Alzheimer's and other Dementias

184 Pages·2011·0.71 MB·English

by  Julian C. Hughes

thefacts
Alzheimer’s
and other
dementias
06
also available in thefacts series
Eating disorders: thefacts Panic disorder: thefacts
SIXTH EDITION THIRD EDITION
Abraham Rachman and de Silva
Sexually transmitted infections: Tourette syndrome: thefacts
t hefacts Robertson and Cavanna
THIRD EDITION
ADHD: thefacts
Barlow
SECOND EDITION
Thyroid disease: t hefacts Selikowitz
FOURTH EDITION
Dyslexia and other learning
Vanderpump and Tunbridge
diffi culties: thefacts
Living with a long-term illness: SECOND EDITION
t hefacts Selikowitz
Campling and Sharpe
Schizophrenia: thefacts
Prenatal tests: t hefacts THIRD EDITION
De Crespigny and Chervenak Tsuang, Faraone, and Glatt
Obsessive-compulsive disorder: Depression: t hefacts
thefacts Wasserman
FOURTH EDITION Polycystic ovary syndrome:
Rachman and De Silva
thefacts
The pill and other forms of Elsheikh and Murphy
hormonal contraception: t hefacts
Autism and Asperger syndrome:
SEVENTH EDITION
t hefacts
Guillebaud and MacGregor
Baron-Cohen
Myotonic dystrophy: thefacts
Motor neuron disease: thefacts
SECOND EDITION
Harper Talbot and Marsden
Ankylosing spondylitis: thefacts Lupus: thefacts
Khan SECOND EDITION
Isenberg and Manzi
Prostate cancer: thefacts
Muscular Dystrophy: thefacts
SECOND EDITION
Mason and Moffat THIRD EDITION
Emery
Multiple sclerosis: thefacts
Osteoarthritis: thefacts
FOURTH EDITION
Matthews Arden, Arden, and Hunter
Essential tremor: thefacts Cosmetic surgery: thefacts
Plumb and Bain Waterhouse
thefacts
Alzheimer’s
and other
dementias
JULIAN C. HUGHES
Consultant in Old Age Psychiatry,
Northumbria Healthcare NHS
Foundation Trust
and Honorary Professor of
Philosophy of Ageing,
Institute for Ageing and Health
Newcastle University, UK
1
1
Great Clarendon Street, Oxford O X2 6 DP
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide in
Oxford New York
Auckland Cape Town Dar es Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi ShanghaiTaipei Toronto
With offi ces in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal Singapore
South Korea SwitzerlandThailandTurkey UkraineVietnam
Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries
Published in the United States
by Oxford University Press Inc., New York
© Oxford University Press, 2011
The moral rights of the author have been asserted
Database right Oxford University Press (maker)
First edition published 2011
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate
reprographics rights organization. Enquiries concerning reproduction
outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above
You must not circulate this book in any other binding or cover
and you must impose this same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloguing in Publication Data
Data available
ISBN 978-0-19-959655-3
10 9 8 7 6 5 4 3 2 1
Typeset in Plantin
by Cenveo, Bangalore, India
Printed in Great Britain
on acid-free paper by
Clays Colour Press Ltd, Gosport, Hampshire
While every effort has been made to ensure that the contents of this book are as complete, accurate
and up-to-date as possible at the date of writing, Oxford University Press is not able to give any
guarantee or assurance that such is the case. Readers are urged to take appropriately qualifi ed
medical advice in all cases. The information in this book is intended to be useful to the general
reader, but should not be used as a means of self-diagnosis or for the prescription of medica-
tion. The authors and the publishers do not accept responsibility or legal liability for any errors
in the text or for the misuse or misapplication of material in this book.
Foreword
Only in recent years have Alzheimer’s disease and other dementias risen in
public awareness. While once the subject seemed never to make the news,
today it seems hardly to be out of it. The raised awareness is in part due to the
activities of organisations like Alzheimer’s Society ,which has campaigned for
the rights of those living with dementia, and in part due to demographics.
Today there are 750,000 people with dementia in the UK but that number
will reach one million by 2021. Of those of us who live beyond the age of 65,
one in three of us will end our lives with dementia.
The next step is to improve everyone’s understanding of dementia, to help us
reduce stigma and enable everyone to be better prepared to face the challenge
that it presents to our society. To begin that we need much more and much
clearer information about dementia, as well as the impact it has on the 100,000
people who develop the condition each year and those who care for them.
That is why A lzheimer’s Society welcomes this contribution from Professor
Hughes, which will enable many more people to understand what dementia is,
