementia eminyakeni eminingi kunalokho ngabe bebeyithola ngaphandle kwalokho. Abanye kuleli qembu basazoyithola.

Ukuvimbela kusikisela ukumisa okuthile ukuba kwenzeke nhlobo. Nge-dementia, lokho akuyona into ucwaningo olungayithembisa muntu namuhla.

Abacwaningi bakhuluma nangokuthi ukubambezela. I-Lancet Commission ibika ubufakazi obusha bokuthi ukwehlisa ingozi kungase kubambezele ukuthi i-dementia iqale futhi kunciphise isikhathi umuntu asichitha ephila nezifo. Ngisho nokubambezela iminyaka embalwa kungabaluleka kakhulu kumuntu nomndeni wakhe.

Kuleli sayithi, sisebenzisa amagama athi “ukwehlisa ingozi” kanye “nokuhlobana” ngenhloso. Uma nibona umkhiqizo, isengezo noma uhlelo oluthembisa “ukuvimbela i-Alzheimer’s”, luphatheni ngokuqaphela. I-NIA incoma ukubuza udokotela ngaphambi kokuzama noma yiliphi iphilisi noma ukwelashwa okuthembisa ukuvimbela i-Alzheimer’s, ngoba imikhiqizo enjalo ingase ingaphepheki, ibe yimali echithwe ngeze, noma kokubili.

Yini etholwe izivivinyo ezinkulu?

Izifundo zokubuka (ezibuka lokho okwenzeka kubantu ngokuhamba kwesikhathi) zingakhombisa izixhumanisi. Izivivinyo ezabela abantu ngethuba (randomized trials), lapho abantu babekwa kuhlelo noma eqenjini lokuqhathanisa ngethuba, yilona ukuhlolwa okunamandla. Nakhu okutholwe ezinye zezivivinyo ezaziwa kakhulu.

I-FINGER (Finland)

Isivivinyo se-FINGER sabhalisa abantu abadala abangu-1,260 abaneminyaka engu-60 kuya ku-77 ababesengozini ephezulu ye-dementia. Ingxenye eyodwa yathola uhlelo lweminyaka emibili lweseluleko sokudla, ukuzivocavoca, ukuzivocavoca kokucabanga ngekhompyutha nokuhlolwa kwempilo yenhliziyo nemithambo yegazi; enye ingxenye yathola iseluleko esijwayelekile sezempilo. Iqembu lohlelo lenze kangcono kancane ohlwini lwezivivinyo zokucabanga, umehluko omncane kodwa obalulekile ngokwezibalo (isivivinyo se-FINGER ku-The Lancet). Isivivinyo sasilinganisa imiphumela yezivivinyo, hhayi ukutholwa kwe-dementia.

I-US POINTER (United States)

I-US POINTER yabhalisa abantu abadala abangu-2,111 abaneminyaka engu-60 kuya ku-79 ababengenzi umsebenzi womzimba, benokudla okungaphilile kangako futhi benezinye izinto ezikhulisa ingozi. Womabili amaqembu akhuthaziwe ukuba enze umsebenzi womzimba nowengqondo kakhulu, adle kangcono, ahlale exhumana nabantu futhi alandelele impilo yenhliziyo. Iqembu elilodwa lathola uhlelo olunesakhiwo, olunomqeqeshi; elinye lazikhombisa lona. Eminyakeni emibili, imiphumela yezivivinyo zokucabanga yathuthuka emaqenjini ombili, kancane ngaphezulu eqenjini elinohlelo olunesakhiwo (isivivinyo se-US POINTER ku-JAMA). Ababhali bathi kudingeka ukulandelelwa okwengeziwe ukuze kwaziwe ukuthi lo mehluko ubalulekile yini empilweni yansuku zonke. Ngenxa yokuthi kwakungekho iqembu “elingenzi lutho”, isivivinyo asikwazi ukusho ukuthi uhlelo ngalunye lusize kangakanani uma luqhathaniswa nokungashintshi nhlobo.

