The first ever National Audit of Dementia found a “shocking” lack of care delivery.It found that care was often delivered in an impersonal manner, staff ignored patients’ requests for help and staff were not trained sufficiently in the care of dementia patients despite figures showing one in four hospital beds is occupied by people with the condition.

Data from 210 hospitals in England and Wales was used in the report along with ward level data from a sample of 145 wards, over 2,000 staff questionnaires and observations of care on the wards.

Professor Peter Crome, the co-author of the report and Chairman of the National Audit of Dementia Steering Group, said that the report had “found problems across practically every aspect of care for patients admitted to hospitals with dementia.”

He added: “There were deficiencies in the assessment of people and there were deficiencies in the interaction betweem staff and patients.”

Hannah Clack from the Alzheimer’s Society called the report “shocking” and stressed the need for “a huge and radical shake-up of the way the NHS deals with people with dementia.”

She added: “People are going into hospital and they’re coming out worse in terms of their dementia and in terms of their physical health.”

The report recommended that all staff should have basic training in dementia, and that all hospitals should have Dementia Champions on every ward.

Middle aged people who are overweight but not obese, are 71% more likely to develop dementia than those with a normal weight, according to research.
Previous studies have also indicated a link between obesity and dementia.

But a study 8,534 of Swedish twins, in the journal Neurology, suggests just being overweight is also a risk factor.

About one out of every 20 people above the age of the 65 has dementia. The Alzheimer’s Society said a healthy lifestyle could reduce the risk.

Those with a body mass index (BMI) – which measures weight relative to height – greater than 30, who are classified as obese, were 288% more likely to develop dementia than those with a BMI between 20 and 25, according to the study.

The clinically overweight, who have a BMI between 25 and 30, were 71% more likely.

Alzheimer’s Society head of research, Dr Susanne Sorensen, said: “This robust study adds to the large body of evidence which suggests that if you pile on the pounds in middle age, your chances of developing dementia later in life are also increased.

“By eating healthily and exercising regularly, you can lessen your risk of developing dementia.”

Alzheimer’s Research UK head of research, Dr Simon Ridley, said: “This study adds to existing evidence that excess weight in middle age could increase our risk of developing dementia.

“It’s likely that dementia is caused by a complex mix of genetic, environmental and lifestyle factors. However, we still need to know much more about the causes of dementia if we are to find an effective treatment that is so desperately needed.”

From: http://www.bbc.co.uk/news/health-13213755

Everyone aged over 45 should consider a small daily dose of aspirin to help protect themselves against heart disease and cancer, a panel of experts have suggested.Evidence is building that the benefits of taking aspirin for many healthy middle aged and older people “far outweigh” the side effects, according to the academics.

In particular, individuals at higher risk from the country’s two biggest killers would be helped by taking the painkiller as a preventive medicine, they added.

The experts were speaking at the Royal Society of Medicine a month after research from Oxford University published in The Lancet showed that taking 75mg of aspirin daily for five years reduces the risk of getting bowel cancer by a quarter, and deaths from the disease by a third.

A 75mg dose is a quarter of the standard over the counter pill.

Earlier studies had already shown that a low daily dose could reduce the risk of developing heart disease.

Members of the panel said that the recent research was potentially of “enormous importance” to public health.

Bowel, or colorectal, cancer is the third most common form of the disease in Britain, with 39,000 diagnoses annually and 16,000 deaths.

The Lancet study suggests greater aspirin use could potentially save thousands of lives a year in relation to this one cancer alone.

But research is also looking into whether aspirin could have a preventive effect on other types of cancer as well.

Combined, all cancers claim more than 150,000 lives in Britain every year, while cardiovascular disease accounts for some 200,000 deaths.

Prof Peter Rothwell, the Oxford neurologist who led the bowel cancer study and was part of yesterday’s panel, has started taking a daily dose of aspirin himself. He said: “I suspect that in five to 10 years’ time we will be prescribing aspirin to middle-aged people, not only for the known vascular benefits.”

But members of the public might take matters into their own hands before then, he predicted.

“If it becomes clear that there are benefits for other cancers, then the balance of risk and benefit will become so clear that people may take the decision to take it for themselves,” he said. “It seems implausible that this effect on colorectal cancer is going to be a completely isolated phenomenon in relation to other cancers, given that we know that there are similarities between how cancers develop.”

