The Severity of Senile Dementia: Dementia has been put as a "national strategic issue" by Various Countries

In 1994, the International Alzheimer's Disease Association (Alzheimer's Disease International, ADI) and the World Health Organization jointly designated September 21 as World Alzheimer's Day (World Alzheimer's Day), calling on the world to pay attention to Alzheimer's disease. The World Health Organization pointed out that senile dementia is one of the most critical diseases that endanger the health of the elderly and cause the increase of the disabled elderly population. It is also the most important disease that causes the death of female elderly people, which is higher than the death rate caused by heart disease and stroke. The physical, psychological, social and economic impact it causes is huge, not only for the patients and their families but also for each country and the whole society.

Accompanying the aging of the population is a surge in elderly patients with dementia. The United Kingdom is aware of the seriousness of this problem and set up a national dementia care strategy as early as 2009, and held the "G8 Dementia Summit” in 2013 with 8 countries attending. Japan set up its first National Strategy for Dementia, called Orange Plan (2013-2017) and in 2015, the Japanese Prime Minister led multiple departments to create the "New Orange Plan". This New Orange Plan calls for more professional and non-professional nursing staff to support and help the elderly with dementia and their families in the country so that they can more easily access treatment and care services in nearby communities.

In 2012, the U.S. Department of Health and Human Services (HHS) formulated the "National Alzheimer's Project Act" (NAPA). In order to better meet the needs of millions of Alzheimer's disease and its related dementia patients and their families, NAPA has set five major goals:

1. To achieve the prevention and effective treatment of Alzheimer's disease by 2025;

2. Optimize the quality and efficiency of care;

3. Increase support for patients with Alzheimer's disease and their families;

4. Strengthen public awareness and participation;

5. Track progress and drive improvements

Obviously, judging from the efficacy of drugs currently on the market and the speed of new drug development, the first goal of the US "National Alzheimer's Disease Project Act" is estimated to be difficult to achieve, because 2025 is only 4 years away. There are only 5 drugs that can be used, and the development of new drugs is extremely slow.

What are the causes of Alzheimer's Disease? What are the current treatment Drugs & Methods?

There are many reasons for dementia, mainly due to the damage of brain cells, and there are more reasons for brain cell damage, among which the highest proportion is caused by the decline and pathological changes of brain cells with the increase of age, including Alzheimer's disease, Frontotemporal Lobe dementia, Parkinson’s disease, Dementia with Lewy bodies, Huntington's disease, etc. The second is vascular dementia caused by cerebrovascular diseases, such as cerebral infarction and cerebral hemorrhage. There is also brain damage caused by physical head trauma; intracranial lesions, such as brain tumors, normobaric hydrocephalus, and chronic subdural hematoma. Dementia is also caused by brain cells nutrient deficiency, such as vitamin B1, B12, or folic acid deficiency. Dementia can also be caused by neurological or vascular diseases, poisoning, or genetic factors. Japanese medical society believes that metabolic diseases, autoimmune diseases, respiratory organs, liver and kidney diseases may also be the causes of senile dementia. In addition, people with diabetes and hypertension, hyperlipidemia, and high cholesterol are highly susceptible to dementia. Thus, it can be seen that not only the elderly can suffer from dementia. There are about 37,500 "young patients with dementia" under the age of 65 in Japan, and it is predicted that the number of young patients will increase year by year.

Japan’s Ministry of Health, Labour and Welfare classifies senile dementia into two categories based on whether it can be treated. Those that are difficult to be cured include Alzheimer's disease, frontotemporal lobe dementia, dementia with Lewy bodies, Huntington's disease, and vascular dementia with cerebrovascular diseases. The rest are classified as "potentially curable dementia."

Alzheimer’s disease is the most common type of dementia in the elderly. Although it has been 115 years since it was discovered, its pathology has not been fully explained. At present, the beta-amyloid hypothesis is dominant, that is, the accumulation of a protein called amyloid-beta (beta-amyloid) in the brain is related to the pathological changes of brain nerve cells. This hypothesis is that dementia is caused by the degeneration of brain nerves and part of the brain atrophy.

Based on this hypothesis, it is believed that if a block is developed β Amyloid protein accumulation of safety drugs, Alzheimer's disease will not lead to further brain neuropathy.

If this happens, progress in dementia can be completely stopped. In this sense, early detection and early treatment will become more important in the future. Therefore, most of the new drugs that are being developed focusing on treating patients before the symptoms appear, with the purpose of preventing or delaying the onset and progression of Alzheimer's disease. Aducanumab is a drug developed based on this hypothesis and theory. Although we still need to wait for the results of its fourth phase of clinical trials, the author sincerely hopes that the results of this phase of trials will be positive. After all, this is the only new hope for Alzheimer's patients around the world for nearly 20 years!

However, the question remains what to treat patients with mid- and late-stage dementia? Modern medicine believes that the brain cells and nerve cells that have degenerated and disappeared will not regenerate, and the lost functions are difficult to recover, and dementia is irreversible. Therefore, strictly speaking, none of the five types of drugs currently on the market are drugs that can cure Alzheimer's disease. That is to say, so far, humans have not developed drugs that can "cure" the disease.

At present, Japan mainly uses a combination of drugs and non-drug treatments, and the expected effect is only to reduce symptoms and delay the progression of the disease as much as possible. The drugs used are mainly the 5 drugs approved by the FDA, including Mematine, Donepezil, Galanthamine, and Namzaric, this is a mixture containing memantine hydrochloride and donepezil. Non-drug treatment methods are mainly physical therapy and some educational activities, including arithmetic, handicraft making, gymnastics, group games, and so on. The author will introduce it in detail in a follow-up article.

Although this new FDA drug Aducanumab is not a life-saving drug for Alzheimer’s disease, we still need to wait for scientific verification, but it also shows that medicine has not given up on Alzheimer’s patients. Human beings are still struggling to find drugs that can cure them and cure the "terminally ill.”

The author Yoko Marikawa is an expert in the elderly care industry in Japan and a pioneer in the elderly care industry. She has long been committed to ensuring and improving the well-being of the elderly by improving the management of nursing homes and the quality of elderly care services. In recent years, in order to find effective solutions to the problems of poor medical services for the elderly, elder abuse, the surge of elderly dementia patients, and the shortage of eldercare workers, Yoko Marikawa has devoted a lot of energy in researching how to use high technology to help solve these serious and urgent social issues, including the use of nursing robots, quantitative management and monitoring systems, etc. This article is an article in Yoko Marikawa's newspaper column "Yoko Marikawa Talks about Eldercare".

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