The Big Question: How serious is the rise in dementia, and are we finally addressing the problem?

(Independent Graphics)

Why are we asking this now?

Yesterday, John Suchet, the former ITN newsreader, became the latest public figure to speak out about the impact of dementia on his family. His wife Bonnie, 67, was diagnosed with Alzheimer’s disease three years ago and is now looked after by her husband with the help of a carer. Mr Suchet, 64, who presents the live quiz show Going For Gold on Five, spoke of his grief at the loss of the partner he knew and the torment of trying to care for her. “The Bonnie I loved has gone. It’s as if she has died. Dementia has taken her.”

Is his decision to speak out unusual?

Less than it used to be. Dementia was once regarded as an embarrassing affliction that was little discussed except in hushed tones by close family members who kept those affected out of sight. In the past decade, it has come out of the closet and gained a higher profile.

The former US president Ronald Reagan broke the mould by acknowledging that he had Alzheimer’s disease in 1994. His admission paved the way for others, including the actor Charlton Heston and the novelist Iris Murdoch. Murdoch’s last novel, Jackson Dilemma, published a year before she was diagnosed in 1996, showed early signs of the disorder, with a dwindled vocabulary and simpler grammar compared to her earlier works. More recently, the comedian Tony Robinson has presented a film about his mother’s experience of Alzheimer’s. The most powerful current ambassador for the cause is the novelist Terry Pratchett, who at the age of 59 was diagnosed with a rare from of Alzheimer’s. In mArch 2008, he donated £1m to research and campaigned for greater recognition of the condition.

Is dementia the same as Alzheimer’s?

No. Dementia refers to the whole class of conditions characterised by loss of memory, confused thought processes and agitation. It affects more than 700,000 people in Britain. More than half (55 per cent) have Alzheimer’s. A further 20 per cent have vascular dementia, caused by mini-strokes which disrupt the blood supply to the brain, which is commonest in people with heart disease and high blood pressure. The remaining 25 per cent have a range of causes, some of which are rare. In all, there are about 200 types of dementia, and many of these are commonly misrepresented as Alzheimer’s disease.

What are the effects of dementia?

It is a slow process of mental derangement that strips sufferers of their memory, personality and eventually their humanity. It is a progressive, neuro-degenerative disorder that is incurable and irreversible. Some people subside gently into dementia without evident distress, but for others the experience of losing their mental faculties is confusing, distressing and – in some cases – frightening. In the case of Alzheimer’s, the condition is thought to be caused by the build-up of protein deposits in the brain – called “plaques and tangles” – whose first symptoms may be a difficulty in finding words.

How is dementia diagnosed?

With difficulty, as it can be hard to distinguish it from the effects of ordinary ageing. Alzheimer’s can |be definitively established only by examination of the brain after death for the presence of plaques and tangles. Accurate diagnosis while the patient is living depends on the clinical skill of the doctor. As a rule of thumb, anyone whose memory starts to cause them problems with managing their daily life should see their GP. If there is a medical reason such as depression, or a vitamin deficiency or the effect of other medicines, it can often be reversed with sometimes miraculous results.

If the cause is not obvious, referral to a memory clinic may be called for where memory tests can help to diagnose dementia, if it is present. Many people are so terrified of being diagnosed with Alzheimer’s that they don’t go to their GP when they have problems – even though their memory loss may have other causes which can be easily treated.

Can anything be done to prevent it?

Yes. Eat a Mediterranean diet rich in fruit and vegetables, take plenty of exercise and keep mentally active. Being overweight at 60 doubles the risk of dementia at 75. Playing chess, Sudoku or similar games is thought to offer protection, but this may come from the human contact as much as the intellectual challenge. Staying socially engaged, with friends or family, may be a more important way of keeping alert. Alcohol only in moderation, and keeping blood pressure and cholesterol under control are important. A study published last year suggested statins – cholesterol lowering drugs taken by millions of people to protect against heart disease – halve the risk of dementia by reducing the formation of fatty plaques in the brain.

How bad will it get?

Very bad – owing to a combination of an ageing population and rising obesity. Currently, one in 20 people aged over 65 has signs of dementia, rising to one in five over 80. Over the next 50 years, the number affected is forecast to rise from 700,000 to 1.5 million because of the ageing of the population. But increasing obesity could double the incidence among the over-65s, raising the total to 2.5 million, according to the Alzheimer’s Society. The current cost of dementia to individuals, families and the state is estimated to be £17bn a year. There is no cure but the lifestyle we choose to follow can make a difference to the risk.

Are there treatments that work?

Despite extraordinary medical advances in the 100 years since the |psychiatrist Alois Alzheimer first described the disease in 1906, there is not much to celebrate in relation to dementia. Three drugs which have been available for more than a decade are claimed to halt progression of Alzheimer’s, but the National Institute for Health and Clinical Excellence (Nice) has ruled that they have a limited impact and should not be prescribed on the NHS for people with early or late stage disease but only for those with “moderate” disease. The decision provoked uproar among charities for the elderly and led to a challenge in the courts which failed to overturn Nice’s ruling.

Last year, Rember, the first of a new class of treatments that has been shown in early trials to be twice as effective as existing treatments in slowing progression of Alzheimer’s, was announced by researchers at the University of Aberdeen. The Alzhheimer’s Society described Rember as a “major new development”, but it must pass further trials before it can be made available to patients.

What about side-effects?

There are antipsychotic drugs to control the worst symptoms of dementia, such as agitation and restlessness, but there is evidence these are over-used, as a “liquid cosh” to subdue difficult behaviour. Research published last month show patients prescribed these drugs have a 70 per cent higher death rate after three years. The powerful sedatives, used in the treatment of schizophrenia, are prescribed to control delusions and aggression which can occur in patients with dementia. Nice recommends that the drugs should be used in severe cases only, for short periods. The average length of time they are prescribed for demenita is one to two years.

Alzheimer’s Society Dementia helpline 0845 3000 336; www.alzheimers.org.uk

Can society rise to the challenge of dementia?

Yes...

* The stigma of the disease has diminished thanks to personalities who have spoken out about it

* There are ways it can be prevented with a healthy diet, exercise, social engagement and avoiding obesity

* Research is yielding new drugs that hold out the promise of slowing the progress of the disease

No...

* The numbers affected are rising rapidly because of the ageing of the population and the rise in obesity

* The cost of caring for people with dementia is imposing an increasing burden on families and the state

* Despite some progress on treatments, a cure for dementia remains a distant prospect