Prof Rothwell said that he thought it would be “sensible” for people to start taking aspirin at about 45, when the chance of developing bowel and other cancers began to rise. “The risk of cancer goes up substantially between the age of 40 and 55,” he said.

As aspirin had a preventive effect, it was advisable to start taking it daily towards the beginning of that period, he explained. However, he said it was ultimately up to individuals to decide whether to take the drug, “rather than us making definitive statements”.

Prof Peter Elwood, of Cardiff University’s School of Medicine, who conducted the first trial into the effect of aspirin on heart disease in the 1970s, said: “I think we are on the brink of another breakthrough of enormous importance to the community in general.”

Prof Gordon McVie, a leading cancer specialist, from the European Institute of Oncology, said the discussion among the experts was whether this was metaphorically a “put-it-in-the-water moment”.

Opinion on the subject varies however. Experts are divided particularly over the question of to whom aspirin should be recommended as a daily preventive medicine.

The drug was formulated as a painkiller more than a century ago but researchers are finding that it can help in diseases ranging from heart disease to dementia.

Advocates believe that its active ingredient is akin to a vitamin that almost everybody should take, as our modern diet does not provide it. Others point out that taking the drug is known to double the incidence of intestinal bleeding, from about one in 1,000 people per year to about two.

The question is how much of the population – in terms of their age and their risk of developing serious diseases – should be recommended to take aspirin on a daily basis.

Prof McVie said: “I think there’s a frankly conservative feeling in this group, that for [colorectal] cancer, it should be targeted for people at higher risk.”

Prof Sir John Burn, a geneticist at Newcastle University, said: “The problem is, if we recommend something to the whole population, then we will see side effects.

“We know aspirin can cause gastrointestinal bleeding. That is to some extent holding back the situation.” Prof Dion Morton, a colorectal surgeon at University Hospital Birmingham, was another of those attending yesterday’s meeting, which was convened by the Aspirin Foundation.

He said that medicine was increasingly using a “stratified approach, where we target the right drugs at the right patients”.

He thought regulatory approval should be sought for doctors to prescribe aspirin as a preventive medicine for those at a higher risk of bowel cancer. “If they have not been told in writing they should be advocating it, they won’t advocate it,” Prof Morton said.

While intestinal bleeding was serious, research suggested that aspirin increased the risk only of less serious cases, said Prof Elwood. He said there was some evidence that the intestines adjusted to aspirin over the long term.

From: http://www.telegraph.co.uk/Daily-aspirin-dose-for-everyone-over-45-to-protect-from-cancer-heart-disease

Hundreds of thousands of patients in the early stages of Alzheimer’s disease could get drug treatments following a U turn by the killer quango NICE.
Having banned the use of Alzheimers drugs for several years the National Institute for Curbing Expenditure (NICE), now says the evidence backs the use of drugs for “mild” symptoms.

Current rules prevent NHS doctors prescribing donepezil, galantamine and rivastigmine in such early cases.

Campaigners said the release of the new draft guidance was a “momentous day”.

As many as 465,000 people in the UK have Alzheimer’s disease, and this is expected to rise as the population ages.

The availability of drugs for the condition on the NHS has been source of controversy for almost a decade.

While there has always been evidence they diminished the symptoms and boosted quality of life for some, it has not always been clear exactly how much improvement they could deliver, to which groups of patients, and for how long.

In 2005, killer quango drugs watchdog NICE ruled that no-one should get the drugs on the NHS, then conceded a year later that patients with “moderate” disease should receive them, while still ruling out “mild” patients.

The secret formula used by NICE to calculate how much “value for money” the drugs offer to the NHS was then the subject of a court action by the Alzheimer’s Society and pharmaceutical companies.

* 2005 Draft NICE guidance recommends no patients should receive Aricept (donepezil), Reminyl (galantamine) or Exelon (rivastigmine)
* May 2006 Final guidance says those with moderate Alzheimer’s are eligible, but not those with mild disease
* October 2006 Internal NICE panel rejects appeals over decision to exclude “mild” patients
* June 2007 High Court backs NICE decision following Judicial Review
* May 2008 Court of Appeal rules NICE should make public their “economic model” which calculates the financial benefits of a drug
* June 2009 NICE admits “technical inaccuracies” in the model, amends it, but does not alter guidance
* October 2010 Five years on, a fresh review of the guidance backs prescribing three drugs for mild Alzheimer’s, and includes a fourth for more advanced disease

After the case went all the way to the House of Lords, NICE was forced to first disclose the formula, then amend it after admitting “technical inaccuracies”, although it said this did not change the outcome.

