Dementia: a million challenges

This week the government announced a new five-year strategy to improve the quality of treatment of dementia in England.

Neil Hunt, chief executive of the Alzheimer's Society, was quoted on BBC Online as saying: ‘One million people will develop dementia in the next ten years. This is a momentous opportunity to avert a dementia crisis that could overwhelm the NHS and social care.’

Gordon Wilcock, Professor of Clinical Geratology in the Nuffield Department of Clinical Medicine at the University of Oxford, chaired one of the major working groups that contributed to the content of the strategy. Professor Wilcock is also Vice President of the Alzheimer’s Society, which ran the various working parties.

I asked him about the strategy and his own work as director of OPTIMA – the Oxford Project to Investigate Memory and Ageing.

OxSciBlog: Why do we need a national dementia strategy?
Gordon Wilcock: Dementia has languished behind many other illnesses in terms of a comprehensive strategy to ensure early diagnosis, treatment and support. It is estimated that there are at least 700,000 people in the UK with dementia, and in most cases the effect of their illness has a major impact on their family and those that care for and about them.

The consequences of dementia also make a major demand upon the resources of both the NHS and social service provision. Anything that can reduce this burden of illness will have major benefits not just for patients and their families, but also within the health and social service caring environments.

OSB: What are the challenges ahead in providing high-quality care for people with dementia and their families?
GW: One of the major challenges is the sheer number of people with the condition who need to be assessed and managed. An equally important challenge however is the need to educate people, both lay and professional people, about dementia and the need to do something positive about it. Providing resources for new services in the current economic climate is also going to be challenging. 

OSB: What outcomes will you be looking for as the strategy is implemented?
GW: I would expect to see a steady increase in the number of people assessed and appropriately diagnosed with dementia, and adequate support provided for them and their families. This is a five-year strategy and I would hope that at the end of this period, everyone with dementia will have access to a specialized clinic, to whom GPs can make referrals having themselves better understood the problems of dementia and how to initiate assessment. 

OSB: What are the priorities for OPTIMA?
GW: OPTIMA’s priorities include improving both diagnosis and treatment, and also to increase our understanding of risk factors that contribute to the development of the diseases that cause dementia. We would like to make it possible to diagnose people before they are significantly impaired and offer them new treatments, as these become available, to slow down the rate at which their brain cells fail.

OSB: What are the challenges for research?
GW: The biggest challenge at the moment is developing tests that will identify the disease processes that are going to cause dementia before they have actually done so. There are a lot of new treatments in development, and some in clinical trials, that may slow the disease such that the onset of dementia may be delayed significantly. Identifying people at this early stage is very important.

Dementia research is also exploring new approaches to treatment, based upon the underlying changes in the brain that affect brain cells. Coupled with this, however, is the need to develop tests that will show whether or not a potential new drug is really going to be helpful. This will probably involve more sophisticated use of brain imaging techniques, and also biochemical changes that can be measured in the blood and cerebrospinal fluid.