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Dementia has challenged scientists, policy-makers, economists and society with a number of
questions which remains unanswered even now. These unanswered questions have lead to
steady rise in treatment costs. Government has a strategy to provide care to all the affected
patients of dementia but have no strategy to deal with rise in demand for treatment and cost of
treatment.

Statistics show that in 2010 there are 821,884 people who are afflicted with dementia in UK
and it is expected to cost economy an exorbitant amount of £23 billion. 1.3 % of the UK
population is suffering from dementia but it indirectly affects 42% of the population who live
with these affected people provides them care and support, so social impact of dementia on
society cannot be computed.



Dementia, prevalence, incidence.




 

 


 

Dementia is a continuously escalating disease and is irreversible and causes an overall

deterioration of mental abilities due to loss of brain cells.

People with dementia appears normal and exhibit characteristics of a normal person but with
disease progressing they exhibit severe impairment in cognitive abilities like memory
impairment, aphasia, apraxia, agnosia, aggression, sleep disturbances, affected problem solving
abilities, as a result a patient suffering from dementia cannot carry out normal activities &
relationships (About.com,2009).V

Symptoms of dementia besides above mentioned are severely affected judgment and reasoning
abilities with loss of consciousness (wrong diagnosis, 2010).

Often symptoms of other mental illness like psychosis and depression are similar to dementia
symptom called as delirium are confused with dementia but clinically dementia is established
only when symptoms exists for more than 6 months (NHS choice, 2009).

Dementia could be differentiated into 2 major types-

1.V Static- which is caused by injury in head

 2.V Progressive- which is due to steady long period degradation in mental skills caused by an
damage or any diseased condition

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Alzheimer͛s disease, Dementia with Lewy bodies (DLB), frontotemporal dementia, vascular
dementia and mixed dementias (medicine net.com,2009).

Disease conditions that can cause dementia are-

Dementia in Parkinson͛s disease, HIV associated dementia, Dementia Pugilistica, Corticobasal
degeneration (CBD), Creutzfeldt-Jakob Disease (CJD), Niemann-Pick disease, Batten diseas,
Lafora body disease and Huntington's disease is a hereditary disease which causes dementia
(medicine net.com, 2009).


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Occipital lobes, parietal lobes, frontal lobes, cerebellum and other movement controlling areas
(Fernandez et al.2010)

   


 


It is the biggest risk factor for dementia. As the risk of getting dementia increases with age
so elderly people are more at risk but that does not mean that it cannot affect young people as
Niemann-Pick disease, Batten disease, Lafora body disease can affect children and in UK alone
there are more than 15,000 people below the age of 65 who are suffering wit dementia
(medicine net.com, 2009) .


 scientists have recently discovered numerous genes are involved in the development
of dementia presence of these genes in a person significantly increases his chances of getting
dementia (medicine net.com, 2009).

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researchers have revealed that smokers suffer from progressive
degradation of mental abilities and risk of getting dementia increases significantly. Also chronic
use of alcohol increases the risk of getting dementia (medicine net.com, 2009).



  causes plaque formation thereby hardening and narrowing of major arteries, it
obstructs the blood supply to various parts of brain and can cause stroke (medicine net.com,
2009).
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elevated levels of low density lipoprotein significantly increases the risk of angina,
heart attack and stroke and hence increased risk of developing vascular dementia (medicine
net.com, 2009).

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it is observed that in there is a link between plasma homocysteine levels and
getting vascular dementia or Alzheimer͛s and people who are at risk have elevated levels of this
amino acid (medicine net.com, 2009).

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people with moderately affected mental abilities are at risk of their
condition progressing to severe dementia. These people are at a high risk than rest population
but it is mandatory that these people will surely develop dementia (medicine net.com, 2009).

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studies have revealed that many of the Down syndrome patients evolve
typical neurofibrillary tangles and plaques of Alzheimer͛s disease (medicine net.com, 2009).

