Dementia: The Epidemic of the 21st Century

Dementia is defined as a syndrome characterized by the progressive decline in cognitive functions and involves disturbances in higher nervous activities: memory, thinking, orientation, understanding, calculation, learning ability, verbal expression, and judgment. It is accompanied by a diminished ability to manage emotions, social behavior, and daily activities. As the disease progresses, individuals become increasingly limited in performing everyday tasks and become less independent. Patients with dementia typically live for 7-10 years after the onset of symptoms. Dementia imposes a significant burden on both caregivers and society at large, making it one of the greatest challenges of modern medicine. Despite being labeled as the epidemic of this century, surprisingly little is known about the epidemiology of dementia.

Epidemiology of Dementia

The prevalence of dementia is higher in women than in men and increases exponentially with age, peaking after the age of 60, with the highest rates observed in North Africa and the Middle East. Globally, the prevalence of dementia among individuals over the age of 60 ranges between 5.6% and 7.6%. Among those aged 65-69 years, 0.8% have dementia, while in the 90s, the prevalence rises to 28.5%. Regarding dementia, a new case appears every 3.2 seconds worldwide, meaning nearly 10 million people develop dementia each year. The incidence is lowest in Europe, where it has even slightly decreased in recent years, but the highest in Asia, with 5 million new cases (4.9% of all cases). The highest number of new cases is found in the age group between 80 and 90 years in Europe and North America, between 75 and 84 years in Asia, and between 65 and 74 years in African countries. The number of cases will double every 20 years, reaching over 131 million by 2015. Approximately 68% (over 90 million) of all patients with dementia will reside in developing countries.

Dementia in Younger Individuals

Most epidemiological studies on dementia focus on age as the primary risk factor for the disease, despite the fact that younger individuals under the age of 65 can also develop dementia. Frontotemporal dementia and dementia caused by alcohol abuse are more common among younger people. Although rare, dementia does occur in this age group, making it necessary to include it in the differential diagnosis for younger patients experiencing cognitive decline.

Burden on Family Members, Physicians, and Medical Staff

The early signs of dementia are often difficult to detect and can be hidden, making the correct professional approach even more important. The mindset that memory disorders are a natural part of aging also contributes to the late detection of dementia. Family members of individuals with dementia often seek professional help only when faced with overwhelming problems.

Dementia Patient by Disease Stage

During the mild stage of dementia, one American study showed that 52% of family members fail to recognize memory disorders, and 13% do not recognize more severe forms of the disease. Family members tend to attribute the patient’s memory problems and other issues to normal aging. In the initial period, it is crucial to educate the patient’s close family members about the nature of the disease, potential behavioral complications, and changes at the intellectual and emotional levels, so they are as prepared as possible when these changes become significant. The patient’s family should be encouraged to have all available members share responsibilities. In the second stage, the patient requires significant help, as they can still do many things but may become stuck while performing activities and not know how to proceed. During this period, they are less aware of their own changes at the intellectual and emotional levels, as well as in their behavior. They need a lot of understanding and calm support. This stage is the most challenging for family members. Due to insomnia, the patient may wander and be confused, start making unfounded accusations, and become suspicious. The third stage represents a severe form of dementia, where the patient, due to loss of physical functions, can no longer move as much and requires care. They communicate with their surroundings minimally and slowly withdraw into their own world. Due to their decreased activity, the apparent demand for care may seem less, but the need for care increases. At this stage, family members are aware of the “departure” of the dementia patient, the death of their body.

Role of Family Physicians and Other Healthcare and Social Workers

In the initial stage, the physician must perform necessary diagnostic procedures to identify potentially reversible forms of dementia that can be treated. During this period, it is also important to educate family members about the disease. In the middle stage of developed dementia, the physician must find a balance between the needs of the patient and the care capabilities of the family members. Outpatient nurses assist family members with home care for the patient. Social workers handle necessary procedures related to the functional ability of the dementia patient. In the third stage, the role of the home care nurse becomes even more significant. According to literature, the care of dementia patients is primarily provided by women. However, data from the Alzheimer’s Association indicate a gradual increase in the proportion of men caring for relatives with dementia, which reflects the gradual destigmatization of the disease, changes in social relationships, and represents a step forward.

Financial Burdens for Dementia Patients

In 2015, the costs of dementia treatment amounted to approximately 660 billion euros, but it is predicted that these costs will rise to one trillion euros over the next decade. From 2010 to 2015, the costs of dementia care increased by 35%, with 86% of these costs occurring in developed countries. Although treatment costs have decreased, most of the funds are directed towards care and social programs. Research in some developed countries has shown that a patient with mild dementia costs the state at least 14,500 euros annually. Studies have shown that the care for patients with heart disease, stroke, and cancer together costs less than the treatment and care of dementia patients. It would make sense to spend more on early detection of dementia risks. Developed countries have conducted studies indicating that early disease detection with all necessary screenings and diagnostics at both primary and secondary levels would cost around 6,000 euros. Considering that a dementia patient lives on average 3-9 years after diagnosis and taking into account the annual costs of dementia care, it becomes clear that early detection and prevention would save the state significantly more money in the long run.

