Professor Michael Hanna, Consultant Neurologist, outlines the causes and diagnosis of dementia and welcomes this new major research boost.
Dementia comprises a devastating group of neurological conditions in which there is progressive decline in cognitive function. Patients typically present with memory difficulties, behavioural and personality changes, speech and language difficulties or other problems caused by dysfunction of specialised areas of the cortex (grey matter) of the brain. Although there are a wide number of different diseases processes that may result in dementia the two commonest causes are Alzheimer's Disease and dementia induced by multiple small strokes (so called multi-infarct dementia). In Alzheimer's disease premature death of populations of neurons progressively occurs but the precise cause is not known. In multi-infarct dementia alternations in blood flow to the cerebral cortex are considered important and risk factors include hypertension. In both forms of dementia there is mounting evidence that life- long physical exercise may reduce risk. However, much remains unknown, there are no curative or diseases modifying treatments and more research is urgently needed.
Detailed individual patient assessment is essential
Each patient presenting with memory difficulties or other symptoms suggestion dementia requires prompt detailed individual assessment and specialised tests to reach a clear diagnosis and to exclude treatable causes. The diagnostic approach will typically include a detailed clinical consultation, memory tests (neuropsychometric tests), MRI brain scan, blood tests and often a lumbar puncture to analyse the spinal fluid before a precise diagnosis and prognosis can be made.
An international social and economic priority requiring more research
Dementia is an increasing social and economic burden. In the UK 800,000 people currently live with the condition, and this is set to grow to exceed one million by 2025. In addition to the significant human costs, the economic impact is enormous. It is estimated that currently 1 in 5 NHS beds is required to care for patients with dementia. The current annual financial impact to the UK is estimated to be £23 billion and an additional £8 billion is attributed to the value of work otherwise done by carers (Alzheimer's Society, 2013). On a global scale, societal costs are expected to increase from $604 billion in 2010 to $1,117 billion by 2030, with 89% of the costs incurred in high income countries (Alzheimer's Disease International, 2010). Currently the research funding for dementia is approximately one fifth [per patient] of that invested in other important diseases such as cancer. Without more research to find a disease modifying therapy the increasing prevalence of dementia in an aging population threatens to overwhelm national social care and health care systems.
Prime Minister's Challenge on Dementia
In the strategy, Prime Minister's challenge on dementia 2020, David Cameron sets out what the government wants to see in place by 2020 in order for England to be "the best place in the world to undertake research into dementia and other neurodegenerative diseases " The key aspirations of the strategy, which builds on progress in recent years, include:
- More than £300 million to be invested by the UK Government in research and medical innovation, with annual investment in dementia research expected to double by 2025
- Launching a separate multi-million pound fund, with investors from the private, public and charity sectors, financing research projects identified by scientists as having the best potential for future success.
- Establishing an international dementia institute in England within 5 years, helping to make the UK a world leader for research on dementia and medical trials.
- Doubling the number of people with dementia taking part in research
- All NHS staff to undergo training in dementia to help improve care
- Training three million more Dementia Friends, to improve awareness and understanding of dementia
- Faster dementia assessments and improvements to support for people with dementia after diagnosis
- The strategy follows the recent announcement of the ARUK £30m Dementia Drug Discovery Alliance, launching three flagship Drug Discovery Institutes at London UCL, Oxford and Cambridge.
Professor Hanna explains "There is an urgent need for a substantial increase in dementia research funding and this announcement by David Cameron is a significant boost for dementia research aimed at finding disease modifying treatments".
Prime Minister's challenge on dementia 2020 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/406076/Dementia_vision.pdf
Government press release -
ARUK Drug Discovery Alliance :
Join Dementia Research website -