The upset displayed by John Suchet is a prima facie illustration – albeit a particularly harrowing one – of the feeling of desolation and isolationism that we as a company see only too often when people initially approach us for help in dealing with this condition.

Hugely helpful as the Admiral Nursing initiative is, as Mr Suchet points out, it remains unavailable to the vast majority of us and so the prospects for most sufferers of this awful disease continue to look ever more bleak – and even more so for their spouses or offspring who are almost invariably left to try and care for them.

The situation is not actually as bleak it might seem however.

By far the most significant factor in relieving the pressure and stress felt by relatives who would otherwise be left to deal with this condition on their own is having someone around who can basically shoulder a lot of the actual day-to-day burden of it on a hands-on basis rather than through counseling alone – or at all in fact. In other words, someone who can shoulder all the behavioural and physical demands of the person actually suffering from the disease and engage them emotionally also.

Time and again I have seen the lives of both sufferers and carers utterly transformed by this measure alone, and finally I have now experienced the benefits myself:

My own mother has for some while been afflicted with Alzheimer’s disease, a problem which was for a time exacerbated by her steadfast resistance to accepting any support at all outside of the family, which is often the case incidentally. But now we have a competent team of carers looking after her, it is hard to describe not only my own feeling of exaltation and well-being in seeing her being properly looked after by proper dementia-trained carers who take all this in their stride, but in witnessing also the distinct recovery in my mother’s own physical and emotional well-being.

And the moral of this story? Even the sufferers of Alzheimer’s disease don’t necessarily have to live a life of misery because of it.

Their study, published in the journal Neurology, looked at 121 people aged over 60, around half of them in the early stages of the disease.

Those with Alzheimer’s who were less fit had four times more signs of brain shrinkage than those who were fit.

The Alzheimer’s Research Trust said other research showed exercise reduced the risk of dementia.

“People with early Alzheimer’s disease may be able to preserve their brain function for a longer period of time by exercising regularly” Dr Jeffrey Burns University of Kansas School of Medicine

Some 700,000 people in the UK are living with dementia, with this number predicted to grow quickly over the next two decades, as the proportion of older people in the population increases.

Other studies looking at the relationship between dementia and exercise tend to focus on whether being active can reduce the risk of the condition developing in the first place.

Dr Jeffrey Burns, from the University of Kansas School of Medicine, said his was one of the first to look at whether exercise could affect the progress of the illness.

His volunteers underwent a treadmill test to see how fit they were and then their brains were scanned for shrinkage, which is one way of measuring the severity of their Alzheimer’s.

Brain volume

While there was no relationship between brain size and exercise in people tested who did not have Alzheimer’s, Dr Burns said the four-fold difference in those who did was evidence that exercise might help.

He said: “People with early Alzheimer’s disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost.

“Evidence shows decreasing brain volume is tied to poorer cognitive performance, so preserving more brain volume may translate into better cognitive performance.”

Susanne Sorensen, head of research at the Alzheimer’s Society, said: “Exercise increases blood flow to the brain, delivering oxygen and nutrients to brain cells.

“This is one possible explanation why dementia progresses slower in people who are physically fit.

“Exercise also reduces your risk of developing dementia so it’s important to take regular exercise. A healthy heart means a healthy brain.”

Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said: “This adds to previous research showing that exercise helps reduce the risk of dementia and slows down its onset.

“A balanced diet and regular exercise can improve the quality of life of older people with dementia, as well as those who do not have the condition.”

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

A US team compared the brains of 35 people who had Alzheimer’s “plaques”, some of whom died with sharp minds and others who showed no dementia symptoms.

The hippocampus, an area at the base of the brain, was on average 20% larger in those with cognitive functions intact.

The Alzheimer’s Society cautioned that it was a “relatively small study”.

The research was presented at a meeting of the American Academy of Neurology.

It has long been recognised that people can die with all the biological evidence of Alzheimer’s – such as a build-up of plaques and tangles within the brain – but having remained perfectly lucid until the last.

Researchers at Oregon Health and Science University in Portland compared the brains of 12 such people with 23 others who had similar levels of plaques, but had been diagnosed with Alzheimer’s before death.

Prevention strategies

“This work is consistent with increasing research that has shown that people with higher levels of education or cognitive reserve may be protected from some of the effects of dementia” Professor Clive Ballard Alzheimer’s Society

The hippocampus is located close to the junction with the spinal cord and is believed to “encode” experiences so they can be stored as long-term memories in another part of the brain.