what the impact is and the challenges it presents.
The greater understanding will also enable us to make better judgments on
ethical issues, some of which Professor Hughes raises in his book. This will
encourage us all to understand that enabling the person with dementia to
continue to live the life that they choose, in an independent way, will allow
them to fl ourish, doing the sort of things we all do to feel fully human. It
means remembering the person, remembering they wish to be known as the
person and not for their dementia.
(Prof) Clive Ballard
Director of Research
Alzheimer’s Society
London E1W 1JX
www.alzheimers.org.uk
v
This page intentionally left blank
Preface
The aim of this book is to set out the important facts about dementia in a way
that is accessible to the non-specialist. As with many diseases, the complexity
around dementia is huge and there are numerous facts to be considered.
These move from facts about how many people suffer from the disease to facts
about the different types of dementia. Underlying these different types of
dementia, there are different causes. The causes themselves are multiple. For
instance, there is no doubt that genetics can cause some cases of dementia,
and make a contribution to almost all causes of dementia, but there are also
environmental reasons to explain why people suffer from dementia. Moreover,
social attitudes—stigma—can add to the distress suffered both by people with
dementia and by their carers.
Much of the fi rst half of the book is concerned to explain what dementia is
and the different types. Much of the second half concerns how people with
dementia should be treated or cared for. But the process of care starts with
good assessment. There might be little more to be said about a disease, as long
as the causes, assessment, and treatment are discussed in broad enough terms.
Dementia, however, raises somewhat unique concerns. The link with ageing
means that dementia poses a startling and huge challenge to the world as our
population ages. The implications of dementia in an ageing world are immense.
At another level, dementia raises questions of a fundamental nature about our
standing as human beings in the world: it poses a threat to personhood, one
which needs to be grasped properly.
Hence, there is an inevitable sense in which discussion of the facts to do with
dementia cannot avoid discussing the values-based judgements that have to be
made in order to try to help both people with dementia and their carers. So,
this book will deal with the facts, but will set these facts within the context of
vii
Preface
a broader understanding of dementia as a condition that stems from the
challenges of ageing and requires us to rethink our standing as human beings
who live in an interdependent world.
Julian C. Hughes
Newcastle upon Tyne
viii
Acknowledgements
I have tried to keep the referencing to a minimum for the sake of clarity. The
book does, however, contain references where the material is taken directly
from other sources. Many of the facts recorded have been derived from or
checked against a variety of sources. My two main references have been the
excellent Oxford Textbook of Old Age Psychiatry, edited by Robin Jacoby,
Catherine Oppenheimer, Tom Dening, and Alan Thomas, and the equally
excellent fourth edition of the defi nitive textbook D ementia, edited by David
Ames, Alistair Burns, and John O’Brien. The full details of both books appear
in Appendix 2. Readers who require further information about dementia are
advised to consult these texts and the other sources listed in Appendix 2.
Readers who require more immediate practical advice should contact their
local Alzheimer’s Society or other relevant support organization. The web
addresses for these organizations appear, with other useful contacts, in
Appendix 1.
I wish to thank the following for permission to reproduce copyright material:
Alzheimer’s Disease International for permission to use the material in Box 1.1
and to adapt material for Figures 1.1 and 1.2; the Alzheimer’s Society for per-
mission to adapt the material for Box 10.1; the Nuffi eld Council on Bioethics
for permission to use Box 14.2 and to adapt the information in Box 14.3; and
Quay Books for permission to adapt the contents of Box 11.1 and to use the
information in Box 14.1. I should particularly like to thank Professor John
O’Brien for providing me with the brain scans that appear in Chapters 4
and 9.
I must thank Nicola Wilson and Jenny Wright, with the rest of the staff involved
at Oxford University Press, for their encouragement and consistently helpful
advice. Finally, I wish to thank Lindsay Turner for her excellent secretarial
help and my wife, Anne, for her proof-reading skills and ubiquitous support.
ix