The dementia timebomb

The brain of an Alzheimer's patient (left) shows significant signs of shrinking compared to a normal brain.

Dementia is a gradual decline of how the brain functions. It is incurable, and slowly interferes with a person's ability to carry out the normal tasks of daily living.

What is dementia?

Dementia is an umbrella term used to refer to a collection of symptoms that can result from a number of different diseases of the brain. There are many different types of dementia, but all tend to cause problems with memory, language skills, information processing, mental agility, understanding and judgement.

Dementia can also trigger other mental health problems such as personality changes, anxiety, mood swings and depression. In more advanced dementia, the person may lose the ability to get up and move, or the interest to eat or drink.

How common is dementia?

There are about 800,000 people in the UK formally diagnosed with dementia

Currently only 43% with the condition get a diagnosis

Approximately one in 20 people over the age of 65 have dementia

By the age of 80 about one in six are affected, and one in three people in the UK will have dementia by the time they die

There are over 17,000 people in the UK under the age of 65 who have dementia

(Source: Alzheimer's Society)

It is a progressive condition that gets worse over time and a person with dementia must increasingly rely on carers as it advances. There is currently no cure although there are treatments that can slow the progression of some types of the condition in some cases. Usually, only about one in three people show a positive response to such drugs.

There are around 100 different types of dementia. However Alzheimer's disease is the most common form, affecting 62% of those living with dementia. Many of these people will have a mixed pattern of dementia with the second most common type - vascular dementia - also contributing to their condition. This occurs due to the damage done to the small blood vessels in the brain.

The number of people with dementia is steadily increasing. While around 800,000 people have been diagnosed with the condition in the UK today, the Alzheimer's Society predicts this number will increase to one million by 2021 and 1.7 million by 2051.

Many others remain undiagnosed, especially in the early stages of dementia, so these figures may be much higher. This rise in numbers is attributed to advances in public health and medical care that enables people to live much longer than they used to. While one in 25 people aged 70 to 79 has a form of dementia, this rises to one in six people over the age of 80.

What causes dementia?

Dementia is caused by damage to brain cells, which stops them from communicating effectively with each other. Gradually brain cells die, leading to the shrinkage of the brain typically seen in brain scans in some types of dementia.

In neurodegenerative diseases, such as Alzheimer's, a gradual build-up of proteins inside and around brain cells can be seen. In Alzheimer's, these proteins form tangles, and sticky clumps known as plaques. It used to be thought that these were the cause of the brain dysfunction but more recent theories liken these plaques and tangles to the "ashes after the fire". In other words, they are the residual damage after the disease has swept through the brain.

Less common types of dementia

Dementia with Lewy Bodies sees tiny balls of protein develop inside nerve cells. This causes 10% of dementia cases in older people and is strongly linked with Parkinson's

Fronto-temporal dementia is caused by damage to the frontal lobe of the brain. It is relatively uncommon

Illnesses that may lead to dementia include Creutzfeldt-Jacob disease, multiple sclerosis and Parkinson's

Vascular dementia develops when the arteries supplying blood to the brain become blocked. This disrupts the supply of oxygen and nutrients to the cells, which leads to very small strokes resulting in brain damage.

Many people with dementia have a combination of Alzheimer's disease and vascular dementia.

Scientists are investigating the genetic background to dementia. It does appear that in a few rare cases the diseases that cause dementia can be inherited. Some people with a particular genetic make-up have a higher risk than others of developing dementia. Risk factors include age, smoking, heavy drinking, poor diet, and a lack of exercise.

Why haven't we found a cure?

One of the main obstacles to creating effective treatments to dementia is that scientists still don't fully understand it. The condition appears to result from a complex interaction of genes, lifestyle factors and other environmental influences. Without knowing the exact mechanisms that cause damage, especially in Alzheimer's, it's impossible to target the disease process effectively.

The blood-brain barrier is another problem. It keeps your brain healthy by preventing toxins reaching the brain. But it can also stop treatments getting through or working effectively. Drugs may only partly cross the barrier as they are too large or awkwardly shaped, which means that dangerous doses would be needed for them to work.

Even if drugs were found that could target the proteins causing damage to brain cells in neurodegenerative disease, the damage may already have been done.