“This larger hippocampus may protect these people from the effects of Alzheimer’s disease-related brain changes,” said lead researcher Deniz Erten-Lyons.

“Hopefully this will lead us eventually to prevention strategies.”

The Alzheimer’s Society said it remained unclear from this “relatively small study” whether the larger hippocampus really was the reason why people with dementia did not display the signs.

“However this work is consistent with increasing research that has shown that people with higher levels of education or cognitive reserve may be protected from some of the effects of dementia,” said Professor Clive Ballard.

“This is an exciting area of research which needs more exploration.”

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

Who’s affected?
The older a person is, the greater the chance they will develop a disease that harms the brain. Diseases that damage the areas that control thinking, memory, reasoning and language can lead to dementia.

It’s rare in people under the age of 60, but affects one person in 20 over the age of 65 and one in five over 80.

What causes it?

In a small number of cases the disease is reversible

When someone is diagnosed with dementia it’s vital the cause is established as far as possible because in a small number of cases the disease is reversible.

Even when the cause is not reversible, a clear diagnosis is important as different drugs are recommended in different types of dementia.

Causes include:

– Diseases resulting in progressive degeneration or death of nerve cells. These include Alzheimer’s (which accounts for more than half of all cases), Parkinson’s disease, Huntington’s disease, Creutzfeldt-Jakob disease and a group of conditions referred to as frontotemporal dementia (FTD). Another condition, called Lewy Body dementia, affects 20 per cent of people with dementia.
– Conditions, such as atherosclerosis, that harm the blood vessels supplying the brain. This type of dementia is known as vascular dementia and accounts for about 20 per cent of dementia cases.
– Conditions producing a dementia that can be reversed with treatment. These include hypothyroidism (underactive thyroid), vitamin B12 deficiency, folate deficiency, syphilis of the nervous system, subdural haematoma (a blood clot round the brain, usually following a blow to the head), hypercalcaemia (abnormally high calcium levels), undiagnosed diabetes, brain tumours or infections, and a condition called normal pressure hydrocephalus.
– Some medicines can interfere with concentration and memory, producing dementia-like symptoms. These include tranquilisers and sleeping pills, antidepressants and certain drugs with an anticholinergic effect (for example, some hayfever and cold remedies, some stomach ulcer drugs and treatments for diarrhoea).

What are the symptoms?
People with dementia often don’t look ill, especially in the early stages, and may have no particular symptoms. But family and friends may notice a change in the person’s personality, or that they seem to have problems remembering things.

The condition usually progresses slowly, and three types of symptoms may appear:

– Cognitive problems – a disturbance of understanding, memory, thinking, calculation, learning capacity, language and judgement.
– Functional problems – difficulty carrying out complex tasks and, as the condition progresses, difficulty with daily living activities, such as personal hygiene and dressing.
– Emotional problems – changes in mood, loss of emotional control and a withdrawal from previous interests, activities and social interactions.

Different types of dementia show slightly different patterns of disease. For example, in Lewy Body dementia, severity varies markedly from day to day, while in Alzheimer’s there is only slight variation from day to day.

In frontotemporal dementia (including Pick’s disease), shrinking of the frontal and temporal lobes of the brain typically causes problems with either behaviour and/or language but not with memory.

People with FTD often become disinhibited and irritable, rude, aggressive or apathetic. They may change their normal habits, become more interested in sex and neglect basic personal hygiene.

At the same time, they lose insight and don’t understand why their behaviour’s causing distress. Alternatively, or at the same time, they may progressively struggle to speak or understand speech. FTD tends to affect younger people (average age of onset is 60), has a strong inherited pattern and is usually relentlessly progressive with behaviour that’s difficult to control.

How is it diagnosed?
There’s no single test that can identify dementia, although a range of blood tests and sophisticated brain scans can help and are important in ruling out reversible causes.

Diagnosis is made by an assessment of symptoms and the use of brief questionnaires that test ability to remember facts, or draw simple diagrams.

What’s the treatment?
Most types of dementia progress slowly. People may live with the condition for ten years or more, requiring increasing levels of support as they become less independent. By carefully planning the person’s environment, and giving structure to their day with supportive activities, it may be possible to reduce the impact of the symptoms.

While there is no treatment that can cure progressive dementia, drugs (especially a type known as cholinesterase inhibitors) play an important part in controlling symptoms and can enable a person with dementia to live independently in the community for longer.

