Losing your mind

Dementia is a clinical syndrome referring to a group of brain diseases characterised by the development of multiple cognitive impairments that are severe enough to interfere with daily functioning. These deficits include memory impairment, language difficulties, confusion and personality or mood changes. The disease is characterised by significant and progressive brain cell death in areas of the brain that control cognitive functions such as memory, language and thought. Alzheimer's disease is the most common cause of dementia accounting for around 60 per cent of all dementia cases.

A combination of factors makes dementia a relevant issue from both a scientific and a social-health perspective. In developed countries there has been a dramatic increase in the elderly population. Furthermore, dementia is the major predictor of morbidity and mortality in the elderly costing the health services more than cardiovascular disease and cancer put together. The occurrence of the disease increases exponentially with age affecting two per cent of individuals aged 65 years, doubling every four years to reach approximately 30 per cent at 80 years of age. Half of the individuals reaching 90 years or more will develop the disease.

For most developed countries and some less developed ones, dementia is causing a tremendous economic and social impact on both affected individuals and the entire society. It has been estimated that the total number of persons with dementia will double every 20 years for the period 2000 to 2040, at a global rate of 4.6 million new dementia cases per year. The costs are enormous. The UK, that has similar prevalence rates to Malta, spends some £17 billion per year. If these figures had to be translated to the Maltese situation, the local expenditure would amount to close to Lm60 million. However, this becomes insignificant when compared to the psychological stress that accompanies the disease. In the majority of cases, it is the relatives that have to take care for the constant needs of these patients. Most care-givers would have to stop working resulting in huge financial pressures on the families concerned. More than half of the relatives will end up needing some form of psychiatric care with stress and depression being the major symptoms.

The situation in Malta is not different from that described in most developed countries. In a recent study published in the June edition of the Malta Medical Journal, it was reported that the estimated number of individuals with dementia in Malta in 2005 was calculated at 4,072. This trend is expected to double by 2035 (amounting to two per cent of the general population).

Unfortunately, there is no cure available and the anti-dementia medicines prescribed, although useful, only address the symptoms. Since the disease is characterised by massive brain cell death, any process that limits this degeneration will be of benefit. Various protective agents have been described including the use of lipid-lowering drugs, anti-inflammatory agents, vitamin intake, a healthy lifestyle, increase in social network and mental stimulation. Conversely, age, high blood pressure, heart failure, diabetes, high cholesterol levels and alcohol are all regarded as risk factors. Further studies are needed to establish exactly the role of protective and risk factors in dementia. What makes it even harder is that little is known on how the brain works.

All this highlights the importance of scientific research in order to understand the various brain processes that occur in dementia. Although various research projects are currently underway locally, especially on determining factors that lead to the significant brain cell death observed in dementia, financial and infrastructural resources are lacking. This is also a challenge we all must face.

• Dr Scerri is a lecturer at the Department of Pathology and is involved in research on Alzheimer's disease both locally and abroad. He is also general secretary of the Malta Dementia Society.