Scientists found recently that dementia may start to develop decades before symptoms show.

Finally, dementia is very difficult to diagnose. There is no single test to pinpoint the disease. A diagnosis is made on the clinical judgement of a patient's symptoms, history and results from a variety of tests, many of which are used to rule out other possible causes.

There is also a stigma attached to the condition, as well as fear, that can make some health professionals reluctant to give the diagnosis. Some experts argue that with no effective treatments, early diagnosis has no benefits.

Less than half of those living with dementia in the UK have received a formal diagnosis. This causes problems for drug trials, as scientists can only guess what type of dementia patients have, and can only confirm their diagnosis at post-mortem.

For information about diagnosis and available treatments, go to NHS Choices

SOURCE:

http://www.bbc.co.uk/science/0/21878238 (accessed 28.10.13)

When does your mental health become a problem?

People often experience sadness in response to difficult life events, but when does this become a mental health problem?

One in four people are expected to experience a mental health problem, yet stigma and discrimination are still very common. Myths such as assuming mental illness is somehow down to a 'personal weakness' still exist.

How do we define mental health?

A person who is considered 'mentally healthy' is someone who can cope with the normal stresses of life and carry out the usual activities they need to in order to look after themselves; can realise their potential; and make a contribution to their community. However, your mental health or sense of 'wellbeing' doesn't always stay the same and can change in response to circumstances and stages of life.

Everyone will go through periods when they feel emotions such as stress and grief, but symptoms of mental illnesses last longer than normal and are often not a reaction to daily events. When these symptoms become severe enough to interfere with a person's ability to function, they may be considered to have a significant psychological or mental illness.

Someone with clinical depression, for example, will feel persistent and intense sadness, making them withdrawn and unmotivated. These symptoms usually develop over several weeks or months, although occasionally can come on much more rapidly.

Mental health problems are defined and classified to help experts refer people for the right care and treatment. The symptoms are grouped in two broad categories - neurotic and psychotic.

Neurotic conditions are extreme forms of 'normal' emotional experiences such as depression, anxiety or obsessive compulsive disorder (OCD). Around one person in 10 experiences these mood disorders at any one time. Psychotic symptoms affect around one in 100 and these interfere with a person's perception of reality, impairing their thoughts and judgments. Conditions include schizophrenia and bipolar disorder.

Mental illness is common but fortunately most people recover or learn to live with the problem, especially if diagnosed early.

How common are mental illnesses in the UK?

Anxiety will affect 10% of the population

Bipolar disorder will affect one in 100

One in every 150 15-year-old girls will get anorexia, and one in every 1000 15-year-old boys

20% of people will become depressed at some point in their lives

OCD will affect 2%

Personality disorder will affect one in 10, though for some it won't be severe

Schizophrenia will affect one in 100

Source: Royal College of Psychiatrists

What causes mental illness?

The exact cause of most mental illnesses is not known but a combination of physical, psychological and environmental factors are thought to play a role.

Many mental illnesses such as bipolar disorder can run in families, which suggests a genetic link. Experts believe many mental illnesses are linked to abnormalities in several genes that predispose people to problems, but don't on their own directly cause them. So a person can inherit a susceptibility to a condition but may not go on to develop it.

Psychological risk factors that make a person more vulnerable include suffering, neglect, loss of a parent, or experiencing abuse.

Difficult life events can then trigger a mental illness in a person who is susceptible. These stressors include illness, divorce, death of a loved one, losing a job, substance abuse, social expectations and a dysfunctional family life.

When is someone thought to be mentally ill?

A mental illness can not be 'tested' by checking blood or body fluids. Instead it is diagnosed, usually by an experienced psychiatrist or clinical psychologist, after studying a patient's symptoms and monitoring them over a period of time.

How ICD-10 classifies bipolar affective disorder:

'A disorder characterized by two or more episodes in which the patient's mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression). '

Many different mental illnesses can have overlapping symptoms, so it can be difficult to tell the conditions apart.

To diagnose a mental health condition, psychiatrists in the UK may refer to the World Health Organisation's International Classification of Diseases (ICD) system. This lists known mental health problems and their symptoms under various sub-categories. It is updated around every 15 years.

