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Dementia – A smouldering fire, an unrecognised burden

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By Charles J.C., MBBS
National Hospital of Sri Lanka

Dementia is a growing public health problem affecting 50 million people globally with 7.7 million new cases diagnosed each year. It is the fifth leading cause of death worldwide. In simple terms, dementia refers to progressive memory loss, resulting in loss of control over previously familiar tasks and an increasing inability to recognize familiar surroundings and people. Dementia is characterized by deterioration in cognitive function (ability to process thoughts) and impaired memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Thus, it causes significant social, occupational, psychological and behavioural impairment.

Dementia usually occurs in the elderly, around the age of 65 years, when the prevalence of dementia is 6-14%. Each five years prevalence doubles; at 85 years of age, prevalence is around 35%. Risk factors for dementia include social isolation, presence of multiple non-communicable diseases (diabetes, high blood pressure, high cholesterol levels, etc.), low educational status, low nutritional status, pathologies involving the brain, psychiatric illness (e.g. schizophrenia), poor blood pressure control, non-use of hormone replacement therapy and illicit drug use. The most common causes of dementia are Alzheimer’s disease (60%) and mini strokes (20%). Other causes include Lewy body dementia, Parkinson’s disease and rarer causes. In younger persons with memory loss, other sinister causes need to be sought.

Alzheimer’s disease results from neurodegeneration, partly due to aging. Aging is a strong independent risk factor but every elderly person will not be affected; a genetic component confers 5% risk. Meanwhile, stroke occurs in the presence of multiple co-morbidities such as diabetes, high blood pressure and high cholesterol levels. As these non-communicable diseases are more prevalent in the elderly, the risk of mini stroke is much higher in the aging population.

Dementia severely affects quality of life and activities of daily living (ADL), with detrimental effects on both the patient and family. The confidence and self-esteem of persons affected with dementia are often broken by the disease, leading to mood fluctuations, anxiety, and depression. Even highly independent people become dependent on their caregivers. Difficulties in adjusting to the changing caregiving role and withstanding the emotional and economic burden of dementia is common within affected families. Caregivers cope by using a range of interventions, from simple cognitive exercises and environmental modification to adding medications to counter behavioral problems.

A particularly challenging behavioural problem is the tendency to fill gaps in memory by making up stories or “confabulation.” For example, in response to the question, “How did you come to hospital?” a patient may respond “bus” or any other plausible mode of transport, simply because they cannot remember how they arrived at the hospital. Younger caregivers may perceive this as purposeful lying by elders, often leading to emotional outbursts, neglect or abuse.

The burden on carers is often overwhelming but remains largely unaddressed. Apart from the emotional toll, healthcare expenses may be high as a result of spending on transport, missed work, bystander expenses, and home-based nursing. Lack of financial assistance and family support add to the stress of caregiving, which progresses from helping to fill gaps in memory or searching for misplaced items to money management and total dependence, while juggling one’s own commitments.

Spouse carers and females are more subjected to caregiving burden, with depression reported in over two-thirds of carers. Poor selfcare, a higher incidence of hypertension, dyslipidemia, reduced immune function and longer duration of respiratory tract infections have been observed in carers. With terminal dementia, institutionalizing the patient, when required, and ultimately losing the patient, will necessarily have a significant impact on carers. Some are haunted by guilt, even after the patient passes away, due to neglect or substandard care. Carers need financial, social, emotional and health support to overcome all these hurdles.

Multidisciplinary team management is needed to treat dementia involving neurologists, psychiatrists, general physicians, primary care physicians, nurses, social workers and occupational therapists. Though inpatient care is required, in most instances community-based care is crucial to facilitate understanding and intervening to address family dynamics and the home environment. In Sri Lanka, there is a major gap in community-based services, an aspect that needs to be explored specifically in relation to dementia management, and, more broadly, with respect to elderly care.

