Alzheimer and Social Policy

Alzheimer and Social Policy

Alzheimer and Social Policy

Introduction

Dementia is a clinical syndrome characterized by global cognitive impairment, which represents a decline from previous levels of functioning, and is associated with impairment in functional abilities and, in many cases, behavioural and psychiatric disturbances. There can be little doubt that it is one of the major public health issues facing the UK and other societies in which life expectancy is increasing (though there are also non-age-related reasons—see below). Taking an international perspective, the Eurodem Consortium found prevalence rose from 1 per cent for sixty to sixty-five-year-olds to 13 per cent for eighty to eighty-five-year-olds and 32 per cent for ninety to ninety-five-year-olds (Gibbons 2007).

Dementia therefore affects around 5 per cent of the over sixty-fives, rising to 20 per cent of the over eighties. UK prevalence data came from the MRC-funded cognitive function and ageing study (CFAS), which estimated that there were then 550,000 people in the UK with dementia—a figure that has now been revised to around 700,000 cases (Alzheimer's Society, 2005, www.alzheimers.org.uk). Prevalence is higher in women than men, partly reflecting their greater longevity. Incidence studies have shown rates of one to three per 1,000 for those aged sixty-five to seventy, rising to fourteen to thirty per 1,000 for those aged eighty to eighty-five(Hofman 2008). In most studies, women also seem to have an increased incidence rate, suggesting their higher prevalence figures are not entirely due to greater lifespan. Possible explanations include gendered differences historically in levels of educational attainment (higher levels of educational achievement may be a protective factor) and possible hormonal influences.

Discussion

There are many different causes of dementia. Alzheimer's disease (AD) accounts for around 60 per cent of all cases; other common types in older people include cerebrovascular disease (vascular dementia (VaD)) and dementia with Lewy bodies (DLB) (accounting for 15-20 per cent of cases each). In cases of early onset, frontotemporal dementia (FTD) is also a common cause, second only to AD. Numerous other causes exist, including other degenerative diseases (e.g. Huntington's disease), prion diseases (Jacob-Creutzfeldt disease), HIV dementia and several toxic and metabolic disorders (e.g. alcohol-related dementia). Dementia also develops in between 30 and 70 per cent of people with Parkinson's disease, depending on duration and age (Aarsland et al., 2003). Increasingly, it is recognized that mixed cases of dementia (e.g. AD and VaD, and AD and DLB) are commonly encountered, especially in older people.

People with dementia are also at increased risk of other physical health problems, and dementia is a major risk factor for delirium due to physical illness or medication. There are many reasons for this association. Dementias such as VaD and DLB frequently occur in those with other severe illnesses (such as stroke and Parkinson's disease). Progressive dementia during the course of AD itself can be associated with marked changes in autonomic function, appetite and eating habits, sleep and neurological signs. Decreased mobility and attention to personal care and diet, together with lack of compliance with medical treatments, renders people ...