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Andrew Husband, MSc, MRPharmS, and
Alan Worsley, PhD, MRPharmS, are senior lecturers at Sunderland
University
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SUMMARY
The term “dementia” is used to describe a number of diseases,
the most common of which is Alzheimer’s disease (AD). Other types
of dementia include vascular dementia, dementia with Lewy bodies and
frontotemporal dementia, as well as dementias resulting from infections,
such as Creutzfeldt-Jakob disease or HIV, and from genetically inherited
syndromes, such as Huntington’s disease (Huntington’s chorea).
Dementia is defined by the World Health Organization as “a syndrome
due to diseases of the brain, usually of a chronic or progress-ive nature,
in which there are disturbances of multiple higher cortical functions,
including memory, thinking, orientation, comprehension, calculation,
learning capacity, language and judgement. Consciousness is not clouded.
The impairments of cognitive function are commonly accompanied, and occasionally
preceded, by deterioration in emotional control, social behaviour or
motivation.” However, there is some variation in this definition
in practice. For example,
patients with dementia with Lewy bodies can experience variations in
consciousness (see below). In addition, it is accepted that early stage
dementia may be mild and, therefore, not fulfil the WHO criteria.
Some dementias, such as those caused by drugs, alcohol or non-organic
psychiatric disorders, are reversible. Most dementias, however, are progressive
and incurable. Although, in some cases, medicines can be prescribed to
alleviate symptoms, most patients with
dementia can expect, eventually, to become unable to communicate and
to need help
performing “activities of daily living”. Eleven of these
activities are essential for self-care,
including eating, dressing, walking and looking after personal hygiene.
The main risk factor for dementia is age. Prevalence is 2 per cent in
those aged 65–69 years compared with 20 per cent in those aged
85–89. The terms senile and pre-senile
dementia have been used to differentiate
between patients under or over 65 years but these are no longer in common
use because the two types share some aetiological features.
Dementia is estimated to affect 24.3 million people worldwide. There
are 4.6 million new cases every year and it is suggested that this figure
will double every 20 years, reaching over 80 million by 2040. Although
60 per cent of patients with dementia live in developed countries the
rate of increase in developing countries is three to four times that
in developed regions, possibly because diagnosis in these countries has
improved.
Patients with cognitive impairment consume substantial health resources.
For example, in the UK, around 224,000 of these people are in institutional
care at an estimated cost of £4.6bn each year.
Full article PDF 80K |
The
Pharmaceutical Journal