These treatments may also help behavioural symptoms such as restlessness or agitation, and improve the quality of life for the person with dementia and their carers. Some people don’t respond to any existing treatments.

Possible future treatments
Scientists are investigating the use of stem cell therapy, antioxidants and vaccination to stop plaque build-up in the brain.

It’s unclear how beneficial the herb Gingko biloba is in delaying the progression of Alzheimer’s and vascular dementia, and relieving their symptoms. There’s some evidence suggesting it may help.

Mental activity is believed to slow the progress of certain types of dementia, so keeping the brain active by doing puzzles and crosswords, for example, is recommended.

Depression is common among people with dementia and antidepressants can also help to improve symptoms.

This article was last medically reviewed by Dr Rob Hicks in January 2008

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

What causes it?
The exact cause of Alzheimer’s disease isn’t known, although some risk factors are known. The risk of developing the disease increases with age, for example.

There’s a higher risk of Alzheimer’s if a family member has the disease. However, inherited genetic factors are responsible in only a small number of families.

When the disease is inherited, it tends to lead to early onset of Alzheimer’s, usually between the ages of 35 and 60. One of several different genes may be at fault, such as the presenilin-1 gene on chromosome 14 or the amyloid precursor protein gene on chromosome 21.

Most cases of Alzheimer’s develop later in life and the genetic link is weaker. The genes at fault here are those for apolipoprotein E. Problems with these genes increase the risk of disease but don’t make it certain – other factors are involved.

Scientists believe other problematic genes may be located on chromosomes 9, 10 and 12. Clearly, it’s a complicated situation with much yet to be explained.

What are the symptoms?
Memory and the ability to think clearly are gradually lost over time. There may also be a change in personality. Someone who used to be a calm person may become agitated or upset more easily, for example. Behaviour problems and communication difficulties may also occur.

People with severe Alzheimer’s may find it difficult to perform everyday tasks, such as dressing, washing and eating. As time passes they may not recognise people or their surroundings, so it’s common for them to go for a walk and get lost.

Other problems, such as depression, may also develop.

What’s the treatment?
There’s no cure for Alzheimer’s disease, but drugs are available that may slow the loss of mental function in mild to moderate cases.

There’s some evidence the herb ginkgo biloba and vitamin E may help delay progression of the disease, too, but further research is required.

Treatment can be given for symptoms such as depression. Techniques to aid memory, such as writing lists or reminders, can be helpful in the early stages.

Support and help can be provided by social services for those with Alzheimer’s disease and their carers, but full-time residential care may be necessary in the later stages of the disease.

Tests to identify those in the early stages of Alzheimer’s disease are in development.

Can it be prevented?
The same risk factors for heart disease are believed to increase the risk of Alzheimer’s. So although there’s no definitive way to prevent the disease, not smoking, keeping blood pressure and cholesterol at healthy levels, taking regular exercise, maintaining a healthy weight and eating a healthy diet rich in the antioxidant vitamins C and E and oily fish are all sensible.

Some research has suggested that taking non-steroidal anti-inflammatory drigs (NSAIDs) or cholesterol-lowering statin drugs may lessen the risk of Alzheimer’s disease, but this research continues.

Other research into brain stem cell therapy, antioxidant therapy and a vaccination to prevent build up of plaques on the brain is also ongoing.

Advice and support
Alzheimer’s Society
Tel: 020 7306 0606
Email: enquiries@alzheimers.org.uk
Website: www.alzheimers.org.uk

Alzheimer’s Scotland – Tel: 0131 243 1453

This article was last medically reviewed by Dr Rob Hicks in October 2007

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

However, for some people, their memory may begin to decline because of changes in the structure of their brain. These changes can lead to other symptoms, which, taken together, can be both distressing and disabling. This usually happens as we reach the last years of our lives, but it can happen earlier.

Some people – by either adjusting their lifestyle, or by seeking some support – can carry on living a fulfilled life. Others may need to be cared for full-time.

What are the symptoms?
The labels of ‘dementia’ or ‘Alzheimer’s’ – which is just one type of dementia- are less important than a person’s ability to remain safely in their own home. The main symptom is loss of memory: often the person will remember things that happened many years ago very clearly, but events in the recent past are forgotten.

This can also happen – to a lesser degree – as part of the normal ageing process and so does not in itself mean that a person is developing dementia.