That new review now proposes giving the drugs to patients with mild symptoms – which covers people in the early stages of the disease, perhaps suffering memory loss and confusion, but not yet dependent on carers for day-to-day activities.

It has also suggested a fourth drug, Ebixa, be made available for the first time to patients with more advanced disease.

The guidance is still subject to appeal by the quango.

Ruth Sutherland, the interim chief executive of the Alzheimer’s Society, said that it was “a momentous day”, with approximately half of the 62,000 people who develop the disease every year likely to benefit from the drugs.

She said that the drugs, which cost approximately £2.80 per person per day, were not a “miracle cure”, but made important differences to people’s lives.

She said: “For the price of a cup of coffee they can mean the difference between recognising your loved ones and playing with your grandchildren.

“It is critical that this draft decision becomes a reality and that all people with Alzheimer’s are given the opportunity to benefit.”

The society’s Director of Research, Professor Clive Ballard, said: “If this guidance is issued, doctors will no longer have to watch people deteriorate without being able to treat them.”

Professor Roy Jones, from the Research Institute for the Care of Older People in Bath, described the decision as “an important milestone”.

He said: “Early diagnosis and access to medication is critical to help reduce both the short and long-term impact of this devastating condition on patients, families and carers.”

From: http://www.bbc.co.uk/news/health-11486367

Dementia care costs are rising fast with the costs associated with dementia amounting to more than 1% of the world’s gross domestic product this year at £388bn a report says.The World Alzheimer Report says this is more than the revenue of retail giant Wal-Mart or oil firm Exxon Mobil.

The authors say dementia poses the most significant health and social crisis of the century as its global financial burden continues to escalate.

They want the World Health Organization to make dementia a world priority as the number of people with dementia is expected to double by 2030, and more than triple by 2050.

But experts say the costs of caring for people with dementia are likely to rise even faster than the prevalence, especially in the developing world, as more formal social care systems emerge and rising incomes lead to higher opportunity costs.

Data from individual countries such as the UK suggests that dementia is already one of the costliest illnesses.

The report brings together the best available data and the most recent insights regarding the worldwide economic cost of dementia.

It calls on the World Health Organization to declare dementia as a world health priority.

Professor Martin Prince, of the UK’s Institute of Psychiatry and who co-authored the report, urged nations to develop better plans for caring for the millions who have the disease.

“Governments must show greater leadership, working with all stakeholders, to drive solutions to the long term care issue.”

Marc Wortmann, head of Alzheimer’s Disease International, an umbrella group of organisations, said: “The scale of this crisis cries out for global action.

“History shows that major diseases can be made manageable – and even preventable – with sufficient global awareness and the political will to make substantial investments in research and care options.”

Dementia experts say governments must lead the way in ensuring national dementia strategies are fully implemented and dementia research is given enough funding to find new tests, treatments and possibly a cure.

From: http://www.bbc.co.uk/news/health-11373018

Tests suggest daily vitamin B supplements can dramatically slow the onset of Alzheimer’s and similar diseases.
Researchers from the University of Oxford have found that taking tablets of three B vitamins every day slows the brain shrinkage that happens with age, causing early signs of dementia such as memory loss.

In a two-year trial, the vitamin supplement delayed the rate of brain atrophy by up to half in a group of elderly people, with a more than 30 per cent reduction overall. Cognitive tests show those with the least shrinkage perform best.

A vitamin pill that curbed the mental decline associated with ageing would have colossal implications. About 1.5 million people in the UK, 14 million in Europe and five million in the US have problems with memory, language or other mental functions known as Mild Cognitive Impairment (MCI), half of whom go on to develop Alzheimer’s or another form of dementia within five years.

Even a slight slowing of this process would have immense human and economic benefits. However, the researchers said it was too soon to recommend elderly people suffering memory lapses should take B vitamin supplements, until further studies had confirmed the benefits and risks.

Large doses of around 300 times the daily recommended intake of B12 and four times the recommended levels of folic acid were used in the trial. The researchers said this meant they acted like a pharmaceutical drug rather than a nutritional supplement and would require further safety tests. They are now seeking funding for another trial.