Some experts argue that the current system relies too strongly on medical approaches for mental health problems. They say it implies the roots of emotional distress are simply in brain abnormalities and underplay the social and psychological causes of distress.

They argue that this leads to a reliance on anti-depressants and anti-psychotic drugs despite known significant side-effects and poor evidence of their effectiveness.

SOURCE:

BBC Science: http://www.bbc.co.uk/science/0/22028518 (accessed 29.06.13)

The Perfect Non-Crime

EVEN if we could make it impossible for people to commit crimes, should we? Or would doing so improperly deprive people of their freedom?

This may sound like a fanciful concern, but it is an increasingly real one. The new federal transportation bill, for example, authorized funding for a program that seeks to prevent the crime of drunken driving not by raising public consciousness or issuing stiffer punishments — but by making the crime practically impossible to commit. The program, the Driver Alcohol Detection System for Safety (Dadss), is developing in-vehicle technology that automatically checks a driver’s blood-alcohol level and, if that level is above the legal limit, prevents the car from starting.

The Dadss program is part of a trend toward what I call the “perfect prevention” of crime: depriving people of the choice to commit an offense in the first place. The federal government’s Intelligent Transportation Systems program, which is creating technology to share data among vehicles and road infrastructure like traffic lights, could make it impossible for a driver to speed or run a red light. And the Digital Millennium Copyright Act of 1998 has already criminalized the development of technologies that can be used to avoid copyright restrictions, making it effectively impossible for most people to illegally share certain copyrighted materials, including video games.

Or consider a more speculative scenario: some pharmaceuticals show the promise of blunting the “high” of cocaine use or reducing antisocial thoughts of the sort that often lead to crime. Widespread dissemination of such drugs — say, putting them in the public water supply — could make some crimes impossible by eliminating a potential offender’s desire to commit them.

Such technologies force us to reconcile two important interests. On one hand is society’s desire for safety and security. On the other hand is the individual’s right to act freely. Conventional crime prevention balances these interests by allowing individuals the freedom to commit crime, but punishing them if they do.

The perfect prevention of crime asks us to consider exactly how far individual freedom extends. Does freedom include a “right” to drive drunk, for instance? It is hard to imagine that it does. But what if the government were to add a drug to the water supply that suppressed antisocial urges and thereby reduced the murder rate? This would seem like an obvious violation of our freedom. We need a clear method of distinguishing such cases.

One way is to keep in mind the distinction between thoughts and actions. A traditional rule in criminal law holds that there can be no crime unless the defendant committed some act: mere thoughts, no matter how horrific, are not sufficient. Thoughts cannot be regulated; everyone has a right to think what they wish without government intrusion.

For most familiar crimes (murder, robbery, rape, arson), the law requires that the actor have some guilty state of mind, whether it is intent, recklessness or negligence. But there is a category of crimes that are forbidden regardless of the actor’s state of mind: so-called strict-liability offenses. One example is the sale of tainted drugs. Another is drunken driving.

In such cases, using technology to prevent the crime entirely would not unduly burden individual freedom; it would simply be effective enforcement of the statute. Because there is no mental state required to be guilty of the offense, the government could require, for instance, that drug manufacturers apply a special tamper-proof coating to all pills, thus making the sale of tainted drugs practically impossible, without intruding on the thoughts of any future seller. By this logic, the Dadss program, too, would be permissible.

But because the government must not intrude on people’s thoughts, perfect prevention is a bad fit for most offenses. Perfect prevention of a crime like murder would require the ability to know what a person was thinking in order to determine whether he possessed the relevant culpable mental state. Even if this could be known, perhaps with the help of some sort of neurological scan, collecting such knowledge would violate an individual’s freedom of thought. Likewise, adding chemicals to the water supply in order to dampen antisocial urges would violate that freedom.

Perfect prevention is a politically attractive approach to crime prevention, and for strict-liability crimes it is permissible and may be good policy if implemented properly. But for most offenses, the threat to individual freedom is too great to justify this approach. This is not because people have a right to commit crimes; they do not. Rather, perfect prevention threatens our right to be free in our thoughts, even when those thoughts turn to crime.

Written by Michael L. Rich (associate professor at Elon University School of Law).

Source: http://www.nytimes.com/2012/08/07/opinion/the-perfect-non-crime.html?_r=2