INTRODUCTION

Dementia is characterized by a decline in cognitive ability, which is associated with daily and independent functioning. Rather than called to be a disease, dementia is thought to be characterized as a syndrome. There are many etiological factors of dementia including neuropsychiatric, neurodegenerative, and many other medical conditions. Multiple diseases are seen to contribute to one of the patient’s dementia syndrome. Dementias with neurodegeneration like the production of Lewy bodies and Alzheimer’s disease are known to be more common in old age patients, whereas brain tumors and other brain injuries are commonly known to be more prevalent in young adults [1].

The number of chemical messengers implicated in decision-making, learning, and memory is known to increase in response to drugs like cholinesterase inhibitors like rivastigmine (Exelon), donepezil (Aricept), and galantamine (Razadyne). These medications were thought to be effective for Alzheimer's disease primarily but they can also be prescribed for other dementia-related disorders, including Parkinson’s disease, vascular dementia, and Lewy bodies dementia. Side effects of these medications include vomiting, nausea, and diarrhea. Some other side effects can be a disturbance in sleep, low heart rate, and faintness [2].

The population of Saudi Arabia is now shifting towards old age. Back in 2016, the number of individuals who were above 60 years was 1.3 million, and now it is expected that this group of age will be extended by 10 million more, which only represents 25% of the population [3]. Another risk factor is associated with the expected increased life expectancy in Saudi Arabia. In the Gulf States, the average human life duration is set up at 72 to 82 years of age [3]. This is almost the age of elder citizens. At ages greater than 65, a person’s brain is already facing some sort of deterioration and hence at such age, cognitive functions are naturally compromised. Accordingly, if the person faces the issue of dementia, it is very difficult for him to survive and thus, it is required all the time to be taken care of. One other risk factor for dementia is that the prevalence of dementia is increasing day by day, and in two decades it is expected to be increased by three times [4].

A stage between normal cognitive functioning and dementia, mild cognitive impairment (MCI) preserves everyday living skills [5]. The annual conversion rate to dementia reaches up to 20% [6]. The early detection of symptoms of dementia can help to reduce or to control the prevalence of the disorder which will be beneficial for both caregivers and patients [7]. Studies evaluating the prevalence of MCI and dementia are very less in Gulf countries and Saudi Arabia. Yet, no published studies are present to evaluate the incidence and prevalence rate.

In the advanced phase, people with dementia are completely dependent on caregivers [8]. Palliative care for those people who are at an advanced stage of dementia, can regulate the burden of symptoms, as well as forestalling the undertreatment of symptoms and unnecessary overtreatment. Moreover, it also lessens the burden of the caregivers and increases the quality of life of the caregivers [9, 10]. Unfortunately, persons with advanced-stage dementia receive very less palliative care and they are exposed to the burden of high symptoms [9]. Caring is more challenging or possesses different challenges for those individuals who are at the advanced stage of dementia rather than those who are having mild to moderate symptoms of dementia. Indeed, dementia research has reached advanced levels but there is still very less evidence about the interventions of palliative care [11]. ACP which is known as advanced care planning is often regarded and mentioned as an important element for better end-of-life care [12, 13]. ACP aims to implement the individual values and preferences of patients regarding possible therapeutic interventions for better health conditions in the future [14, 15]. The concerned persons showed their interests or wishes towards the treatment preferences, mindful aspects, and caregiving. It is an informative cycle going up against the individuals with dementia, family caregivers, and well-being experts with the conceivable course of dementia and death [8, 9].