I-SPRINT MIND (umfutho wegazi)

I-SPRINT MIND yafunda abantu abadala base-US abangu-9,361 abaneminyaka engu-50 nangaphezulu abanomfutho wegazi ophakeme. Bahlelwa enhlosweni ephansi yomfutho wegazi (inombolo ephezulu engaphansi kuka-120) noma enhlosweni ejwayelekile (engaphansi kuka-140). Inhloso ephansi yehlise kakhulu ukuphazamiseka okuncane kokucabanga nenkumbulo, isigaba senkinga yenkumbulo nokucabanga okungase kuqale ngaphambi kwe-dementia. Ngokuthi i-dementia ebonakala ingaba khona (probable dementia), kwakunezehlakalo ezimbalwa eqenjini lenhloso ephansi, kodwa umehluko wawungabalulekile ngokwezibalo. Isivivinyo simiswe kusenesikhathi futhi sasinezehlakalo ezimbalwa ze-dementia kunalezo ezilindelekile, ngakho singase sibe sincane kakhulu ukuphendula lowo mbuzo (i-SPRINT MIND ku-JAMA).

Lokho ukubuyekezwa okuhlanganisayo okukushoyo

Ukubuyekezwa kwe-Cochrane kwango-2021 kwahlanganisa izivivinyo ezinkulu eziyisishiyagalolunye zezinhlelo ezibhekana nezingozi eziningana ngesikhathi esisodwa, nabantu abangaphezu kuka-18,000. Kwathola inzuzo encane ezivivinyweni zokucabanga, kodwa akukho mehluko ocacile enanini labantu abathole i-dementia ezivivinyweni ezimbili ezakulinganisa (ukubuyekezwa kwe-Cochrane kwezindlela eziningi).

Ukubuyekezwa kwango-2017 yi-National Academies of Sciences, Engineering, and Medicine, okufinyezwe yi-NIA, kwathola ubufakazi “obukhuthazayo kodwa obungaphelele” ezindleleni ezintathu: ukulawula umfutho wegazi ophakeme, ukwandisa umsebenzi womzimba, nokuqeqeshwa kokucabanga.

Kuyabaluleka yini ukuthi siqala nini?

Iseluleko se-Lancet Commission ukwehlisa izingozi ngokushesha ngangokunokwenzeka futhi uzigcine zingaphansi isikhathi eside ngangokunokwenzeka: “kusenesikhathi kungcono” kanye “nesikhathi eside kungcono”. Iphinde ithi akusekho masinyane noma sekuphelelwe isikhathi sokwehlisa ingozi. Ubufakazi obuningi bubhekene nobudala obumaphakathi, cishe eminyakeni engu-40 kuya ku-65, kodwa ezinye izinto, njengokulahlekelwa ukubona nokuhlukaniswa nabantu, ziyizingozi zokuphila kwakamuva lapho ukwenza okuthile kusengase kuthi kuyaphumelela.

Umbiko uthi manje sekunobufakazi obunamandla bokuthi ukuchayeka isikhathi eside engozini kunomphumela omkhulu. Isibonelo, ushukela oqala maphakathi nokuphila ubonakala ubaluleke kakhulu kunoshukela oqala kamuva.

Ingabe ingozi ye-dementia iyafana kubo bonke abantu?

Cha. I-Commission yathola ukuthi abantu emazweni anemali ephansi nemaphakathi, abantu abavela emaqenjini amancane nabantu abanemali encane bavame ukuthwala ingxenye enkulu yalezi zingozi, ngakho i-dementia ivame ukuthuthuka eminyakeni encane. Izingozi eziningi zihlotshaniswa nezimo abantu abangazikhethanga, njengomgangatho wesikole ababenawo besengabantwana, umoya lapho behlala khona, nokuthi ukudla okunempilo kuyathengeka futhi kuseduze yini.

