The future
Alzheimer’s disease, or any other form of dementia, is a personal tragedy for the sufferer and for those who love them and shoulder the burden of caring for them. It is a tragedy that is affecting more and more people.
Not so very long ago, doctors thought of Alzheimer’s disease and other conditions that cause dementia as being quite rare. Today, everyone has heard of dementia and many have had the sad experience of looking after a close relative suffering from it. Why is this? One important reason is that the world’s population is getting older.
THE AGEING POPULATION
At the beginning of the twentieth century, the average life expectancy of a new-born baby in the UK was about 50 years. Thanks to improved living conditions – better housing, better nutrition – and better medical care, an increasing proportion of each succeeding generation has survived into old age. The average life expectancy of a baby born today is now over 77 years. This improvement, together with the fact that people have been having smaller families, means that the population has been growing older. In 1951, only seven per cent of the population was aged 65 and over, but by 2000 this had grown to 18 per cent.
This ageing of the population means, of course, that there are many more cases of diseases that affect elderly people.
The population of the UK, and of almost every other country in the world, will continue to get older until well into the twenty-first century. We can predict that dementia will become an even bigger problem as time goes on. Countries in the developing world, such as Brazil, Kenya and Bangladesh, where populations are young and dementia still a rare condition, will soon be faced with the same problem.
RESEARCH INTO DEMENTIA
If you are looking after someone with dementia, you may feel very lonely. Perhaps it seems as if no one else cares much about what you are going through. This impression is quite wrong. There is a major medical research effort in all the countries of the Western World into discovering the causes of Alzheimer’s disease and the other diseases that lead to dementia. Equally important, scientists are working hard to develop successful treatments for dementia.
Let us look at what has been achieved so far and what we hope will happen in the future. If progress seems slow, you must remember that even 20 years ago dementia wasn’t thought to be a significant medical problem and it was low on the list of priorities for research. We knew very little about the condition then, so researchers had to start almost from scratch.
One of their first tasks was to find out how large the problem was. Epidemiologists – medical researchers who study the patterns of disease in the population – have carried out many surveys in different parts of the world and, as a result, we have a fairly accurate idea of how frequently dementia occurs. This information was crucial in drawing attention to the scale of the problem and how urgent it was to find out more about it. Some of these surveys also provided clues about the causes of some of the diseases that cause dementia. For example, the results of one study carried out in the UK hinted that Alzheimer’s disease was more common in parts of the country where the drinking water contained small amounts of aluminium. Further studies failed, however, to confirm any link between aluminium and Alzheimer’s disease, so this lead turned out to be a red herring.
In the laboratory, enormous strides have been made in understanding the processes that go on inside the nerve cells of the brains of people affected by Alzheimer’s disease. We now know that a protein molecule – called amyloid – whose normal function is to join one cell to its next door neighbour accumulates in abnormally large quantities in the brains of Alzheimer’s sufferers. It appears that the cellular machinery that breaks down this protein when it is no longer needed fails. Over the past few years, scientists have been working to develop a treatment for the disease that uses immunisation to prevent the build-up of amyloid in the brain. This treatment is still in the experimental stage at present.
Biochemists have discovered that levels of a chemical called acetylcholine are very low in some parts of the brains of people who have died from Alzheimer’s disease.
Acetylcholine is one of the chemical messengers in the brain; it allows one nerve cell to communicate with another. This discovery led to research to find a drug that would raise the levels of acetylcholine. It is hoped that replenishing stores of this chemical will partly restore brain function.
Geneticists are also working on the problem of dementia. An important discovery a few years ago was that in a small number of cases Alzheimer’s disease is caused by a defective gene. If geneticists can now find out what the normal gene does, we may gain a better understanding of what goes wrong in the disease.
THE OUTLOOK
We don’t yet know which of these lines of research will prove to be fruitful and which will turn out to be a blind alley. We can’t predict where the next advance will come from, and it is important that investigation continues on a broad front. Finding out the causes of dementia and understanding what goes wrong inside the nerve cells of the brain is a very difficult task. Progress is slow and, if you are looking after someone with dementia, we must warn you that advances will probably come too late to help you personally.
Some people who know or look after a person with dementia decide to join one of the voluntary organisations mentioned earlier.
These charities offer help and advice to sufferers and their families, and some also provide funding for scientists who are investigating the causes of dementia and trying to develop treatments. Individuals can help in a number of ways, whether taking part in fund-raising activities or volunteering to help with home sitting services, transport schemes or support groups. By getting involved in this sort of activity, people often feel that they have a chance to do something positive. It is one way in which good can come out of the tragedy that is dementia.
