Niche In-Brief Spring 2018 - Flipbook - Page 3
Rethink dementia
Moving towards the ‘Healthy Brains’ Clinic’ model
Over 18% of the UK’s population is now over 65 years
old, and this proportion is increasing to the point where
the UK will soon be a ‘super-aged’ society, defined as
20% of the population over the age of 65. Ageing is the
single most important risk factor for dementia, thus the
prevalence of dementia is also increasing. By 2025, there
will be an estimated 1 million people living with dementia
in the UK and this figure is set to double by 2050 (a rise of
146%).
Worldwide, there are currently nearly 50 million people
already living with dementia, and this number is projected
to triple by 2050. Alzheimer's Disease is the most
common form of dementia, constituting over 60% of all
those with dementia. Until recently, the focus for the
treatment of dementia has been on alleviating symptoms,
patients are not normally offered treatment until they meet
the criteria for ‘dementia’ and are no longer in the ‘mild
cognitive impairment’ (MCI) stage. These treatments
have a modest effect at improving symptoms of memory
loss and some behavioural problems, but have no effect
on slowing the underlying neurodegeneration of the
disease. Historically, in the UK, Memory Assessment
Services were established to administer and monitor
these treatments. The model of these Memory
Assessment Services, however, is now outdated and
there is a demand for change.
The case for change:
Currently, there is greater focus on the prevention of
dementia by slowing the conversion from mild cognitive
impairment stage to full dementia. It is now known that
delaying the onset of the full syndrome of dementia, by
even a few years, will significantly reduce the overall
prevalence of dementia in society, and will have a
significant positive impact on the lives of individuals, as
well as the overall impact of dementia on the economy
(Zissimopoulos et al. 2014).
which may have the potential to slow the progression
to more advanced dementia in Alzheimer's Disease,
will be licenced for clinical use within the next few
years (Ritchie et al. 2017). Several compounds with
disease modifying treatment potential are now
undergoing final pre-licensing clinical trials. Currently,
these drugs are mostly focussed on either eliminating
or reducing the build-up of the toxic forms of the
protein amyloid, an important component of
Alzheimer's pathology, but other strategies are also
being investigated. The full impact of a licensed
disease modifying treatment is unclear, but the
repercussions on resources and the need for a
cultural change in diagnosis and treatment is
substantial.
The key factor to the use of these new agents will be
the accurate and early detection of Alzheimer's
Disease in the very early stages of dementia. If
detected too late, the chance that the disease
modifying treatment may work will be significantly
less. By the time clinical symptoms appear, it is likely
that amyloid pathology has been present in the brain
for several years and extensive neuronal damage is
already present (Sperling et al. 2011). Thus, an
essential approach to therapy is to halt the
development of, or get rid of toxic amyloid, prior to the
damage occurring. This requires a radical re-think in
the diagnosis and management of Alzheimer's
Disease.
There are two main strategies to achieve this. Firstly,
‘prevention’ involves the identification of those at risk for
progression to dementia (not all those with mild cognitive
impairment will progress to dementia) and the
management of those risk factors (Livingston et al. 2017).
Secondly, there is the promise of disease modifying
treatments. Disease modifying treatments are currently
being offered to patients in the context of clinical trials,
however, it is anticipated that some of these treatments,
3