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Dementia – An Overview
Tom Dening
Professor of Dementia Research
March 14th 2013
ELC, Nottingham
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Dementia
• A collection of features that includes memory
loss and other symptoms – mood, thinking,
judgement, language etc. – with at least some
impairment of everyday functioning
• Due to disease of the brain
• Usually distinguished from delirium
• If memory loss is the only problem, we refer to
mild cognitive impairment (MCI)
Causes of dementia
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Alzheimer’s disease
Vascular dementia
Dementia with Lewy bodies
Parkinson’s disease with dementia
Front temporal dementia
Others – Huntington’s disease, alcohol, head
injury, other brain diseases
How common is dementia?
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750 000 pwd in UK now
1.5 million by 2050
Worldwide 36m now, 115m by 2050
Uncommon <age 70
Common >age 80 – about 20% prevalence
Risk of getting dementia before death about
30% of people dying in their 80s
• Does everyone get dementia if they live long
enough?
Impact of dementia
• Cost to UK economy at least £17bn
– depends how you calculate costs of informal care
• Worldwide approx. $600bn in 2010 (ADI, 2010)
– if dementia care were a country, it would be the
world’s 18th largest economy, between Turkey and
Indonesia
– if it were a company, it would be the world’s largest
• Biggest cause of lived with disability globally
Impact of dementia 2
• About 670 000 people in UK acting as primary
carers for pwd
• At least 250 000 care home residents with
dementia
– up to 80% of care home residents have
dementia
• About 17 000 cases of dementia with onset <65
(young onset or working age dementia)
• Government policy
• Everyone knows someone with dementia
PM’s Dementia Challenge
Three key areas:
• Driving improvements in health and care
• Creating dementia friendly communities that
understand how to help
• Better research
Nottinghamshire
Estimated Dementia Prevalence: Projections 2012 to 2030
4,500
4,000
Estimated counts
3,500
3,000
Bassetlaw
Mansfield and Ashfield
2,500
Newark and Sherwood
2,000
Nottingham North and East
1,500
Nottingham West
Principia Rushcliffe_incOOA
1,000
500
2010
2015
2020
2025
2030
Nottinghamshire
Estimated Dementia Incidence: Projections 2012 to 2030
1,200
Estimated counts
1,000
Bassetlaw
800
Mansfield and Ashfield
Newark and Sherwood
600
Nottingham North and East
Nottingham West
400
Principia Rushcliffe_incOOA
200
2010
2015
2020
2025
2030
Research in Dementia:
Some questions for you
1. What research in dementia do you know
about?
2. What gets in the newspapers?
3. Are there any particular issues or challenges in
doing research with people who have
dementia?
Where is dementia research needed?
all along on the pathway!
Recent research in dementia
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Genetics & molecular biology
Causes and risk factors
Diagnosis
Treatment
The experience of people with dementia
Services for pwd and carers
Research into dementia care
Genetics
• Family history is common but usually no
distinct pattern
• Some families with dominant inheritance
– very rare
• Amyloid precursor protein (APP) genes
• Presenilins (1 and 2)
• Genes with increased risk in older people
– apoE ε4
?vascular risk
– TREM2
inflammation
– about 10 others with small effects
Molecular biology
• AD is characterised by accumulation of amyloid
plaques and neurofibrillary tangles (tau protein),
as well as neuronal loss and vascular changes
• APP is a membrane protein which normally gets
divided into soluble forms – however if this is
disrupted → insoluble forms which appear as
plaques
• Disease starts in medial temporal structures,
especially hippocampus
• Debate as what process starts first
Neuroimaging (brain scanning)
• Many techniques:
– CT, MRI, PET, SPET, DaT, PiB scans
– which of these have you heard of?
• Powerful research tools
– use in clinical practice?
Treatment
• Not just drugs!
• Always think about nonpharmacological
measures first
• No cures for dementia at present
– ?ever possible if damage has occurred
Having said which, let’s look at
pharmacological therapies for AD
• Cholinesterase inhibitors
– donepezil, rivastigmine, galantamine
• Memantine
• Numerous negative trials of other drugs
• More recent research trials
– immunotherapy (solanezumab, bapineuzumab)
– nutraceuticals (medical foods)
– minocycline
• Treatments for BPSD
Other approaches to treatment
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General health
Vascular risk factors
Exercise
Mental activity?
Gingko, vitamins, fish oils etc., etc.:
– not much evidence of benefit
Service based research
• Evaluation of new services
• Clinical audit of established services
• Pragmatic clinical trials of interventions of
various kinds, e.g. dementia crisis teams
Research in dementia care
• Dominated by person centred (or relationship
centred) approach
• Various methodologies available, e.g.
dementia care mapping
• Ethical and consent issues
Care home research
• A growing field
• Various collaborations to improve standards
and to promote research
– e.g. ENRICH, My Home Life
• http://www.dendron.nihr.ac.uk/enrich/index.php
• a DeNDRoN supported venture to increase the
amount of research done in care homes
• and to safeguard research quality
• gives advice to homes, carers, researchers
about conducting research in homes
• Research Ready Care Home Network
http://myhomelife.org.uk/
Collaborative partnership to improve care home quality, involves AgeUK, City
University & Dementia UK
Eight key themes for practice & research:
Tailoring care to each individual:
• Maintaining Identity
• Creating Community
• Sharing Decision-making
Helping resident, relatives and staff navigate their way through the journey of
care:
• Managing Transitions
• Improving Health and Healthcare
• Supporting Good End of Life
Leadership and management required to transform care into best practice:
• Keeping Workforce Fit for Purpose
• Promoting a Positive Culture
Key themes in care home research
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Quality of care & quality of life
Physical and mental health
Engagement, involvement & activity
Support to care homes
Carers and families
End of life care
The care home sector
Research in Nottingham
• Chair in Dementia Research
– joint venture with University, Notts Healthcare, Barchester
– Barchester & Notts already in partnership, e.g. Forest
Hospital
• existing projects & other academics
– NIHR CLAHRC-NDL
– Rehab & Ageing
– Psychology
– MRC-CFAS
• develop new programme
– ESRC bid
– multicentre clinical trials
• build capacity through PhDs etc.
“Manifesto”
• Everyone knows someone with dementia
• Post spans the whole of OPMH not just dementia
• Dementia as a developmental disorder
– life course of dementia can be >10 yrs.
– consistent with departmental philosophy
• Most people with dementia are in the social
sphere [i.e. not clinical services] most of the time
• We will do research on any part of the pathway
resources etc. permitting
Where we hope to be
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Centre of excellence within IMH
Increase capacity through studentships etc.
Develop links with other UoN campuses
National & international reputation
Contributions to national agenda
– policy
– impact/implementation of research
– research funding
• Sustainable and looking forward
Research in Dementia:
Some questions for you
1. What research in dementia do you know about?
2. What gets in the newspapers?
3. Are there any particular issues or challenges in
doing research with people who have
dementia?
Thank you