What is the disease from which 30 million people suffer worldwide, and will increase to 130 million by 2050? In Britain, the number of sufferers will be around two million. No one fully understands the details of this disease, and there is no cure. It is an immensely costly disease for the state, and for the families of sufferers. In one case known to me, the out-of-pocket costs to the family were £300,000. Despite the lack of knowledge and the immense cost, research into alleviation is substantially underfunded compared with cancer and heart conditions. And, by the way, one in six of those over 80 will get it. That means you, unless you cheat by dying earlier.
I am referring to dementia, and in particular, Alzheimer’s. But it doesn’t really matter, does it? These are ancient people who have had their lives and are now reduced to gibbering idiocy through living too long. Once we have shuffled them into a care home all we need do is make an occasional visit (they probably won’t recognise us) and hope that they snuff it before their life savings run out. I am being harsh, but how long ago did you badger your MP to fight for the funding of more research, and an alleviation of crippling costs?
I am not qualified to write technically, but in elementary terms there is, in Alzheimer’s, a protein called amyloid-β which clumps together to form sticky plaques in the brain. There is also tau, a protein which causes tangles in the brain. The result is neuroinflammation and disaster. Even mild dementia can kill brain cells. They will never be restored. You will get some idea of the clinical difficulties when you learn that more than 200 clinical trials for Alzheimer’s therapies have been binned because the treatments proved ineffective. And no existing treatment addresses the underlying disease process.
Another area of research is to find ways of staving off the start of Alzheimer’s. Even pushing back its onset for a few years would be of great benefit to the individual and a substantial saving in the necessary care which both the state and the individual contribute. Studies based on drug treatment before the problems start are in action but, as I write, there are no conclusive results, either of efficacy or alleviation – and there may not be. The latest (and large) study failed in its final trials.
Although Alzheimer’s can, in exceptional cases, start as early as the 40s, many readers will see its onset only as a remote threat. But they may well have older relatives who are vulnerable. Until a cure or substantial alleviation has been found, the prospect is not inviting. But the first step is to have adequate powers of attorney: sufferers can no longer make their own decisions. Then the costs of nursing care must be considered – and they are considerable.
Anyone who has assets, including the value of their house, which exceed £23,250 must pay for their care. The average cost of care homes with nursing varies from £631 per week in the North East to £920 per week in the South East. Multiply by 52 and you’ll know how many years your relative will dare to survive. Take charitable consolation from the possibility that part of those fees may be being used to subsidise the low fees paid by local councils for the indigent patient in the next bed.
Oh wait, I must have got that wrong. The last Conservative manifesto undertook to cap care home fees to a total of £72,000. But once they had our votes they postponed its introduction until 2020. And what’s the betting on it appearing at that date, even allowing for our rocky financial future? More fool us for failing to be cynical.
There is a little light on the horizon. There is a correlation between mental activity and the likelihood of dementia. This emerged from a remarkable study in which the post-mortem brains of nuns were compared with their detailed biographies – testing the theory that brain performance is improved following demanding mental exercise. It seems that challenging the brain creates other routes for rational processes. In one dramatic example a nun preserved her mental capacity until death, even though her brain was fully invaded by the plaques and tangles of Alzheimer’s.
So one approach to delaying dementia is to undertake new activities which challenge us to develop further mental skills. It might be learning a new language, mastering a demanding craft or undertaking voluntary work which requires thought and initiative. These are worthwhile in themselves, but if they do lead to fending off Alzheimer’s, we should be grateful indeed. And there is no time to lose. The nuns who fared best were those who showed challenging and intellectual vigour from their childhood.