The best sources of vitamin B are fresh dairy products and meats. The word fresh is key, as the nutritional value of foods can decline when they are frozen, overcooked, or combined with different additives.

Dark-green leafy vegetables such as spinach, arugula, kale, collard greens, chicory, dandelion greens and Swiss chard, are a great source of folic acid. By steaming these vegetables as opposed to frying or simmering, you reap the greatest benefits because their vitamin content remains intact.

The Oxford research, carried out in association with colleagues in Norway, involved 168 people with MCI, half of whom were given daily doses of vitamin B12, B6 and folic acid (B9).

After two years, MRI scans showed the brains of those who had taken the vitamins had shrunk less – by 0.76 per cent a year – than those given placebo (1.08 per cent) – a 31 per cent difference. In the quarter of elderly people who responded best, the reduction in the rate of shrinkage was 53 per cent.

Brain shrinkage is known to occur more rapidly in people with MCI or Alzheimer’s and high levels of the amino acid homocysteine are linked to an increased risk of the conditions. The researchers believe that the B vitamins slowed the brain atrophy seen in MCI and Alzheimer’s by reducing the levels of homocysteine. People with the highest levels of homocysteine in their blood benefited most.

Although the trial was not designed to measure thinking ability, the researchers found that individuals with the lowest rates of shrinkage had the highest mental test scores.

The findings are published in the journal PLoS [Public Library of Science] One.

Professor David Smith of the Department of Pharmacology, Oxford University, and co-leader of the trial, said: “This is a very striking, dramatic result. It is our hope that this simple and safe treatment will delay the development of Alzheimer’s disease in many people who suffer from mild memory problems.

“These are immensely promising results but we do need to do more trials to conclude whether these particular B vitamins can slow or prevent development of Alzheimer’s. So I wouldn’t yet recommend that anyone getting a bit older and beginning to be worried about memory lapses should rush out and buy vitamin B supplements without seeing a doctor.”

Professor Smith said the key question was whether MCI was a mild manifestation of the more extreme Alzheimer’s disease. “Is this a continuum? Are we seeing a disease that begins a long time ago and gets worse and worse? I personally think so.”

The long-term effects of taking big doses of the vitamins were not known, and there was some evidence that high folate intake could be linked to cancer, he said. However, asked if he would try the vitamin treatment if he was diagnosed with MCI he said: “Yes, no hesitation. I would take it.”

Chris Kennard, chair of the Medical Research Council’s Neurosciences and Mental Health Board which co-funded the study, said: “This trial brings us a step closer to unravelling the complex neurobiology of ageing and cognitive decline.”

From: http://www.independent.co.uk/daily-vitamin-pill-could-reduce-dementias-effects-by-up-to-50-per-cent

NHS hospitals could lose their right to carry out certain procedures if they fail to meet a new set of NHS ”quality standards” set out by Andrew Lansley, the Health Secretary.
Some 150 clinical areas will eventually have their own set of quality standards, with the first three published today covering dementia, blood clots and stroke.

The standards set out the type of care patients can expect and some timeframes for treatment.

Mr Lansley, who has scrapped several of Labour’s key targets, including the guarantee of a GP appointment within 48 hours, insisted the new standards were not just another set of targets.

Speaking at the launch of the standards, which have been developed by the National Institute for Health and Clinical Excellence (Nice), Mr Lansley said they were not mini-targets as they were ”evidence-based” measures identified by the NHS itself.

”These are standards, not diktats. It is not politicians establishing these, I am not picking them out. ‘If I started doing that, I would be distorting clinical standards.”

The latest standards from Nice are drawn from various sources, including existing Nice guidelines, and reports from the Royal Colleges, the Department of Health and the National Audit Office.

It will be up to local managers – or possibly GPs in the future – to check if the NHS is meeting them.

If trusts fail to reach the standards, they could face losing contracts to carry out services, such as stroke care, which could be commissioned from other hospitals instead.

It is unclear how data will be collected nationally so patients can assess whether standards are being met.

Dr Tim Kendall, who led development of the dementia standard, said it would help transform the experience of dementia patients but also support carers.

”Some carers suffer far more than they should. People with dementia effectively die while the person caring for them watches them disappear,” he said.

The stroke standard sets out how patients can expect to receive a minimum of 45 minutes, five days a week, of therapies to help them improve, such as speech therapy or help with movement.

From: http://www.telegraph.co.uk/NHS-quality-standards-set-out-by-Andrew-Lansley