This week, with reports of GP concerns over support services across the media and Secretary of State for Health Jeremy Hunt speaking at the Alzheimer’s Society’s annual conference on Thursday, dementia is once again at the centre of the healthcare agenda.
As is often the case, it is the numbers that illustrate the scale of the problem caused by dementia in the UK. There are around 800,000 people in the UK with dementia, with someone being diagnosed every 3 minutes. 1 in 3 people over 65 will develop dementia, and two-thirds of people with dementia are women. It is estimated that by 2021, the number of people with dementia in the UK will have increased to around 1 million.
(For a full statistical insight into the impact and scale of dementia in the UK, check out the Alzheimer’s Society’s fantastic infographic here.)
Back in 2012, David Cameron described the state of dementia care as a ‘national crisis’ and pledged that the research budget would be doubled to £66m by 2015. Since then, dementia has had a prominent place within the healthcare concerns of the government and Jeremey Hunt has raised the political profile of dementia on several occasions during his time as Secretary of State for Health. December 2013 saw London host the G8 Dementia Summit, which also committed to increasing the amount of funding for dementia research, while earlier this year, the government published the ‘Prime Minister’s challenge on dementia 2020’, in which David Cameron describes dementia as a ‘personal priority’.
Looking at dementia in terms of the economics, again the numbers are revealing. The total cost of dementia to society in the UK is £26.3 billion, with an average cost of £32,250 per person. In 2010, the annual global cost of dementia was estimated at $604 billion. Yet in the UK, only £90 is spent on research on dementia per sufferer. There are also the intangible, emotional effects to both the patient and their family, which may indeed be more pronounced with dementia than with most other diseases.
Economic cost of medical person per capita per year in the UK courtesy of the Scienceogram (www.sciencogram.org ) - http://scienceogram.org/in-depth/health/
As discussed in an article from The Guardian earlier this year, when compared to cancer or heart disease, the amount spent on dementia ‘bears little relation to their costs to health services’. Whilst the government spending gap between dementia and cancer/heart disease has narrowed over the past few years (government funding for dementia research rose from 9% to 21%), the proportion of funding from charities to these diseases remains unchanged. The figures quoted by The Guardian from a study by a health economics research centre at Oxford University are as follows:
- The health and social care costs for dementia in 2012 came to £11.6bn, more than double the £5bn for cancer, while those for stroke were £2.9bn and CHD £2.5bn.
- It is also suggested that another £12bn (half of the overall costs) is met by unpaid carers.
- The combined government and charitable research spending in 2012 was £856m, with charities contributing nearly £509m. From the combined total, £546m (64%) was devoted to cancer, £165m (21%) to CHD, £85m (10%) to dementia and £58m (7%) to stroke.
- That means for every £10 in health and social care costs attributable to each disease, cancer received £1.09 in research funding, CHD 65p, stroke 20p and dementia 7p.
Comparative health and social costs of dementia, cancer, stroke and CHD, courtesy of BMJ Open - http://bmjopen.bmj.com/content/5/4/e006648.full.pdf
Proportion of economic cost and research spending for dementia, cancer, stroke and CHD, courtesy of https://momoneymoscience.wordpress.com/category/data/
This discrepancy between economic cost and research funding when it comes to dementia is likely to be for a number of reasons. Whilst our understanding of cancer increases, a clear grasp of what exactly is happening on a physiological level during dementia eludes researchers. Furthermore, whilst many novel cancer therapies prove effective year after year, there are still currently no effective long-lasting drug treatments for Alzheimer’s disease. It is also suggested that the public perception is that dementia is simply a part of getting older, rather than a diagnosable condition. Meanwhile, whilst cancer survival rates continue to improve, the number of cases of dementia within an aging population, both within the UK and globally, continues to soar.
It is here that in vitro diagnostics comes in. Whilst blood tests are used to rule out other conditions that can cause similar symptoms, such as thyroid hormones and vitamin B12 levels, dementia diagnosis is generally achieved through brain scanning, using CT or MRI. The problem is that the point at which dementia can be recognized using a brain scan is often a point at which the condition is already quite far advanced. Not only is this unfortunate for the patients themselves, scientists believe it is a major reason for the lack of progress in treatment options - trial patients are simply recruited too late, when their disease is too far advanced.
Over the past few years, however, the emergence of simple blood tests, within a research environment, have raised hopes that early-stage diagnosis of dementia is possible. Last year, a study led by King’s College London identified 10 proteins in the blood that can predict the onset of Alzheimer’s disease, with an accuracy of 87%. Involving the analysis of over 1000 people, this study was the largest of its kind and raised the prospect of being able identify patients in the early stages of memory loss for clinical trials to find drugs to halt the progression of the disease.
This is welcome research on an issue we’ve made a national priority. Developing tests and biomarkers will be important steps forward in the global fight against dementia as we search for a cure.
Jeremy Hunt MP
Last month, a study that had identified a protein that could signal the first signs of dementia 10 years early hit the national headlines, as reported by The Telegraph. The protein, called MAPKAPK5, was found to be significantly lower individuals who go on to develop Mild Cognitive Impairment, which often leads to dementia. This study involved taking samples from 100 sets of twins, removing the impact of age and genetics, and monitored cognitive ability over a 10 year period. Additionally, a Danish study also suggests that a low level of apolipoprotein E in the blood increases the risk of developing dementia in the future.
We urgently need to improve approaches to deliver more timely and accurate diagnosis. Accurate and early diagnosis of Alzheimer’s will be essential for the development of new treatments.
Dr Eric Karran, Director of Research, Alzheimer’s Research UK
The prevailing attitude today is that preventing dementia by identifying symptoms early is likely to be more effective than trying to reverse it. Whilst these studies are at an early research stage, the findings so far are extremely promising and may signal a new dawn in dementia diagnosis offered by in vitro diagnostics.
Check out BIVDA’s #TestingTuesday dementia storify here. For more information about dementia and dementia research, visit the Alzheimer’s Society and Alzheimer’s Research UK websites.
(Thumbnail from http://medcitynews.com/2014/12/can-self-reporting-work-dementia-patients/)