Dementia has been described as the long goodbye. Those who have family and friends suffering from it will totally identify with this description.
Dementia is the disease most of us fear over all others: the loss of control, the loss of what is happening to us. I remember being told by a close relative: “If I get dementia, please get rid of me.” Easy to say, I am sure we would all feel like passing that sentiment onto close relatives, but it is clearly not workable.
Around 24 million people worldwide are currently diagnosed with dementia, including 750,000 in the UK, with these numbers expected to double in the next 20 years.
Once diagnosed, the prognosis is grim; dementia, in all its forms, is progressive and incurable. However, obtaining the correct initial diagnosis can be hit-and-miss, especially in the early stages when doctors can get it wrong.
Alternatively, some people will remain in denial and refuse to be seen by a doctor to obtain a specific diagnosis; they don’t want to hear what they know in their hearts.
In a study of 2,000 people, the proportion of those diagnosed with dementia ranged from 3.1 per cent to 29.1 per cent, depending on the criteria used by the doctor. When all six agreed measures were employed, just 20 people, or one per cent, had been correctly diagnosed. This suggests that dementia is dramatically over-diagnosed in the early stages (N. Engl. J. Med., 1997).
Although dementia is “one of the greatest challenges society faces today”, according to Sir Ian Carruthers, a senior manager with the UK’s NHS, treatment is almost exclusively restricted to pharmaceutical drugs.
At best, they only work for a short time, if at all, and usually only while the disease’s symptoms are mild. Antipsychotics kill around 1,800 patients every year, and only around 20 per cent of those who take them benefit.
This concentration on a failing drug therapy is blocking the adoption of a range of alternative therapies that show more promise than drugs, say leading health advisers.
While promise is shown, there is a case for more research on a wider selection of therapies, which is not going to happen while there is the dependency on the failing drug therapy.
Around 60 per cent of elderly residents in care homes across Europe have dementia and many of them are given a powerful antipsychotic drug as a ‘chemical cosh’ to make them docile. As such, the drugs are for the benefit of the carers and not for the patient.
In a report by Sube Banerjee (Time for Action: The Use of Antipsychotic Medication for People with Dementia), he estimates that around 180,000 people with dementia in the UK are given an antipsychotic, killing 1,800 patients, causing permanent brain and heart damage in a further 1,620 patients.
“There is an unambiguous case for a substantial reduction in the use of antipsychotics alongside the wider adoption of alternative interventions, which we know can help to maximise the quality of life for people with dementia and their carers,” said Prof. Banerjee.
There is a wide range of non-drug alternatives which appear to work better, although evidence is often based on a small number of patients. Unfortunately, any non-drug approach does not attract the funding to carry out large-scale research that is attracted by pharmaceutical drugs.
A selection of these alternatives are detailed with a brief description; there are more available.
Music therapy: Thirty-three studies found that this kind of therapy was extremely effective both for patients and carers. Hand massage, touch therapy and physical exercise were also beneficial (Int. Geriatr. Psychiatry, 2010).
Acupuncture: Electro-acupuncture especially appears to have a positive effect on the brain processes associated with dementia.
Snoezelen: This multisensory therapy stimulates sight, hearing, touch, taste and smell by using lighting effects, tactile surfaces, meditative music and essential oils. It began as an aid to overcome learning disabilities, but has recently been used to treat dementia.
Researchers have found it difficult to produce a definitive view of its effectiveness, as practitioners sometimes use only parts of the entire system. However, two studies have shown that it helps to improve many of the behavioural problems associated with dementia, including apathy, restlessness, disturbed behaviour and repetitive actions (Cochrane Database Syst. Rev., 2002).
Ginkgo biloba: This herb is a mainstay of traditional Chinese medicine for the treatment of memory loss, confusion and anxiety. It has been well researched, and while some studies found benefits no better than a placebo, one study produced significant benefits for dementia patients in whom cognition, mood and depression were all improved (Cochrane Database Syst. Rev., 2009).
B vitamins: B1, B3 and B12 are vital for healthy cognitive functioning. Nutritionist Melvyn Werbach says dementia is a classic case of niacin deficiency, and he has successfully reversed some cases of dementia when niacin levels were normalised.
Similarly, B1-dependent enzymes, essential for brain func-tioning, are often impaired in Alzheimer’s patients; small but significant improvements in brain functioning have been witnessed in Alzheimer’s patients who were given just three grams of B1 daily (J. Geriatr. Psychiatry Neurol., 1993).
kathryn@maltanet.net