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of a disease could be defined as ͞the total cases of the disease in the population at
a given time divided by the number of individuals in the population͟. It gives a projection of
how commonly the disease is occurring in the society (Ferri et al, 2005).




of a disease could be defined as͞the risk of developing new condition within a
specified period of time͟. It is represented as proportion or rate (Ferri et al, 2005).

Until 2008 more than 30 million have been affected with dementia worldwide and it is
projected that by 2050 patients of dementia will cross 100 million mark. In UK, almost 1.3% of
the total population which amounts to 821,884 people is suffering from dementia. By 2051 it
projected that UK will have 1,735,087 dementia patients (Ferri et al, 2005).

Important fact is that 50% of the dementia cases in Caucasian society are Alzheimer͛s disease
showing high prevalence of the dementia in western world.

Until early 21st century it was believed that dementia is a disease that affects older people
above 65 years of age but in UK alone 15,034 people with dementia have been reported who
are below 65 years of age and this group includes children as well (Fernandez et al, 2010).

Below in table 1 it is depicted that currently in 2010 age group 80-84 have highest number of
patients but as the society will modernize patients in age group 8084 will increase along with
other groups such 85-89 and 90-94 years age group. Hence in this table impact of lifestyle is
clearly shown (refer table 1).
 
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In table 2 different age groups and prevalence rates of dementia in males and females have
been shown below. We can see that in Europe prevalence rates in males and females were very
low and similar till age group 55-59 years, while prevalence rates in UK showed mixed trends in
males and females. But as the age increases in Europe and UK males show lesser prevalence
rates than females. So unknown factor not mentioned in the study increases the prevalence
rates in females (refer table 2).
 
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In table 3 number of people affected with dementia in UK have been shown and we can see the
highest number of dementia patients are in England contributing significantly to the total
number of dementia patients in UK (refer table 3).
 900,000

800,000

700,000

600,000

500,000

400,000
Series 1
300,000

200,000

100,000

0
England (2005) Scotland Wales (2005) Northern UK (2010)
(2010) Island (2010)

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Table 4 shows number of patients affected with dementia in developing countries and it
indicates that impact of genetics and lifestyle of patients on dementia.

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In Table 5 below risk of developing dementia has been projected and we can see that risk of
getting dementia till 40-44 years is 1in 10,000 but as the age increase to 60-64 chances of
getting dementia increases to 1 in 1000 and in age group 85-89 risk of dementia increases to 1
in 10.





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National institute of health and clinical excellence (NICE) recommends two kinds of treatment
for dementia.

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2
  

 consists of special ordered exercises carried out by carers.
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   involves a memory-stimulating, problem-solving and interactive
sessions carried out by carers (NHS choice,2009).

 
 therapy aims to restore the person with his senses and makes him
aware of this going on around him (NHS choice,2009).
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music, sounds, massage cushions and sensations to stimulate the brain (NHS
choice,2009).

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 Although medical treatment is not very successful but the therapy is aimed at
preventing the progression of disease but cannot recover the damage done.


  


     blocks the degradation of acetylycholine e.g donepezil

   
 are used to treat the symptoms of dementia like depression,
dizziness etc (NHS choice,2009).

 
 e.g. memantine(NHS choice,2009). 

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Studies have unfolded the mystery of dementia and factors that can influence the development
of dementia. Researchers have suggested that people with blood glucose level under control
are low at risk to dementia (medicine net.com,2009)

Studies also have revealed that people who exercise intellect stimulating activities, such as
social communications with other people, chess, and crossword puzzles and playing a musical
instrument are at a lower risk of developing dementia (medicine net.com,2009).

Other factors that can influence development of dementia development are plasma
homocysteine concentration, lowering cholesterol levels, lowering blood pressure, exercise and
controlling inflammation (medicine net.com,2009).