Yingakho izincomo ze-Commission zibhekiswe ohulumeni njengoba zibhekiswe abantu ngabanye: imfundo enhle yezingane zonke, umoya ohlanzekile, izindlela zokunciphisa ukubhema, ushukela nosawoti omncane ekudleni okuthengiswa ezitolo nasezindaweni zokudlela, nezinsiza zokuzwa kwabo bonke abazidingayo. Umzamo womuntu ngamunye uyabaluleka, kodwa kuyabaluleka nomhlaba abantu abahlala kuwo. Kungenye futhi indlela yokungasoli muntu ngokutholwa kwesifo.

Yimiphi imikhawulo yangempela yalolu cwaningo?

• I-dementia ithatha amashumi eminyaka ukuthuthuka, kodwa izivivinyo eziningi zihlala iminyaka emibili kuya kwemihlanu. Ukulinganisa i-dementia uqobo, hhayi nje imiphumela yezivivinyo, kudinga izifundo ezinde kakhulu nezinkulu kakhulu.
• Izivivinyo eziningi zilinganisa izivivinyo zokucabanga. Ukuthuthuka okuncane kwesivivinyo akusho ngempela ukuthi abantu abambalwa bazothola i-dementia noma ukuthi impilo yansuku zonke izoba lula.
• Ababambiqhaza ezifundweni bavame ukuba nempilo engcono futhi bafundile ukwedlula umphakathi jikelele. I-Lancet Commission iphawula ukuthi ubufakazi obuningi busavela emazweni anemali ephezulu nokuthi amaqembu amancane awamelelwa ngokwanele.
• Ezinye izixhumanisi ziya ngezindlela zombili. Ukungenzi umsebenzi omningi noma ukungaxhumani kakhulu nabantu kungaba umphumela wokuqala we-dementia, hhayi imbangela kuphela.
• Izivivinyo zokudla zibe nokuphoxa kuze kube manje. Isivivinyo seminyaka emithathu se-MIND diet asikatholanga umehluko obalulekile ekucabangeni uma kuqhathaniswa nokudla kweqembu lokuqhathanisa. Bhekani umhlahlandlela wethu wokudla.
• Imidlalo yobuchopho ayikaboniswa ukuthi ivimbela i-dementia. Bhekani umhlahlandlela wethu wemidlalo yobuchopho ne-dementia.
• Ukuzila kunobufakazi obulinganiselwe kakhulu babantu, futhi kungaba nobungozi kubantu abadala. Bhekani umhlahlandlela wethu wokuzila.

Uma othile enze konke “kahle”, kungani ethole i-dementia?

Ngoba i-dementia akulona nje umphumela wezinqumo. I-NIA ithi ubudala buyisici esikhulu esaziwayo sengozi ye-Alzheimer’s, futhi akekho ongayishintsha. Izakhi zofuzo zidlala indima. Futhi ososayensi abakaqondi ngokugcwele ukuthi yini ebangela i-Alzheimer’s kubantu abaningi. Ngisho noma zonke izinto eziyi-14 ezikhulisa ingozi zisuswa, isilinganiso se-Lancet Commission uqobo sishiya ngaphezu kwengxenye yezehlakalo zingachazwanga.

Ngakho uma nikhathalele umuntu owayezivocavoca, edla kahle, engazange abheme futhi wathola i-dementia, akukho okwahamba kabi ngakubo, noma kunina. Uma nina nibhekene ne-dementia, akulona iphutha lenu. Ukuzizwa unecala kuvamile emindenini, kodwa akufanele. Okubalulekile manje induduzo, ukuxhumana nezinsuku ezinhle, futhi imibono yethu yemisebenzi kanye nomhlahlandlela wokuzinakekela komnakekeli iyindawo enhle yokuqala.

Yiziphi izinyathelo enganixoxa ngazo nodokotela?