Many high-income countries have national dementia policies in preparation for the growing number of people living with dementia. The World Health Organization (WHO) declared dementia a public health priority in 2017 to increase awareness, support systems, and global initiatives to address the disease burden. WHO has also launched an international surveillance platform, Global Dementia Observatory, which includes guidelines and checklists to facilitate dementia preparedness at the country level (https://www.who.int/mental_health/neurology/dementia/Global_Observatory/en/). Among them, are valuable tools for carers, such as iSupport–a manual for carers of people living with dementia (https://www.who.int/mental_health/neurology/dementia/isupport_manual/en/).

Dementia has a significant on healthcare systems, particularly with respect to expenditures; about 1% of GDP is spent on dementia globally, mostly in high-income countries. The average duration of hospital stays of people with dementia is long compared to other diseases and at least 10 times more than any other diagnosis considered. Because dementia is not an acute life-threatening problem, it does not receive the attention it should, particularly in countries like Sri Lanka that lack financial and human resources to establish multi-professional primary care teams and basic infrastructure for long term management of dementia. However, this situation will likely change in future owing to the growing disease burden, and its wide-ranging impacts on health and productivity.

Though definitive treatment has not arrived yet, many therapies are currently under investigation. As neuronal loss cannot be replaced by new cells, the scope of extant treatment is to slow the rate of neuronal loss and counter behavioural problems. Early diagnosis and optimal management will improve quality of life and reduce the carer burden.

At present, people living with dementia have little support in Sri Lanka. Aside from the Lanka Alzheimer’s Foundation, few formal support systems exist in the country, with even less in the peripheries. Establishing community-based long-term care for elders along with respite care for carers are much needed initiatives that would need to be evaluated by the public health sector as part of a national programme on dementia preparedness in Sri Lanka.

The aim of this article is to increase awareness on dementia and, in particular, highlight the burden on carers as well as the absence of support services for affected families in Sri Lanka.



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Putting people back into ‘development’ – a challenge for South

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In need of swift empowerment; working people of Sri Lanka.

Should Sri Lanka consider an 18th IMF programme? Some academicians exploring Sri Lanka’s development prospects in depth are raising this issue. It is yet to emerge as a hot topic among policy and decision-making circles in this country but common sense would sooner rather than later dictate that it be taken up for discussion by the wider public and a decision arrived at.

The issue of an 18th IMF programme was raised with some urgency locally by none other than Dr. Ganeshan Wignaraja,Visiting Senior Fellow, ODI Global London, one of whose presentations, made at the Regional Centre for Strategic Studies (RCSS), Colombo, was highlighted in this column last week, May 7th. An IMF programme is far from the ideal way out for a bankrupt country such as Sri Lanka but a policy of economic pragmatism would indicate that there is no other way out for Sri Lanka. Such a programme is the proverbial ‘Bird in the hand’ for Sri Lanka and it may be compelled to avail of it to get itself out of the morass of economic failures it is bogged down in currently.

While local economic growth possibilities are far from encouraging at present, such prospects globally are far from bright as well. Some of the more thought-provoking data in the latter regard were disclosed by Dr. Wignaraja. For example, ‘The IMF’s April 2026 World Economic Outlook projects global growth slowing to 3.1 percent in 2026; with downside risks dominating: prolonged conflict, geopolitical fragmentation, renewed trade tensions, bearing down hardest on emergent and developing economies.’

However, as is known, an ‘IMF bailout’ is fraught with huge risks for the people of a developing country. ‘The Silver Bullet’ brings hardships for the people usually and they would be required by their governments to increasingly ‘tighten their belts’ and brace for perhaps indefinite material hardships and discontent. For Sri Lanka, the cost of living is unsettlingly high and 20 percent of the population is languishing below the poverty line of $ 3.65 per day.