 
 
 


 

Worldwide treatment cost of dementia varies from country to country and also depends upon
the types of medicines available. Overall estimated cost of dementia in 2007 was US$315.4
Billion, which includes medicines cost and care cost (Alzheimer͛s disease international, 2009).

The mean life long treatment and care cost for dementia is $174,000(Alzheimer͛s disease
international, 2009).

Dementia treatment costs in some of the South-east Asian countries are given bellow:

Singapore US$391 million Indonesia US$2,128 million

Malaysia US$511 million Myanmar US$118 million
Philippines US$601 million Thailand US$1,330 million
Viet Nam US$751 million

The worldwide drug market for dementia is estimated to be US30+)42  (major pharma
markets like U S, UK, and Japan accounts for US$ 5.5 Billion of the worldwide sales) (Alzheimer͛s
disease international, 2009).
 The latest drug approved
for treatment of
dementia is Aricept
(donezpil) which alone
occupies a market of $2.5
Billion (refer table 6).

Table 6. showing worldwide

sales of dementia drugs

©  

 5

The cumulative cost of treating late onset dementia in UK is estimated to be mean value of
£27,647 per person. To treat 1.3% of the dementia affected population of UK, it costs NHS
annually over £23 Billion. Sum of £23 billion comprises of income lost by people providing them
care, who have to leave their jobs or have to reduce working hours. Reduction in income affects
economy indirectly by reduction in the amount of taxes paid to the Exchequer. In 2007
Exchequer lost £123 million pounds in terms of taxes and due to reduction in working hours £
690 pounds were lost. In 2002, in Scotland a law (Receipt of Attendance Allowance) was passes
which entitled dementia patients free care which added an additional burden of £919 pounds
on the economy(Fernandez  , 2010).

It is projected that by 2026, treatment cost of dementia will increase by 45 % to £34.6 billion.
This increase in the cost is attributed to increase in the service cost which will add an additional
£9 billion. This cost is expected to increase further due to increase in the pay and inflation each
year and it could add a maximum amount of £47.5 billion (Fernandez  , 2010).

All these factors have a huge economic impact on the treatment of mental health.
 
Table 6.showing the cost associated with prevalent diseases adapted from (î
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Figure 1. showing the cost associated with different services for dementia adapted from (î
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Table 7 below shows the comparative cost between dementia and other prevalent diseases like
cancer, heart disease and stroke. It is clearly evident from the statistics that cost of treatment
of cancer per year per patient is £5,999 and that of heart disease is £3,455 while the mean
salary in UK is £24,700 and as already mentioned cost of treatment on dementia is £27,647.

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Table 7. showing the annual cost of treating one dementia patient adapted from (î
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As no such medicine is available till now which can cure or reverse the effects of dementia
treatment is aimed at preventing further progression of the disease by symptomatic drugs and
behavioral & psychological exercises.

NICE recommends psychological and behavioral therapy as the first line treatment for
dementia. Acetylcholinesterase inhibitors has been recommended by NICE treatment for
moderate dementia. Early detection and prevention of further progression of disease will not
only benefit the patient but will also reduce the utilization of services which could be provided
to other needy people and can save cost (NHS choice , 2009).

For treating
people with
For mild moderately
dementia, e severe-to-
stimates severe
were from dementia
using
Acetylcholinesterase £56,000 to memantine
inhibitors (AChIs) cost £72,000 was estimated
associated for 1 QALY QALY. as £70,000 to
was £23,000 to £90,000
£35,000, depending
on the choice of drug.
Aricept costs £2.50 a
day 
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Recently in a study conducted has revealed that long time exposure of NSAID͛s can lower the
risk of vascular dementia by controlling stroke and can also control inflammation reducing
chances of Alzheimer͛s disease(Fernandez  , 2010).

In table 8 shown below are various neurological diseases and potential savings that could be
achieved by introducing an effective intervention and statistics show that maximum saving
could be achieved by an effective intervention.
 
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