By Olaolu Fawole
She still knows the smell of her daughter’s hair. However, she cannot remember her name.
He spent forty years building a home, raising children, solving problems, and leading his community. Now he stands in his own kitchen, confused, afraid, unable to find the door he has walked through ten thousand times.
This is dementia. Not madness. Not a spiritual attack. Not the visitation of a forgotten ancestor’s curse. It is a clinical condition, progressive and irreversible, in which the brain begins, slowly and mercilessly, to let go of everything a person is, was, and hoped to be.
With the right knowledge and the right care, it is a condition that families and communities can respond to with compassion, dignity, and purpose.
What dementia is, and what it is not
Dementia is not a normal part of ageing. That distinction matters enormously in a country where the line between medical diagnosis and spiritual interpretation remains dangerously blurred.
When an elderly person begins to forget, the family’s first instinct is rarely neurology. It is enemies. Witchcraft. Prayers. Native doctors.
By the time the correct diagnosis is reached, if it ever is, the disease has progressed well beyond the window of early intervention.
The condition progressively impairs cognitive function, memory, thinking, behaviour, and the ability to perform everyday activities.
It arrives quietly, advances steadily, and leaves families managing a grief that has no clean name in most Nigerian languages. The grief of watching someone disappear while they are still present.
The diseases behind the condition
Dementia is not a single disease. It is an umbrella term covering more than 100 conditions that damage the brain in different ways, at different speeds, and through different biological pathways.
Alzheimer’s disease is the most common cause, accounting for the majority of cases globally. It is driven by abnormal protein deposits, amyloid plaques and tau tangles, that progressively destroy connections between nerve cells.
Memory loss is its most recognisable signature, but it also erodes language, judgement, and spatial awareness.
For many Nigerian families, it is Alzheimer’s they are living with, without ever knowing its name.
Vascular dementia, the second most common type, results from strokes or disruptions to blood flow in the brain, conditions alarmingly prevalent in Nigeria, where hypertension, diabetes, and high cholesterol often go undiagnosed and unmanaged for years.
Every uncontrolled blood pressure reading, every untreated stroke, carries the potential to become a dementia diagnosis down the line.
This is the form most directly preventable and most directly connected to Nigeria’s wider primary healthcare challenges.
Lewy body dementia is caused by abnormal protein deposits that disrupt the brain’s chemical messengers.
It shares symptoms with both Alzheimer’s and Parkinson’s disease, making it particularly difficult to diagnose.
Visual hallucinations affect approximately 80 percent of those living with it.
Frontotemporal dementia affects the regions governing personality, behaviour, and language.
Unlike Alzheimer’s, memory may remain relatively intact in the early stages while behaviour changes dramatically, leading families to mistake it for mental illness or moral failure long before a correct diagnosis is reached.
Some people carry more than one form simultaneously, known as mixed dementia, which complicates both diagnosis and care.
Knowing the signs before it is too late
Dementia does not announce itself. It arrives quietly, disguised, in its earliest stages, as ordinary forgetfulness.
The challenge is learning to tell the difference between the forgetfulness of a busy life and the forgetfulness of a brain beginning to fail.
The most common early sign is memory loss that disrupts daily life, not merely forgetting a name and remembering it later, but forgetting important dates, events, and recently learned information entirely.
Asking the same question repeatedly. Relying on others for things once handled effortlessly alone.
Early dementia also presents as difficulty with language and communication, struggling to find the right words, losing track of conversations, being unable to follow familiar sequences such as cooking a dish prepared for decades.
When that happens, it is not carelessness. It is a symptom. Disorientation in time and place is another warning sign. Problems with visual perception may also emerge, difficulty judging distances, or seeing things that are not there. Changes in mood, withdrawal from social life, unexplained anxiety, low energy are among the harder signs to recognise because they overlap with depression and grief.
In Nigeria, where an elder becoming quiet and withdrawn is sometimes interpreted as wisdom or spiritual reflection, these signs are particularly easy to miss.
As dementia progresses, the person may experience hallucinations, develop false beliefs, or become verbally and physically agitated not from character, but from confusion and fear.
An early diagnosis is a doorway to support, planning, and the best possible quality of life for the time that remains.
The numbers are a warning
According to a systematic review published in the Journal of Global Health Reports, dementia prevalence among Nigeria’s ageing population sits at nearly five percent, with women significantly more affected than men, a disparity linked to longer life expectancy and historically lower access to formal education.
The same research found that dementia cases surged by 400 percent among Nigerians aged 60 and above between 1995 and 2015.
Globally, dementia is the seventh leading cause of death and one of the leading causes of disability among older people. Its economic cost runs into trillions of dollars annually, roughly half borne directly by family members providing an average of five hours of care every day.
