Health

Keeping dementia at bay

Dementia is devastating lives as doctors struggle to develop a test for the disease, but meanwhile simple lifestyle changes can hold it at bay, reports Judy Hobson

A tidal wave of dementia is sweeping across the world, threatening to bankrupt national economies. It is now the most feared illness of old age and set to be the biggest killer of the 21st century.

Already some 47 million people worldwide have the condition and, according to the Alzheimer's Society, this includes 850,000 in the UK. By 2025, the UK figure will have risen to more than a million.

While there are around 50,000 people in this country under 65 who have dementia, it is regarded as the disease of old age, with one in 14 over 65s affected. Indeed, after the age of 65 our risk of having it doubles every five years.

As human longevity has increased, so has the prevalence of dementia. It is a consequence of some good news: that we are getting much better at treating cardiovascular disease and certain cancers, conditions that would have killed us off before we started displaying symptoms of dementia. The World Health Organisation (WHO) is so concerned about the global dementia epidemic that it is calling on nations to work together to find an effective treatment for the disease by 2025.

"And," says Dr James Pickett, head of research at the Alzheimer;s Society, "it is possible this goal will be met.

"The target is another eight years away and several trials will finish before then, but over the past decade we have seen some failures so we will need to be lucky."

Dr Pickett believes the key lies in identifying those at risk of dementia early enough to treat them with drugs known as disease modifiers that help slow down its progression.

In the not too distant future, when people in their forties go to their GP for a routine health check, he envisages then having a test to assess their risk of developing dementia. "We already monitor cholesterol levels to see if someone is at risk of having a heart attack. What if we could identify a marker that would indicate their risk of getting dementia? that is our Holy Grail. It could turn out to be something as simple as a blood test."

After the age of 40, we lose up to 10,000 brain cells a day and, as we get older , our circulation slows, so less oxygen reaches those brain cells we have left and often we do not stretch them as we used to.

Symptoms include confusion in unfamiliar surrounding, setting up in the night to go to work even after retirement, having difficulty following a TV drama and forgetting what a common everyday object is used for. Understandably, sufferers grow anxious and sometimes display a distinct change in personality- an outgoing person can become introverted while a reserved one can become uninhibited.

As yet there is no drug to prevent or cure demntia, but the good news is there are measires you can take today to help keep it at bay. 

According to a study by the Lancet Commission on Dementia Prevention and Care, published last July, more than a third of cases (35 percent) could be prevented through simple lifestyle measures such as stopping smoking, treating hearing loss in middle age and reducing high blood pressure. This compares with just a seven percent reduction that would occur if researchers found a way to target a gene called ApoE4, which is a major risk factor for the development of Alzheimer's Disease in the over 65s.

Other preventative measures the Lancet Commission identified include watching your weight, keeping diabetes under control, taking regular exercise and avoiding social isolation.

"We also know," Dr Pickett says, "that where dementia is concerned there is definitely something in the concept 'use it or lose it'. It really does help to keep your brain active."

And observational studies have shown that the more years people spend in education is a preventative factor.

Dr Pickett says: "It would appear that the more time you spend in education helps you to build upa cognitive reserve so that if you do develop the disease youwill experience a much slower decline. It owuld seem people with these higher cognitive reserves are able to better tolerate having plaques on their brains."

The major challenge researchers face is the fact that dementia has many presentations. Alzheimer;s Disease is the most common of these, with sufferers having difficulty carrying out everyday tasks, misusing words and often displaying poor organisational skills. 

Vascular dementia, the second most common, is the result of small strokes that cause brain cell damage. This is the type of dementia experienced by former Prime Minister Margaret Thatcher iin later life.

Some people have Fronto Temporal Dementia which can affect their personalities and lead to inappropriate behaviour. Others have Dementia with Lewy Bodies, caused by nerve cell damage, which leads to poor motor control and tremors. They may also experience hallucinations and have nightmares.

Genetics, Dr Pickett adds, do play a role and having a family history of the disease can increase your chances of developing it. Two years ago a website was launched to help sufferers and their carers to find out about the many trials under way to find drugs that will either stop the disease's progression or slow it down. To date, some 25,000 people have registered their interest in participating in the research. To find out more, log on to: www.joindementiaresearch.nihr.ac.uk or tel:0300 222 1122

meanwhile, Dr Pickett's advice tot he middle-aged is: "Continue to do things that are good for your heart because they're also good for your brain- eat healthily, take regular exercise, watch your weight and quit smoking.

"Do activities that will stretch your brain, but choose ones you will really enjoy because then you're more likely to continue doing them. It is no good starting to learn a new language if you hate languages."

If you are caring for someone with dementia, it can help to label rooms and cupboards to help them find their way around: put important items such as keys, money and medication in the same place; and encourage them to clean their teeth regularly because gum disease and tooth decay can become a problem.

For more information log on to www.alzheimers.org.uk

A guide to alcoholism and dementia by Ollie Clark. This post also includes an infographic outlining the long-term effects of alcohol on the brain.

What do you think to this? Has anyone you know been affected by dementia? 

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