These statistics should help put the spotlight on the people of a country, who are theoretically the subjects and beneficiaries of development, and one of the main reasons, in so far as democracies are concerned, for the existence of governments. Placing people at the centre of the development process is urgently needed in the global South and shifting the focus to other considerations would be tantamount to governments dabbling in misplaced priorities.

Technocrats are needed for the propelling of economic growth but a Southern country’s main approach to development cannot be entirely technocratic in nature. The well being of the people and how it is affected by such growth strategies need to be prime focuses in discussions on development. Accordingly, discourses on how poverty alleviation could be facilitated need urgent initiation and perpetuation. There is no getting away from people’s empowerment.

In the South over the decades, the above themes have been, more or less, allowed to lapse in discussions on development. With economic liberalization and ‘market economics’ being allowed to eclipse development, correctly understood, people’s well being could be said to have been downplayed by Southern governments.

The development issues of Southern publics could be also said to have been compounded over the years as a result of the hemisphere lacking a single and effective ‘voice’ that could consistently and forcefully take up its questions with the global powers and institutions that matter. That is, the South lacks an all-embracing, umbrella organization that could bring together and muster the collective will of the South and work towards the realization of its best interests.

This columnist has time and again brought up the need for concerned Southern sections to explore the potential within the now virtually moribund Non-Aligned Movement to reactivate itself and fill the above lacuna in the South’s organizational and mobilization capability. In its heyday NAM not only possessed this institutional capability but had ample ‘voice power’ in the form of its founding fathers, with Jawaharlal Nehru of India, for example, proving a power to reckon with in this regard. The lack of such leaders at present needs to be factored in as well as accounting for the South’s lack of power and presence in the deliberative forums of the world that have a bearing on the hemisphere’s well being.

The Executive Director of the RCSS, Ambassador (Retd) Ravinatha Aryasinha, articulated some interesting thoughts on the above and related questions at a forum a couple of months back. Speaking at the launching of the book authored by Prof. Gamini Keerewella titled, ‘Reimagining International Relations from a Global South Perspective’, at the Bandaranaike Centre for International Studies, Colombo, Amb. Aryasinha said, among other things: ‘Historically, there is a precedent that has been realized by the Non-Aligned group of countries – unfortunately, rather than being reformed and modified at the end of the Cold War, it has been tossed away.’

The inability of the nominally existent NAM to come out of its state of veritable paralysis and voice and act in the name of the South in the current international crises lends credence to the view that the organization has allowed itself to be ‘tossed away.’ The challenge before NAM is to prove that it is by no means a spent force.

As indicted, NAM needs vibrant voices that could advocate value-based advancement for the global South. Moral principles need to triumph over Realpolitik. Such transformative changes could come to pass if there is a fresh meeting of enlightened minds within the South. Pakistan by offering to mediate in the ongoing conflict between the US and Iran, for instance, proved that there are still states within the South that could look beyond narrow self-interest and work towards some collective goals. Hopefully, Pakistan’s example will be emulated.

Along with Pakistan some Gulf states have shown willingness to work towards a de-escalation of the present hostilities in West Asia. This could be a beginning for the undertaking of more ambitious, collective projects by the South that have as their goals political solutions to current international crises. These developments prove that the South is not bereft of visionary thinking that could lay the basis for a measure of world peace. That is, there are grounds to be hopeful.

NAM needs to see it as its responsibility to make good use of these hopeful signs to bring the South together once again and work towards the realization of its founding principles, such as initiating value-based international politics and laying the basis for the collective economic betterment of Southern people.

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Artificial Intelligence in Academia: Menace or Tool?

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(The author is on X as @sasmester)

I have often been told by university colleagues how soulless and dangerous ‘artificial intelligence’ (AI) is to academia and humanity. They lament that students no longer read anything as they can now get various AI programmes to summarise what is recommended which is mostly in the English language to Sinhala or Tamil or get easier versions in English itself. They get their assignments and even dissertations fully or partially written by AI. And I am led to believe that universities do not have reliable detection software to assess plagiarism and academic fraud that have been committed using AI beyond the software freely available on the internet with their own limitations. This is due to financial restrictions in these institutions. Even these common malpractices have been done mostly with the aid of free AI programmes which are readily available, which means cheating in this sense is free and mostly safe. For teachers, this is a ‘menace’ in the same way ‘copying’ once was. But its implications are far worse.

