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Dementia: A comprehensive review of diagnosis, management, future directions

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Dementia is a broad term describing a decline in cognitive function, impacting memory, thinking, and social abilities, severe enough to interfere with daily life.

Alzheimer’s disease is the most common cause, accounting for 60-80 per cent of dementia cases.

Types of Dementia

1. Alzheimer’s disease: Characterised by amyloid plaques and tau tangles in the brain.

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2. Vascular dementia: Caused by reduced blood flow to the brain, often due to a series of small strokes.

3. Lewy body dementia: Marked by abnormal protein aggregates (Lewy bodies) in the brain.

4. Frontotemporal dementia: Involves degeneration of the front and temporal lobes, affecting personality, behavior, and language.

5. Mixed dementia: Combination of Alzheimer’s and vascular dementia or other pathologies.

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Risk factors and prevention

1. Age: Increasing age is the greatest risk factor.

2. Genetics: Family history and genetic mutations (e.g., APOE ε4).

3. Lifestyle factors: Physical inactivity, poor diet, smoking, and social isolation.

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4. Medical conditions: Hypertension, diabetes, and cardiovascular disease.

Diagnosis

1. Clinical assessment: Medical history, cognitive testing, and physical examination.

2. Neuroimaging: MRI, CT, and PET scans to rule out other causes.

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3. Biomarkers: CSF analysis and blood tests for amyloid and tau proteins.

4. Neuropsychological testing: Assessing cognitive function and decline.

Management and treatment

1. Pharmacological interventions: Cholinesterase inhibitors and memantine for symptom management.

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2. Non-pharmacological approaches: Cognitive stimulation, physical exercise, and caregiver support.

3. Lifestyle modifications: Healthy diet, regular exercise, and social engagement.

4. Caregiver support: Education, respite care, and counseling.

Emerging therapies and research directions

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1. Disease-modifying therapies: Targeting amyloid and tau pathologies.

2. Immunotherapy: Anti-amyloid antibodies and vaccines.

3. Lifestyle interventions: Promoting cognitive reserve and brain health.

4. Precision medicine: Tailoring treatments to individual genetic and biomarker profiles.

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Challenges and future perspectives

1. Early diagnosis: Identifying dementia at the preclinical stage.

2. Personalised approaches: Addressing heterogeneity in dementia pathophysiology.

3. Global health initiatives: Addressing disparities in dementia care and research.

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4. Support for caregivers: Providing resources and reducing caregiver burden.

Conclusion

Dementia is a complex and multifaceted condition, requiring a comprehensive approach to diagnosis, management, and research.

Advances in understanding dementia pathophysiology and developing effective therapies offer hope for improved outcomes and quality of life for affected individuals and their families.

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BY ROBERT EKOW GRIMMOND THOMPSON

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Understanding women’s emotionsProofreadUnderstanding women’s emotionsProofread

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The emotional lives of women are deep and complex. They are shaped by biology, the brain, and how women interact with the world around them. While everyone feels emotions, science shows unique patterns in how women process and express them.

1. How the brain and body work

​Emotions are not just feelings in the mind. They are physical processes controlled by the brain and body:

Connected brain halves: Studies show that women often have strong connections between the left and right sides of the brain. This helps women link logic with intuition and feelings very quickly.

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Strong memories: The brain’s emotional centre helps women remember emotional events with vivid detail. This builds strong gut feelings and helps women learn from past experiences.

Hormone changes: Hormones like estrogen and progesterone change throughout the month. Estrogen can boost good moods and energy, while progesterone can cause calmness or quiet reflection. These shifts are natural physical responses.

2. Empathy and connection

​Women often show high levels of empathy and social skill:

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Mirror neurons: People have brain cells called mirror neurons that let us feel what others feel. Research suggests these networks help women deeply sense and understand the emotions of people around them.

​The “Tend-and-Befriend” Response: When stressed, men often react with fight or flight. Women often use a “tend-and-befriend” response. Driven by bonding hormones, women are wired to care for others and seek support from friends and community during hard times.

3. Society and expectations

​Society also shapes how women express their feelings:

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Different rules: Girls are often taught to be nurturing and expressive. However, society sometimes judges women harshly if they show anger or act too assertive at work. This forces women to balance their true feelings with outside expectations.

Emotional labor: Women often carry the weight of keeping families and workplaces happy. While this builds strong bonds, it can also lead to tiredness if they do not take time for themselves.

4. Resilience and Intuition

​These biological and social factors give women great emotional strength:

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The Power of Sharing: Many women are good at processing sadness, joy, and love by talking with others. This helps them heal and grow.

Listening to intuition: “Woman’s intuition” is real. It is not magic; it is the brain quickly putting together past experiences, physical clues, and deep observations into a clear gut feeling.

