British epidemic of dementia

Press, 9 August 1985, Page 14

British epidemic of dementia

JUNE GOODFIELD, “Observer,” examines the disturbing rise of Alzheimer's Disease in Britain.

Old age is a shipwreck, wrote Charles de Gaulle, and those who founder, catastrophically and immediately, upon its rocks can count themselves lucky. For others, the circumstances are prolonged, painful and tragic.

Alzheimer’s Disease — senile dementia — now one of the most serious problems of our ageing populations, begins imperceptibly and progresses slowly. Small changes in wellestablished habits may be the first indication of something amiss. The tiny social detail is often so trivial as to trigger only puzzlement. One married couple had long agreed as to which of two shoe brushes should be used to apply the polish and which to buff the shoes. One day the wife noticed that her husband was regularly reversing the brushes, though totally unaware that he had done so. Such unawareness is characteristic of the symdrome.

From time to time, whether young or old, we all mislay our car keys — and know it. But Alzheimer’s patients are both unaware that they have forgotten where they put them and do not even know that they have lost them. They will be confused and bewildered, knowing something is wrong but not at all certain what it is.

Confusion and forgetfulness, restlessness and irritability come first, then estimates of times or distance or place are obscured in a typical pattern of mental retardation.

The higher functions erode, as, after memory, intellect goes, then reasoning, learning and finally personality. The daughter of one patient, aged 53, told me, “Alzheimer’s is such a selfish disease. It goes so slow and takes everything away. Now it’s hard for me to remember what my father was like before.

“He’s losing all his human qualities. It’s my father but my dad has gone.”

It is then, a bereavement, but a death which leaves the body behind, sometimes for years.

Yet after a short, bewildering period, the patient is oblivious and the family alone bears the burden.

The statistics show why the term epidemic can be applied. In Britain one person in 10 over the age of 65 suffers from some form of dementia; some 60 to 65 per cent of these are Alzheimer’s victims.

In the United States, 25 million people aged 65 or older have the disease; 2.5 million people (10 per cent of the population), are mildly demented; 1.3 million people (5 per cent), require institutionalisation.

At present 56 per cent of all beds in nursing homes are occupied by the demented, and many could survive for years. Yet many victims are not really old at all, being struck down in early or late middle age.

So whether in terms of scientific difficulty, medical helplessness, personal distress, social disruption or financial and emotional drain, Alzheimer’s presents a most formidable challenge. As the baby-boom generation becomes our senior citizens, the problem is going to get worse. The disease is called after a German neurologist, Alois Alzheimer, who in 1907 described the brain changes characteristic of it. The cause is not known, though the consequences are — neural tangles, solid plaques and reduction of brain tissue — features all present in the ageing brain, though to a lesser degree.

Possible causes for Alzheimer’s disease range from the genetic — there are familial patterns — to enzyme defects, to unconventional slow viruses that remain in the body for years.

We need to set up an experimental model that mirrors the entire course of Alzheimer’s. Only then can we hope to identify the disease early and search for adequate prevention or therapy.

At this moment, Alzheimer’s is more of a social problem than a medical one.

Somehow we must take the burden off the families, or at least remove it partially, if only temporarily. This objective is the main thrust of the Alzheimer’s Disease Society, whose president is Dr Jonathan Miller.

Founded in 1979 by Professor Gordon Wilcock and a retired S.R.N., Cora Phillips, whose husband died from the disease when only 68, the society began as a small self-help group. But recently it has undergone a major change to a service provision, with eight regional headquarters, supporting six day centres, of which the first were Middlesbrough and New-

castle (five more open this year). It is being allied to a number of self-help groups for visiting patients’ homes, helping out with odd jobs, doing the shopping, and most importantly, allowing temporary relief so the carers can go out, if only for 20 minutes.

There are presently 4000 national members, but these are increasing by 70 per cent each year. Supported by grants from government and industry, and some charitable donations, with legacies just beginning to come in, the society publishes exceptionally’ good leaflets that introduce the carers to those strategies which make life pleasanter and. easier for both parties clamped together by dementia.

The Christchurch support group, A.D.A.R.D.S. (Alzheimer’s Disease and related disorders), holds regular meetings. Contact: Citizen’s Advice Bureau, 68-413, or write, P.O. Box 2355.