Where memory ends and fear begins. . .Dementia and the price of growing old

WHEN Laizah Moyo of Masendu Village in Bulilima District, Matabeleland South Province, wandered into a neighbour’s homestead late one night, she unknowingly stepped into the crosshairs of a community that had long been suspicious of her.

Gogo MaMoyo, as she is known in the village, was already marked. Old age alone was enough to earn her sideways glances and hushed conversations, but in a society where witchcraft is widely believed to be the preserve of the elderly, her growing confusion only deepened the mistrust.

Walking into a neighbour’s yard is not a crime on its own. But MaMoyo did so under circumstances that, to many villagers, were damning. She was found naked, disoriented and muttering to herself in the darkness.

In local folklore, witches are said to operate at night, unclothed and unashamed. To some, this was confirmation enough.

To the villagers, this was as close to being caught red-handed as one could ever get. All the so-called “evidence” pointed in one direction. Gogo MaMoyo was a witch, and no explanation would be sufficient to convince many otherwise.

Suddenly, a string of unexplained illnesses, deaths of livestock and minor misfortunes began to make sense. Even the most ordinary aches and pains found a convenient culprit. In whispered conversations, it was said that the old woman rode a hyena in her spare time, slipping in and out of homesteads unseen.

As accusations mounted, it mattered little that her family insisted she had been diagnosed with dementia years earlier. Medical explanations stood no chance against fear, superstition and generations of deeply entrenched belief.

Across Zimbabwe, stories like MaMoyo’s are far from isolated. In a country where witchcraft accusations are common, elderly women often find themselves at the centre of suspicion. This is no coincidence. Women make up the majority of people living with dementia, and the symptoms of the condition, memory loss, confusion, personality changes and disinhibition, are easily misinterpreted as signs of malevolent intent.

Dementia is a growing, yet under-recognised public health crisis across Africa. Research shows that prevalence rates on the continent range from as low as 2,3 percent to as high as 20 percent, depending on the population studied.

According to estimates, cases in sub-Saharan Africa are projected to rise from about 2,13 million in 2015 to more than 7,6 million by 2050, driven largely by ageing populations and a rise in cardiovascular diseases such as hypertension, diabetes and stroke.

Despite this looming crisis, dementia remains poorly understood in many African societies. In some local languages, there is no specific term for the condition, leaving families to explain the illness using cultural or spiritual frameworks.

As a result, what is essentially a neurological disorder often becomes a social and moral judgement.
Global studies from North America and Europe consistently show that dementia is more prevalent among women than men. While longer life expectancy partly explains this disparity, research also points to lifelong socio-economic disadvantages faced by women. Lower levels of formal education, poorer childhood nutrition and limited access to healthcare all contribute to reduced cognitive reserve, the brain’s ability to cope with age-related changes.

These disadvantages follow women into old age, where cognitive decline collides with cultural expectations and suspicion. In both rural and urban settings, older women are disproportionately accused of witchcraft, often suffering abuse, abandonment or forced displacement as a result.

“Females tend to live longer than males, and they also tend to bear a lot of emotional stress and burdens,” said Dr Temitope Farombi, a neurologist. “One thing that protects them earlier in life is oestrogen, which provides a buffer against stress. But as women age, that protection reduces.

“Women carry the stress of childbirth, raising families and caregiving for much of their lives. That cumulative burden affects brain health. That is why we see dementia being more frequent in older women. Age and gender are big risk factors, and they are non-modifiable. You cannot change your age or your gender.”

While certain beliefs are deeply rooted and often reinforced by personal experiences, especially in rural and remote communities, Dr Farombi said ignorance remained the greatest enemy of dementia sufferers.

“At family level, we need to identify symptoms early because dementia is often misconstrued as witchcraft, voodoo or spiritual punishment,” he said. “Recognition is very crucial. Knowledge allows families to support the person living with dementia instead of fearing them.

“At the moment, a lot of research is focused on treatment, but we must be clear — dementia cannot be cured. It can only be managed. That makes community support and understanding even more important.”

Medical research shows that early diagnosis, proper caregiving and social support can significantly improve the quality of life for people living with dementia, even in low-resource settings. Simple interventions such as structured routines, familiar environments and caregiver education can reduce distress and dangerous behaviours like wandering.

Yet in Zimbabwe, access to specialised care remains limited, particularly outside major cities. Most families shoulder the burden alone, often without guidance, financial support or protection from social stigma.

Dr Gift Ngwende, a neurologist working with rural health initiatives in Zimbabwe, said superstition continues to delay diagnosis and treatment, worsening outcomes for patients and their families.

“Dementia is a medical condition that requires compassion, care and medical intervention,” he said. “When communities interpret these symptoms through the lens of witchcraft, it endangers the lives of our elders and prevents families from seeking help.

“By the time some patients reach health facilities, the damage, socially and psychologically, has already been done.”