In Nigeria, that weight falls almost entirely on women, daughters, daughters-in-law, wives , who are themselves ageing, themselves exhausted, and themselves in need of support.
Can dementia be prevented? What the evidence says
The 2024 Lancet Commission on Dementia Prevention concluded that approximately 45 percent of all dementia cases globally are potentially preventable by addressing 14 modifiable risk factors across different stages of life. Nearly half.
That is a generation of families that could be spared this grief, if the right steps are taken early enough.
In early life, the single most important protective factor is education. Completing secondary school builds cognitive reserve, a mental buffer that helps the brain maintain function as it ages.
In a country where millions of children still do not complete secondary education, this finding carries profound policy weight.
The investment in a child’s schooling today is, among other things, an investment in their brain health decades from now. In midlife, the risks become familiar and preventable.
Physical inactivity significantly raises the risk of dementia. A daily walk, consistent movement, regular exercise are not merely good for the body. They are medicine for the brain. According to the World Health Organisation and Alzheimer’s Disease International, smokers have higher risk of developing dementia than non-smokers.
Quitting tobacco is one of the most direct interventions available, achievable without specialist care or expensive medication.
Excessive alcohol consumption is equally a confirmed risk factor. Untreated hypertension, diabetes, high cholesterol, obesity, depression, hearing loss, and social isolation are all confirmed risk factors, several of which are already epidemic in Nigeria, frequently undiagnosed and inadequately managed.
People who check their blood pressure, monitor their blood sugar, and treat their chronic conditions are directly protecting their brain in old age.
Cognitive stimulation, reading, learning, problem-solving, meaningful social engagement also builds protection against cognitive decline. The elder who remains mentally and socially active is doing something that medicine now confirms: building resilience against the very disease this piece describes.
Prevention is not a guarantee. But the evidence is now clear enough to say with confidence.
The choices made in youth and midlife shape the brain’s health in old age. Nigeria cannot afford to ignore that evidence.
Caring for a person living with dementia
Caring for a person with dementia is one of the most demanding things a human being can do. It is physically exhausting, emotionally draining, and often profoundly lonely. However, if approached with understanding, it is one of the most dignified expressions of love a family can offer an elder in their most vulnerable season.
The foundation of good dementia care is patience, not the passive patience of endurance, but the active patience of understanding. When a father asks the same question for the fortieth time, he genuinely does not remember asking. Responding with calmness, without frustration, without making him feel foolish, is care at its highest form.
Routine is medicine
A consistent daily schedule, waking, meals, activities, rest at the same times each day reduces confusion and anxiety. Familiar environments are safer and more comforting than new ones. Familiar faces, familiar songs, familiar smells, these are the anchors that help a person with dementia feel safe in a world increasingly difficult to navigate.
Communication requires adjustment
Speak slowly, clearly, and simply. Use short sentences. Ask one question at a time. Do not argue or attempt to correct false beliefs, if a mother believes she needs to go to a market she left thirty years ago, redirect her gently rather than confronting her with a reality she cannot currently hold. The goal is not to win an argument. The goal is to preserve her peace.
Physical care matters equally
Nutrition, hydration, gentle movement, and a safe home environment are all critical. Falls are a serious risk, therefore remove sharp hazards, secure doors, and ensure adequate lighting, particularly at night when disorientation worsens.
Caregivers must also care for themselves
Caregiver burnout is real and dangerous, both to the caregiver and to the person in their care. Rest is not abandonment. Seeking help is not failure. Connecting with others in similar situations is not weakness. It is wisdom.
What families, communities, and government must do
Nigeria currently lacks a comprehensive national dementia strategy, and access to specialised neurological services remains limited outside major urban centres. The Federal Ministry of Health and the Nigerian Institute of Medical Research have a responsibility to place neurological health, including dementia, at the centre of national health planning, not at its margins.
Government cannot do this alone. Every pastor who tells a congregation that a confused elder needs a doctor, not deliverance, is saving a life. Every community health worker trained to identify early dementia symptoms is a diagnostic bridge in a country with too few neurologists. Every family that speaks openly about what they are managing, rather than hiding it in shame, is dismantling a stigma that costs lives.
Public awareness campaigns conducted in Hausa, Yoruba, Igbo, Pidgin, and every language through which Nigerians actually receive information are urgently needed.
If your father repeats himself constantly and forgets what he said moments ago, that is not stubbornness. If your mother wanders from the house and cannot find her way home, that is not spiritual confusion. If the grandparent who sacrificed everything for you no longer recognises your face, that is not rejection.
It is a disease. It has a name. It can be understood, managed, and met with the care it demands.
That is not too much to ask. And it begins with knowing their condition by its correct name.