Conclusion

​Women’s emotions are a powerful and sophisticated system. They are driven by brain science, body chemistry, and deep empathy. Understanding these systems helps us see the vital role women play in building strong relationships and communities.

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By Robert Ekow Grimmond-Thompson

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Confronting newborn abandonment in Ghana: When a cry for help is heard in a dustbin – Part 2

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An abandoned baby

The root causes: It is never just one reason

My years of counselling at CPAC show me abandonment is rarely an act of malice. It is the tragic endpoint of seven overwhelming distresses:

1. Severe maternal mental illness —The hidden emergency

a) Clinical Postpartum Depression (PPD): This is far beyond “baby blues.” It is a severe mood disorder that can appear weeks to months after birth. Due to a massive drop in hormones, extreme sleep deprivation, and emotional exhaustion, the mother feels deep sadness, worthlessness, and complete emotional numbness towards her baby. Picture: A new mother sits by her bed all day, staring blankly. Her baby cries for hours, but she cannot lift her hands to carry the baby. She whispers, “This baby would be better off without me.” She does not hate the baby; she feels she has completely failed as a mother.

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b) Peripartum Psychosis (Postpartum Psychosis): This is a psychiatric emergency. Rare but extremely dangerous, appearing suddenly within the first 2-3 weeks after delivery. The mother completely loses touch with reality. She hears commanding voices telling her to abandon the baby, or believes the baby is possessed by an evil spirit or is a “spirit child” who will bring a curse. Picture: A mother genuinely believes she heard a voice saying, “Leave this child at the crossroads at midnight or your family will die.” She abandons the baby not out of hatred, but because her broken mind believes she is obeying a higher spiritual order to save her family.

c) Pre-existing untreated Schizophrenia: This is a chronic, severe mental disorder that existed before the pregnancy. The stress of pregnancy and labour shatters her fragile coping. She suffers from paranoid delusions — believing people want to poison her and the baby — flat affect (zero facial expression), and grossly disorganised thinking, making it impossible to plan how to feed or clean a baby. Picture: A young woman whose family called her illness “spiritual attack” instead of taking her for medication wanders away after delivery, completely forgetting she even gave birth, leaving the infant behind.

2. Extreme socio-economic deprivation: For many girls in some parts of Ghana such as Kasoa, Madina, or Bekwai, poverty is not a statistic; it is a daily panic. No money for antenatal care, no money for hospital delivery, no money for baby diapers or formula. When a mother cannot feed herself, the thought of feeding another mouth feels impossible. Some mothers say, “I left her where someone richer would find her, because I could not watch her starve to death in my hands.” It is a distorted act of survival.

3. Intense societal stigma and shame: In Ghana, pregnancy outside marriage, teenage pregnancy, or pregnancy from rape can bring extreme family rejection. The girl is called “spoilt,” beaten, banned from church, or sacked from school. The fear of bringing shame to the family name is heavier than the fear of police. So she hides the pregnancy for 9 months, delivers alone, and abandons in secret to protect her family’s “honour.”

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4. Paternal abandonment — The Man Who Ran Away: Behind almost every abandoned baby is a man who vanished. He says, “It is not mine,” or “Abort it,” and switches off his phone. The mother is left utterly isolated — no emotional, financial, or social support. She is criminalised alone, but the abandonment started with him. Psychological research shows paternal denial is one of the strongest predictors of maternal panic and newborn abandonment. 

5. Substance abuse disorders: Alcohol, tramadol, and other drug addiction impair the brain’s executive functioning — the ability to plan, judge consequences, and process emotions. A mother struggling with addiction may give birth in a highly intoxicated or withdrawal state, unable to comprehend the needs of the newborn, leading to neglect and eventual abandonment.

6. The spirit child cultural phenomenon and superstition: In some remote pockets of Northern Ghana and even in few parts of Central and Ashanti regions, public health research shows babies born with congenital deformities, severe disabilities, or whose mothers die in childbirth are branded as “spirit children” or cursed. In extreme instances, families, under cultural pressure, mandate that such babies be exposed or abandoned at shrines or bushes. This is not mental illness, but a harmful cultural belief system that still kills.

The invisible wounds

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On the baby: Risk of death from hypothermia, sepsis, and infection. Survivors suffer Anaclitic Depression and Failure to Thrive due to lack of touch. As adults, they battle Reactive Attachment Disorder, chronic mistrust, and identity crisis — “Why did my mother leave me in a dustbin?”

On the mother: Lifelong hidden grief, intense guilt, chronic PTSD, depression, and elevated suicide risk. A prison cell does not heal this.

On the nation: Overburdened orphanages like Osu Children’s Home, draining health budgets, and overworked Social Welfare officers.

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