There’s often a pattern of other thinking problems and behaviour that (in union with severe loss of short-term memory) may mean that a person’s ability to care for themselves is declining. Other symptoms can include:

– lack of concentration
– confusion about time and place
– self-neglect
– restlessness
– a tendency to wander aimlessly
– sometimes saying or doing outrageous things
– mood can be depressed, anxious or agitated
– reasoning can be come slow and muddled
– some people may experience hallucinations or delusions

Dementia rarely happens suddenly. For most people, the process is a slow development. There are many causes of memory loss and dementia, and each type will present a different pattern of these symptoms.

The underlying cause isn’t always clear. Alzheimer’s disease does appear to run in families, but having a relative with Alzheimer’s doesn’t appear significantly to raise your own risk of developing the problem.

There are some types – as in vascular dementia – where part of the cause can be identified as a reduced blood supply to the brain. This is most often caused by high blood pressure, but when this isn’t the case it’s not always clear why the brain’s blood supply should have reduced.

How common is it?
Most types of dementia become more common with age. About five per cent of people aged 65 or over may have some form of Alzheimer’s, while about 20 per cent of people aged 80 or over will. This doesn’t mean that five per cent of 65-year-olds will need to be cared for in special hospital wards for the elderly. Many, with comparatively mild symptoms, may be able to cope in sheltered accommodation – or stay at home supported by home helps and nursing care.

What can I do to help myself?
The first thing is not to worry unnecessarily. A problem with forgetfulness doesn’t mean that you have dementia.

If you find yourself forgetting certain things, you could try to give yourself memory prompts. If (for instance) you find that you forget to buy food, leave notes in your kitchen cupboards near the back, reminding you to go to the shops. So when you come across the notes, keep them on you until you have bought more food.

This may seem cumbersome, but it’s only an extension of the ‘to do’ lists that people make in everyday life.

If you’re worried that things might be getting worse, it’s important to share those worries with someone you can trust. If this doesn’t include members of your family, it may be wise to consult your family doctor.

If there comes a time when you’re unable to take decisions for yourself, you may want to set out in advance the arrangements you’d like to be made for your care. It may be possible for you to appoint someone trusted to have power of attorney over your affairs.

What professional help is available?
There are specialist teams in most areas that care for people with dementia; they’re usually part of the local mental health services. It’s usual for referrals to be made through a family doctor. Teams usually consist of psychiatrists, community psychiatric nurses (CPNs), clinical psychologists and social workers.

For most dementias, there are no treatments or cures for the condition. However, some of the symptoms can be lessened by careful use of medication.

Otherwise, teams caring for people with dementia will often be concerned with monitoring the course of the condition, and ensuring the environment in which the person is living is best suited to their needs.

Another good source of information is the Royal College of Psychiatrists online factsheets.

It’s also important to look after the carers of people with dementia, who are often relatives looking after people at home, which can be very stressful.

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

An ageing population means the burden of dementia on the UK will double to £35bn-a-year within 20 years.

They told Health Secretary Alan Johnson that more should be spent researching new treatments for Alzheimer’s disease.

The 11 specialists claimed only 3% of the annual NHS research budget was aimed at dementia. But the government said it was looking to improve care.

“As the NHS turns 60, the question isn’t whether it will last a further 60 years, but if it can survive the next 20″ Open letter to Health Secretary Alan Johnson

The open letter to Mr Johnson says that the NHS “may well be unsustainable” as the number of people with dementia increases.

They wrote: “As the NHS turns 60, the question isn’t whether it will last a further 60 years, but if it can survive the next 20.

“The government must greatly increase dementia research now.”

The signatories included Professor Simon Lovestone, from King’s College London, Professor Nick Fox, from University College London, and Professor John Mayer, from Nottingham University.

National strategy

Rebecca Wood, the chief executive of the Alzheimer’s Research Trust, said that a quarter of the Department of Health’s £700m research and development money was spent on cancer research, more than six times the figure received by dementia researchers.

“If underinvestment persists, the economic consequences arising from dementia care costs will be catastrophic.”

A spokesman for the King’s Fund, whose recent report predicted the doubling of costs for dementia care, said: “There is no cure for dementia.

“Unless there is a major breakthrough in drugs to arrest the course of this illness, there will be a great need for extra care and support, some of it quite intense.”

But a Department of Health spokesman said that the first ever “National Dementia Strategy”, which the government is currently working on, would improve early diagnosis, treatment and care.

She said that “significant funding” had already been made in dementia research, with the department investing £20m over five years from 2006 in a national research network on dementia and other neurodegenerative diseases.

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society