But given the global investments made over AI, it cannot be wished away despite the enormous negative impact its use has on the environment, particularly due to its massive demand for energy. So, AI is with us to stay, and it has a considerable role to play in human civilisation even though like most innovations and inventions, this too carries its own burden of negativity. In this context, instead of demonising AI and lamenting its replacement of human agency and ingenuity, one needs to think seriously about how to deal with and engage with it reflectively and pragmatically as there is much it can offer if people are intelligent enough to make rational and sensible choices.

When I am making these observations, I am restricting myself to a handful of practices involving only writing both in university-based examination processes and in the fields of creative writing.

My initial introduction to AI was through the Research Methods class I used to teach in New Delhi. In 2022, this class was supposed to go to Dharmshala in Uttar Pradesh for fieldwork training, and we needed to write a funding proposal quickly. One of the students in the class, already familiar with ChatGPT introduced by OpenAI as a free programme in 2022, did the proposal with its help before the two-hour class was over. I edited it soon after and sent it off to the university administration for funding which we received. That stint of field work was completed in five days and was the most detailed work undertaken as a training programme up to that time in the university which had considerable output ranging from a documentary film to a detailed ethnography based on the findings.

While the technical details, the format of the proposal and its basic writing were done by AI due to the time constraints the class faced, its fine-tuning was done by me and a few students. AI could not then and even now cannot undertake that level of specificity without close human intervention. But the film, the ethnography and the actual process of research had nothing to do with AI. It was the result of human labour, thinking, planning and at times creativity and ingenuity. This was an early example of how AI could coexist in an academic environment if its technical usefulness was clearly understood and potential for excesses was also understood. But this was a time, easily accessible AI was just emerging, and we did not know much about it. But I was fortunate enough to have intelligent students in my class who gave me a crash course into this kind of AI use, which I followed up with my own reading and experimentation later on. As a result, I am keener now to see how it can be used for the betterment of academic practice rather than taking an uncritically demonising position, which I know will not lead anywhere.

But how is this possible? The lamentations of my colleagues about the abuse of AI in academic practice is not unfounded. It is a serious threat that remains mostly unaddressed not only in our country but almost everywhere else in the world too. This is mostly because the advancements of AI even in day-to-day free usage have far exceeded any thoughts for actionable codes of ethics to ensure its practice is sensible and ethical. At the same time, I cannot see why a student should not use AI to correct his spelling and grammar in assignments. I also cannot see why a student cannot seek AI’s help to secure research material from secondary sources available online which I have been doing for years. For instance, the originals of specific books and rare manuscripts might not be available in any repositories in our part of the world. In such situations, what AI might find us is all we have access to in a world where we are restricted in our mobility due to semi-racist visa regimes of failed empires and former superpowers as well as our own lack of ability to travel due to our own unenviable economic conditions. But unfortunately, the materials we need are often only available in research centers and libraries in those nations.

Similarly, when it comes to academic prose, it makes no sense now to take years to translate works from multiple languages to Sinhala and Tamil. This has always been a time-consuming, cumbersome and expensive process. Non-availability of Sinhala and English translations of core originals in languages such as English, French, German and so on has been a long-term problem for our country. But this can now be done well – at least from English to our languages – quite quickly and with a very low margin for error by using specific AI programmes which are meant to do precisely this. What this means is a quick expansion of knowledge in local languages which would have ordinarily taken years to achieve or might not have been possible at all. But still, this needs significant human intervention and time towards perfection. However, I do not think AI-based translations work as well for fiction and poetry or creative works more generally. But the ability for AI to emulate nuance and feeling in language is fast emerging. These are two clear examples of improving technical abilities in research and writing in which AI can be of help.

