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21 October 2022

Changing how we treat dementia

We must focus more on prevention and early diagnosis.

By Paula Head

Dementia can be a devastating disease. Alongside causing memory loss, it can change the way someone speaks, thinks, feels and behaves. It impacts people’s relationships with their family and friends and stops them being able to live independently. It is also the leading cause of death in Britain; dementia and Alzheimer’s disease (the most common type of dementia) accounted for 12.7 per cent of deaths in England and Wales in 2018.

There are roughly 900,000 people with dementia in the UK, affecting one in every 14 people over 65, and this is expected to rise to one million by 2025. Although it mostly affects older people, it is not a “normal” or “natural” part of ageing. Despite its prevalence, it has not been prioritised in terms of health funding, and access to detection, diagnosis and care is inconsistent across the country. It is also not well known that lifestyle changes can be very successful in limiting its progression.

When people think about dementia, they tend to visualise its later stages – severe memory loss and behaviour change, and the burden it places on families and carers. Up until now, there has been little in the way of preventative treatment, so the NHS’s focus has been on medication that alleviates symptoms and on providing social care for the individual. Quite rightly, people living with dementia need a strong support system to enable them to live independently for as long as possible.

But more focus now needs to be put on early diagnosis and prevention. As policy value access lead at pharmaceutical company Roche, my role involves working with the NHS and government to inform healthcare policy. One of the core parts of my job is co-creating solutions to healthcare problems that deliver better outcomes for more patients faster. This is particularly important for people living with degenerative diseases such as dementia, and this is why Roche is so focused on helping to shape patient pathways.

We need to shift from a purely social care to a more integrated medical-social care mindset, from reaction to prevention. We need to start thinking about early detection and rapid diagnosis.

We would like to see the NHS establish a clear, consistent set of standards around these two things, so that every region in the UK provides equal access to dementia services. Who you are or where you live should never be a barrier to receiving access to care and support services and appropriate treatment – there is no place for inequality in this health crisis.

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These national guidelines should also provide clear definitions for terms used in dementia diagnosis, such as what constitutes “mild cognitive impairment”, which is the stage between normal ageing and dementia. For those who do start experiencing symptoms such as memory loss, we’d also like to see a faster and more streamlined diagnosis pathway, where everyone in the country has access to the necessary specialist tests if deemed necessary – such as positron emission tomography (PET) scans, magnetic resonance imaging (MRI), and cerebrospinal fluid testing (CSF). Currently, despite being recommended by the National Institute for Health and Care Excellence (Nice) guidelines, some of these tests are only utilised for 2 per cent of people who attend memory assessment clinics, according to NHS England. Following diagnosis, we’d like to see psychological counselling available for all dementia patients, with one point of contact for ongoing support.

This would be no mean feat and it requires an integrated approach, with health and social care services working together. Dementia services are already delivered by dedicated and hardworking healthcare professionals, and the government should help achieve this goal through funding and resourcing the dementia workforce.

Much more can also be done in raising awareness of prevention and empowering people to make lifestyle changes themselves. The medical journal the Lancet outlines 12 modifiable risk factors, which could reduce dementia cases globally by a massive 40 per cent. These include: education level, hearing loss, hypertension, obesity, alcohol intake, head injury, smoking, depression, social isolation, physical inactivity, diabetes and air pollution. While the ability to make changes will be dependent on personal circumstances, proactive choices such as exercising more, reading and staying in touch with friends and family could reduce the risk of dementia for thousands of people.

We’d like to see a robust public health campaign about these risk factors, tailored to different communities and demographics across the UK. Charities including Alzheimer’s Research UK already run initiatives that emphasise the benefits of exercise and diet for the brain, such as its “What’s good for your heart is good for your head” campaign. Now we’d like to see the government and NHS take a leading role on this. These risk factors and their link to brain health could also be better communicated by GPs in the routine medical check-ups that people aged 40 to 64 undergo.

Given where we are with the 900,000 people in the UK live with dementia research into potential treatments, the NHS must adapt its systems and processes around the diagnosis, treatment and care of dementia and Alzheimer’s. This disease results in thousands of deaths every year, immeasurable pain and suffering for patients and their families, and a heavy toll on our NHS and social care services. We cannot afford to just focus on care any more – we must turn to prevention and early detection, to save lives and livelihoods.

Advertorial funded by Roche Products Ltd. Date of publication: October 2022 / M-GB-00009571

This advertorial will appear in our Healthcare Spotlight print supplement, published on 28 October 2022.

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