Talking about preferences and characteristics may feature the conflict between families' and patients’ insight on treatment interventions [16]. There is a disagreement concerning the ideal time for starting ACP during the illness, e.g., to begin ahead of schedule after screening [17], and who should be answerable for [18]. In the advanced phase of dementia, frequent intermediary decisions are fundamental and proxies can be tested to settle on existential choices for the individual with dementia. Family caregivers don’t feel set up to present choices in defense of the disintegration or moving toward death [16] and preferences communicated earlier may negate current conduct. Surrogates and well-being experts actualize preferences of patients' values including the individual with dementia, however much as could be expected customized to the current limit [19]. Most family caregivers pick augmenting comfort as an essential objective of care [20]. Without ACP, individuals with dementia are in danger to get troublesome medications toward the end of life [21]. Despite the arrangement of palliative consideration components, a change of care objective to comfort generally happens shortly before death [15, 22]. Scientific research demonstrated a relationship between written ACP and the nature of care in the dying phase.

Aims and Objective

• To assess the palliative care of dementia patients in tertiary care hospitals;
• To evaluate the facilities for the plan of management (whether local or international);
• To assess the patient and the family satisfaction;
• To assess the corporation between the patient’s family and the physician.
• To assess the adequacy of persons and skills involved in the care of dementia patients.

MATERIALS AND METHODS

Electronic Database

Scientific data was retrieved using the PubMed database.

Search Terms

Specific key search terms were used for data retrieval to get precise literature as follows:

• Dementia and Saudi Arabia;
• Palliative care of dementia patients in tertiary care hospitals;
• Facilities for a plan (whether local or international);
• Patient and family satisfaction;
• Adequacy of persons and skills involved in the care of dementia patients.

The Year 2000-2019

For each search term, ten papers were collected from many Google scholars. Additionally, the data was collected between the time duration of 2000 to 2022. Initially, 20 papers per search term were collected, and then a Second search filer was applied, where every fifth paper was analyzed for the search terms, which gave 4 papers.

Data Curation

Initially, without any filter, the search terms give out n=290 for “dementia and Saudi Arabia”, n=23 for “Palliative care of dementia patients in tertiary care hospital”, n=2 for “Facilities for a plan (whether local or international) in Saudi Arabia”, n=6 for “palliative care and patient satisfaction in Saudi Arabia” and n=7 for “physician and dementia in Saudi”. All the data was then manually evaluated to remove irrelevant and out-of-context papers.

RESULTS AND DISCUSSION

Of all the used search terms, the maximum number of data was extracted from the term “dementia and Saudi Arabia” and all the other search terms showed very little data availability. It depicts that as we make the search term very precise, the number of available papers decreases. However, this fall is even greater than 90%, which depicts that there is lesser research data available for Saudi Arabia. Even the general term does not have sufficient data, which shows that not much research is conducted in the region of Saudi Arabia for dementia. 

Database search for the prevalence of dementia in Saudi Arabia as well awareness of the Saudi general population of dementia and its associated risk factors (Tables 1 and 2).

Analysis revealed that out of 290 papers under the search term “Dementia and Saudi Arabia”, most of the papers linked dementia to genetic predispositions, as was evident from several reviews, as well as case studies. The age factor was also important, as when the data was randomly curated. Through manual analysis, age appeared to be another important factor for dementia in KSA as shown in graph 1. When environmental factors were accessed, it was found that data was also related to dementia. Another risk factor for dementia in KSA was found to be in combination with certain factors of age, environment as well as genes. The combination of age and environmental factors shows that there is a link between the development and the progression of dementia. Some other factors include genes and environment and a combination of all the factors i.e.; genes, environment as well as age, as shown in Figure 1.

The results for the search term Palliative care of dementia patients in tertiary care hospitals came out to be 26 papers in total. Among these papers, a few papers were not related to palliative care and the remaining papers were discussing the implementation of palliative care as a plan to be applied in hospitals as illustrated in Figure 2.

In the context of the patient's and the family's satisfaction, appreciable data is available for palliative care, not only for dementia but also for other widely distributed and deadly diseases such as cancer. Cancer patients receiving palliative care in Saudi Arabia appear to have a very good association between their quality of life and their contentment with their treatment. Eight papers were observed in this section, in which patients, as well as their families’ satisfaction, was discussed and after applying the filter of years, it was reduced to only six papers.