But looking for sources of information with help the help of AI or using it as a tool to undertake essential translations from one language to another is quite different from simply using it without ascertaining the accuracy of collected information, getting AI to do all your work without any reflection or without any hard work at all, including engaging AI to do the final product in a writing assignment — be that a term paper or a work of fiction. If one proceeds in this direction, as many unfortunately do nowadays, then, our ability to think and be creative as a species will become diminished over time and our sense of humanity itself will take a toll. This is what my colleagues worry about when they say AI is making younger generations soulless.

It is here that ethical practices on how to use AI responsibly without compromising our sense of humanity must play a central role. But these ethical practices must be formally written and taught, followed by viable programmes for detection and publication if unethical practices are followed. This needs to be the case particularly in teaching institutions as well as the broader domain of creative writing. After all, what is the fun in reading a novel or a collection of poetry written by AI?

It is time people began to think about what AI can do in their own fields without falling prey to its power and their own laziness. This brings to my mind Geoffrey Hinton’s words: “There is no chance of stopping AI’s development. But we need to ensure alignment; to ensure it is beneficial to us …” Similarly, as Yann LeCun observed, “AI is not just about replicating human intelligence; it’s about creating intelligent systems that can surpass human limitations.” In this sense, it is up to us to find our edge in creativity and common sense to find the most sensible way forward in using AI.

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Engelbert’s 90th birthday bash

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The legendary Engelbert Humperdinck, who is known for his hit songs such as ‘A Man Without Love’, ‘Release Me’, ‘Spanish Eyes’, ‘The Last Waltz’, ‘Am I That Easy To Forget’, ‘Ten Guitars’ and ‘I Can’t Stop Loving You’, turned 90 on 02 May, 2026, and there were some lovely Hollywood-related celebrations.

Before his birthday, Engelbert’s new single ‘I’ve Got You’ was released – on 23 April – and Engelbert had this to say: “‘I’ve Got You’ is especially close to my heart. It speaks to love, loyalty, and the quiet strength we find in one another”.

The main birthday event was held at The Starlight Cabaret, in Los Angeles, California, and Sri Lankan Raju Rasiah, now based in the States, and his wife Renuka, who are personal friends of Engelbert, were invited to participate in the celebrations, along with Ingrid Melicon – also a Sri Lankan, now domiciled in America.

The invitation said “An evening of music, memories and celebration. Let’s make it a night to remember!” And it certainly turned out to be a night never ever to be forgotten!

Invitees experienced a “magical entrance” with Engelbert’s name lighting up the screen and showing him performing his hit songs.

The invitees were also presented with a unique gift – a necklace with Engelbert’s face, engraved with the words “Remember, I Love You.”

Engelbert’s son, Bradley Dorsey, sang a tribute song ‘Only You’ for his dad, while Eddy Fisher’s daughters, Tricia and Joely, also got on stage to entertaining the distinguish gathering.

Engelbert didn’t perform but got on stage for the cutting of the birthday cake.

There was also a video compilation of birthday wishes from fellow celebrities, and the lineup included Gloria Gaynor, Micky Dolenz, Wayne Newton, Pat Boone, Lulu, Judy Collins, Deana Martin, Angélica María, Rupert Everett, Matt Goss, and more.

Birthday boy Engelbert Humperdinck

At 90, Engelbert is still performing. He’s on THE CELEBRATION TOUR for his 90th year, with over 50 international dates in 2026, including Australia, Germany, the US, and Canada. He’ll be at Massey Hall in, Toronto, on 06 October, 2026. He said: “The stage is my home… Canada has always been a highlight”.

He performed 60+ concerts, worldwide, in 2025, and says karaoke keeps his songs fresh: “Most of my songs are on karaoke because people love to sing them”.

 

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