Lezi yizindawo ezifundwa kakhulu. Kufanele zikhulunywe ekuhlolweni kwempilo ngoba eziningi ziyasiza nasempilweni yenhliziyo, isimo sengqondo nokuzimela, kungakhathaliseki ukuthi umphumela wazo ku-dementia uba yini.

1. Umfutho wegazi. Buzani ukuthi izibalo zenu ziyini nokuthi yiyiphi inhloso efanele nina. I-Lancet Commission iphakamisa ukuhlosa inombolo ephezulu engu-130 noma ngaphansi kusukela cishe eminyakeni engu-40, kodwa inhloso efanele kumuntu omdala incike empilweni yakhe iyonke.
2. Ukuzwa. Celani ukuhlolwa kokuzwa, nokuthi izinsiza zokuzwa zingasiza yini. Umhlahlandlela wethu wokuzwa uchaza ucwaningo.
3. Ukubona. Hlolisani amehlo njalo futhi nibuze ukuthi izinkinga ezifana ne-cataract zingalashwa yini.
4. I-cholesterol. Buzani ukuthi i-cholesterol yenu ye-LDL kufanele ihlolwe yini nokuthi kukhona okufanele kushintshwe yini.
5. Ushukela egazini. Uma ninesifo sikashukela, buzani ukuthi ningayilawula kanjani ngokuphepha.
6. Isimo sengqondo. Ukucindezeleka kuvamile futhi kuyalashwa. Tshelani udokotela uma nizizwe nibuthaka noma nilahlekelwe isithakazelo ezintweni ngaphezu kwamasonto ambalwa.
7. Ukubhema notshwala. Buzani ngosizo lokuyeka ukubhema nangemikhawulo ephephile yotshwala.
8. Ukunyakaza. Buzani ukuthi hlobo luni lomsebenzi olulungile kinina. Umhlahlandlela wethu wokuzivocavoca unemibono.
9. Ukuvikela ikhanda. Gqokani i-helmethi lapho nigibela ibhayisikili nasemidlalweni yokuthintana, futhi nibuze ngokuvimbela ukuwa.
10. Ukuhlala nixhumana. Isikhathi nabanye abantu siyingxenye yempilo ephilile. Bhekani umhlahlandlela wethu wokuxhumana nabantu, kanye nobuthongo.

Ngaphambi kokushintsha imithi, ukudla, izengezo, ukuzila noma ukuzivocavoca, khulumani nodokotela wenu kuqala, ikakhulukazi uma ninesifo senhliziyo, isifo sikashukela, umlando wokuwa, noma seniphila ne-dementia.

Khulumani nodokotela

Uma nibona izinguquko enkumbulweni noma ekucabangeni ezinikhathazayo, kunina noma komunye umuntu, enzani isikhathi sokubonana nodokotela. I-NIA iphawula ukuthi izinkinga zenkumbulo zingaba nezinye izimbangela, njengemiphumela emibi yemithi, izinkinga ze-thyroid, ukucindezeleka noma i-vitamin B12 ephansi, nokuthi ezinye zalezi zinkinga ziyaphela uma imbangela ilashwa. Umhlahlandlela wethu wezimpawu zokuxwayisa uchaza lokho okufanele nikubheke.

Funani usizo oluphuthumayo ngezinguquko ezingazelelwe: ukudideka okungazelelwe, ubuthaka noma ukungazwa ohlangothini olulodwa, ubunzima bokukhuluma, noma ikhanda elibuhlungu kakhulu kungaba yizimpawu ze-stroke noma esinye isimo esiphuthumayo. Shayelani inombolo yezimo eziphuthumayo yendawo yakini.

Lapho i-Golden Moments ifaka khona

I-Golden Moments yenza imisebenzi elula yokwabelana, efana namakhadi engxoxo, ne-bingo yezithombe kanye nokuphumula kokuphefumula okuthulile. Iyokujabulela nokuba ndawonye. Ayiyona indlela yokwelapha, futhi ayivimbeli noma yehlise i-dementia.