Everyone has their scatty days, but what happens when occasionally misplacing car keys turns into forgetting how to carry out simple daily tasks? Lisa Fell reports
Alzheimer's disease is the most common form of dementia. It is a progressive disease affecting the brain. Gradually, over time, symptoms become more severe causing an inability to perform everyday activities. The disease has three stages: mild, moderate and severe. The early stages of the condition may begin with minor memory loss and problems saying the right words. As the disease progresses, symptoms include confusion, mood swings, frustration and general withdrawal. How long this would take varies depending on the individual.
There is no cure for Alzheimer's, however, there is drug treatment that can slow down the progress. Alzheimer's disease attacks the nerve and brain cells causing clumps of protein to form around the cells. The brain shrinks allowing gaps to develop in the temporal lobe and hippocampus. These areas of the brain are responsible for storing and retrieving new information and the ability to remember, speak, think and make decisions.
The cause of Alzheimer's remains unknown, however, factors such as age, genetic inheritance, environmental factors, diet and overall health are thought to be responsible.
The risk of developing Alzheimer's disease increases with age but this does not mean everyone will get it. By age 85, about 35 out of 100 people will have some form of dementia, however, it is not just older people at risk.
Most people with Alzheimer's do not have a history of the disease in their families. Saying that, a family history of the disease increases the risk of other family members developing it. When Alzheimer's disease is inherited, symptoms may start relatively early between the ages of 35 and 60.
People with Down's syndrome have a higher risk of developing the condition due to high levels of protein in their brains.
Damage from a head injury can potentially cause dementia and may increase the risk of Alzheimer's disease later in life. Research has shown people who smoke and those who have high blood pressure or cholesterol levels also increase their risk.
Tell Tale signs
Detecting Alzheimer's disease at its earliest stages remains an ongoing challenge as there is no basic test. A person with symptoms may be referred to a specialist to help with diagnosis. Their memory would be assessed and their blood checked to rule out any other causes such as a vitamin deficiency, thyroid problems, depression, side affects of drugs and brain tumours. A brain scan may be carried out to detect changes in the brain.
Although there is no current cure available for Alzheimer's disease, certain interventions and medication can help treat the symptoms.
People with Alzheimer's have been shown to have a shortage of the chemical acetylcholine in their brains. The drugs Aricept, Exelon and Reminyl may be prescribed to treat early stages of Alzheimer's disease and work by maintaining existing supplies of acetylcholine.
A drug called Ebixa was launched in the UK in 2002. This drug works in a different way to the other three. Ebixa is the only drug suitable for use in people in the later stages of dementia.
Although there is currently no way of preventing Alzheimer's disease, researchers believe exercise, a healthy diet, not smoking, avoiding too much alcohol and taking steps to keep an active mind may help delay its onset.
Vital stats
Alzheimer's disease affects 24 million people worldwide and around 450,000 people in the UK.
Dementia in general affects over 750,000 people and approximately 18,500 sufferers are under the age of 65. It affects one person in 20 over the age of 65 and one person in five over the age of 80. Alzheimer's disease is the most common form of dementia, making up 60% of all cases. The proportion of people with dementia doubles for every five-year age group. One third of people over 95 have the disease and 60,000 deaths a year are directly attributable to dementia. Worldwide, there is a new case every seven seconds.
The financial cost of dementia to the UK is over £17bn a year. As the population ages, the need for treatment and prevention increases. If the disease's age of onset could be delayed by five years, the incidence would decrease by up to 50%. Family carers of people with dementia save the UK over £6bn a year. One third of sufferers live in care homes while two thirds live in the community.
For each Alzheimer's patient, only £11 is spent on UK research compared with £289 for cancer patients.
Public spending
Just 2% of government funding through the Medical Research Council was spent on dementia research in 2003-4, despite the number of UK sufferers being forecasted to double within a generation. Of the £32m spent on mental health research by the Medical Research Council in 2003-04, £7.2m funded studies looking at dementia research. Over the last seven years government research has halved. With an ageing and increasingly overweight population, the incidence of diabetes, arthritis and osteoporosis is likely to increase and the prevalence of Alzheimer's disease is expected to almost double over the next 25 years unless a treatment breakthrough is discovered.
- Lisa Fell is life and disability underwriter at Aegon Scottish Equitable
Sources: www.alzheimers.org.uk; www.nhsdirect.nhs.uk; www.alzheimers-research.org.uk; www.swissre
UNDERWRITING IMPLICATIONS
The prognosis for Alzheimer's is poor as the disease continues to progress rapidly. Applications for life, critical illness and total permanent disability benefit are normally declined.
When assessing family history, underwriters have to look at hereditary risk and at whether the applicant has any early signs of the disease as well as any other factors that may increase the chance of developing the condition.
A family history of Alzheimer's disease in one or more first-degree relatives occurring before the age of 60 would incur a small rating. If applicants are over 60 years old have no symptoms, standard terms could be offered.
Although costly, many insurers may need to seek information from the client's general practitioner at the time of underwriting.
Several genes associated with the condition have been discovered recently and genetic tests for predicting and diagnosing the disease are already available. The Genetics and Insurance Committee maintains the presence of an Alzheimer's gene would not be a basis for underwriting insurance premiums.
