Dementia cases set to soar

A study carried out by Maltese researchers found that there are an estimated 4,072 people suffering from dementia. This figure is expected to almost double by 2035. One of the researchers, Charles Scerri, tells Cynthia Busuttil why the government needs to tackle this brain-degenerative disease now.

As Malta's ageing population increases, dementia, like other health conditions normally associated with the elderly population, will grow substantially, affecting two per cent of the general population by 2050.

This, according to Charles Scerri, will put more pressure on both the national health sector as well as social services to take care of the increasing number of sufferers.

"Who will take care of these patients? At the moment most of the care comes from family members, but the decreasing birth rate means that there will be fewer and fewer people to take care of the elderly in the coming decades, so the pressure on the government to provide care will increase."

Dementia is a term used to describe a group of brain diseases which result in the progressive impairment of brain function with symptoms that may include significant loss of memory, confusion, language difficulties, problems performing routine tasks and personality or mood changes. The disease is characterised by significant and progressive brain cell death which causes the brain to shrink by some 25 per cent in severe cases. The most affected brain areas are those that control cognitive functions such as memory, language and thought. Alzheimer's Disease is the most common cause of dementia and accounts for half the cases.

"Initially, small, yet abnormal deficits in memory will be observed, like repeating the same question over and over again. As the disease progresses, the patients stop recognising their partners and children, and eventually even speech will be impaired. In the majority of cases, it is the relatives that have to take care of all their needs - including feeding them, cleaning them, and even putting them in and out of bed. This involves constant care and most of the care-givers would have to stop working because it would be impossible to care for a patient with dementia while holding down a job. This ends up in huge financial pressures on the families concerned."

However, the psychological stress offers the greatest challenge. "It's an emotional rollercoaster seeing your loved ones slowly wasting away, existing, but not living. It is therefore understandable that some 60 per cent of relatives will end up needing psychiatric care themselves."

This will put even more financial pressure on the government since most of the psychiatric medications that are prescribed for the affected relatives are usually provided for free through the national health system. Dr Scerri - who is also the general secretary of the Malta Dementia Society and a lecturer in neuropathology at the university's Department of Pathology, Faculty of Medicine and Surgery - points out that the United Kingdom spends more on dementia than on cancer and cardiovascular disease put together.

"The World Health Organisation estimates that dementia contributes to 11.2 per cent of years lived with disability in people aged 60 years and over - much more than cardiovascular disease (five per cent) and all forms of cancer (2.4 per cent). Dementia is the major predictor of morbidity and mortality in the elderly and the government needs to provide the resources. The United Kingdom, that has similar prevalence rates to Malta, spends some £17 billion a year for dementia - £24,000 per individual per year."

If these figures had to be translated to the Maltese situation, the local expenditure would amount to close to £100 million (around Lm63 million/€27 million). Dr Scerri says the government does not know exactly how much dementia is costing the local health system since most of the care is still provided by the family. But he points out that the pressures on family members are becoming so extensive that some are unable to continue caring for their elderly.

Recently, a respite centre where people with dementia can go three times a week opened at St Vincent de Paul residence. "We need to increase such services and we also need to train more people in this type of care. The dignity of the individual should always be placed first in our priorities," he says.

The Malta Dementia Society will soon launch a helpline for patients and their relatives through funds from last year's L-Istrina. Patients themselves might need someone to talk to at the onset of the disease, when they are aware that something is wrong with them. "In the beginning many individuals with dementia are aware that something wrong is happening to them and as a result end up depressed. As time goes by, and memory is progressively lost, so does the feeling of past and future."

In a study published in June's issue of the Malta Medical Journal, Dr Scerri, together with researchers Stephen Abela, Julian Mamo and Carmelo Aquilina, used international dementia models and local statistics to compile an estimate of the number of individuals with dementia in the Maltese islands. While the estimated number of cases in 2005 was calculated at 4,072, the trend is expected to increase sharply in the coming years - to 6,345 in 2025 and 6,821 in 2035.

At the moment Malta is one of the few European countries where the government does not offer any form of financial reimbursement for anti-dementia medicines, Dr Scerri says, adding that there are four medicines approved in Malta, but none are supplied for free by the national health services.

"Unfortunately these medicines are not cheap, costing patients up to €140 a month. You have to keep in mind that most patients are over 60 years old, live on a single pension, and have other expenses, including health-related ones."

Dr Scerri explains that although useful, anti-dementia medicines only address some of the symptoms and are not effective in each and every case. A trial period of about six months is necessary to check whether these medicines have any useful effect on a particular individual.

To date there is nothing that can be done to regenerate the brain cells that are lost in this particular disease. "Cells in other parts of the body are able to replicate. But brain cells are so specialised in their function that they have lost this ability to replicate. So, if a cell is lost, it is lost forever and thousands of them die everyday as part of the normal brain function."

He adds that some researchers argue that if we manage to find a way to replicate brain cells, we would have found the recipe for a long-lasting life. "If the brain does not die, the body will stay healthier for much longer as a significant amount of disability comes from the fact that the brain loses some of its functions with age."

One way to replace the dead cells is by using embryonic stem cells - research that has raised several ethical and moral issues. Dr Scerri explained that although tissue stem cells are readily available, these are only able to develop into the cell from where they originated. On the other hand, embryonic stem cells can develop into any type of cell as they would not have received the instructions of which cells they are developing into.

Although embryonic stem cell research is still surrounded by controversy, patients with terminal illnesses look at it differently. In an EU-wide study among patients, 75 per cent of the 5,400 respondents said they would not refuse personal treatment which had been developed through embryonic stem cell research. Moreover, 83 per cent agreed that public funding should be used in embryonic stem cell research.

All this highlights the importance of research not only to try and find a treatment - or better a cure - for dementia, but also to improve the quality of life of sufferers.

"It is imperative to be able to tell patients that we are doing our best to help them, to increase their dignity and improve their quality of life, even if we cannot cure them."

He points out that several research projects are currently underway, even though the Departments of Pathology and Clinical Pharmacology and Therapeutics have very limited resources. Most of this work is effectively being carried out in one laboratory within the Pharmacology Department which is also shared by other research project workers and students.

"I am currently conducting research concerning various aspects of dementia both from a social perspective as well as from a scientific aspect, investigating factors that are responsible for such an alarming rate of brain cell death," he said.

Internationally, research on dementia is ongoing and there is also some hope for a vaccine against the disease. Dr Scerri explains that such a vaccine - targeting a particular protein in the brain which causes the cellular damage - was already tested but human clinical trials had to be stopped in 2002 as it caused fatal brain inflammation in about six per cent of clinical trial participants.

"They are now working on finding out what went wrong in order to come up with a solution. If such a vaccine is made available, it would be a major breakthrough," he says.

"I think the next 20 years will be very exciting. In the meantime, our hope remains in our research" he adds.