Global Strategy for Dementia Control by 2020

In response to the urgent need for equitable access to appropriate care for dementia patients, the desire for increased funding for research in basic sciences and the synthesis of new medications, as well as the introduction of prevention, awareness, and public education programs, the WHO has implemented measures aimed at improving the situation regarding the number of dementia patients. This represents the foundation for a coordinated and integrated approach involving all stakeholders to address the problem of dementia and related conditions. The Strategy for Dementia Management in Slovenia by 2020 summarizes the essential elements and commitments contained in documents adopted at the European and global levels, as well as strategies for managing dementia in other countries. The goal of the strategy is to ensure preventive measures, early disease detection, and appropriate standards of healthcare and social protection for individuals with dementia. It is based on the recognition that people with dementia are a particularly vulnerable target group, rapidly increasing due to demographic changes and an aging population, and that a focus on the individual and their needs requires a coordinated and swift response from the state and a multidisciplinary approach to treatment. The Strategy outlines strategic areas related to treating individuals with dementia, including raising awareness and reducing stigma, early diagnosis and comprehensive treatment of dementia patients, access to dementia treatments and medications, ensuring access to social care services, and providing individual, comprehensive, and palliative care for those with dementia. Unfortunately, the action plan still does not follow the Dementia Control Strategy in Slovenia by 2020, leaving many formal and informal institutions and associations for comprehensive dementia care unconnected, which is detrimental to everyone, particularly dementia patients and their families.

Factors Influencing Dementia Development

By reducing risk factors, promoting a healthy lifestyle, and understanding the condition, the overall prevalence of dementia could potentially decrease slightly. Therefore, this plan encourages investment in research examining normal versus pathological aging and investigating risk factors that are predetermined (genetics, sex) and those associated with hypertension, diabetes, cardiovascular diseases, and other health conditions (vascular, immune factors) or unhealthy lifestyles, with inactivity, obesity, smoking, and alcohol consumption being prominent. Future prevalence of dementia will only be reduced through education, appropriate care, and support, making the development of a suitable national healthcare and social system essential and one of the highest priorities in dementia management strategy. Within regions, there are differences in risk factors for the onset of dementia. In some areas, higher prevalence of dementia among these patients is driven by cancer and cardiovascular diseases, while in others, diabetes, hypertension, and smoking are more prevalent. However, all share the common factor that incidence increases with age, especially after 75 years of age in both sexes. There are already markers on the market that detect neuropathology of dementia in preclinical stages, and markers have also been developed to assess the risk of dementia in patients with cognitive impairment (e.g., florbetapir). The process of bringing such a marker to market is lengthy and expensive, and even after market release, it still faces a long journey before it is applied in standardized diagnostic procedures.

Raising Awareness and Reducing Stigma of the Disease

The initial signs of dementia are often poorly recognized in the public, which leads to people receiving appropriate medical help only in the advanced stages of the disease. The foundations of treating patients include awareness and recognition of the early signs of the disease, timely visits to a family doctor, early diagnosis, treatment, home care for dementia patients and support from social services, monitoring and post-diagnostic support planning, adequately equipped homes for the elderly and care centers, appropriate palliative care, and training for healthcare professionals. Early diagnosis allows for appropriate management and support, helping patients remain at home as long as possible, which is both the most humane and cost-effective option for society.

The ADAM Project

The nationwide ADAM project for early detection of dementia among the older Slovenian population aims to raise awareness among both the general and professional public about the growing issue of dementia and contribute to reducing the stigma associated with the disease. The project involves conducting memory and cognition screening tests that may indicate early stages of dementia and facilitates applied scientific research focused on developing new, accessible, and non-invasive diagnostic methods for dementia using EEG technology. It is conducted under the expert guidance of the Clinical Department of Neurological Diseases at the University Medical Centre in Ljubljana. As part of the ADAM project, around 460 older individuals aged 60 to 90 from six regions in Slovenia have been examined. Volunteers completed various tests, including questionnaires, interviews, and EEG measurements. All research participants received feedback on their current memory status based on established international screening tests for early forms of dementia. The goal is to develop an effective annual preventive screening program for the systematic early detection of Alzheimer’s dementia in Slovenia and to enable the development of new diagnostic methods for the disease using EEG technology.

Natural Dietary Supplement to Prevent Burnout and Improve Concentration and Memory

Scientists, in collaboration with physicians, have developed a natural dietary supplement, MemoMax®, based on active ingredients of natural origin. The patented capsule production process ensures a high absorption rate of the active ingredients, which positively impact mood, memory, and concentration.

MemoMax® is intended for individuals who:

• Have difficulty learning,
• Experience problems with concentration and alertness,
• Feel tired and exhausted during learning,
• Are experiencing the effects of dementia,
• Are fatigued due to stress,
• Have weakened blood circulation.

This article is sourced from Najzdravnik.comhttps://najzdravnik.com/blogs/blog/demenca-epidemija-21-stoletja