What will be the largest public health issue facing doctors in the next 10 years? Pose this tricky question to a medic, an aspiring med student at interview, or quite possibly any individual abreast of current affairs, and the response is likely to indicate obesity and/or its associated disease states (Type 2 Diabetes, Heart Disease etc.). Probably somewhat less considered, however, would be the social impact of neurodegeneration in the near future – a loss of physiological structure or function of neurons. To the average reader, neurodegeneration may seem at first a little random or currently unproblematic; until we consider the
’s demographic, that is. UK
Illustrated by the graph to the left, the median age of the male
population has risen by five years over the past quarter of a century. Consequently, the UK has an ever-ageing population and an ever-rising incidence of illnesses associated with older age. One of these is dementia- the loss of cognitive function (perception, thinking and reasoning- the comprehension and treatment of ideas) usually associated with neurodegeneration of the elderly. With over 1% of the country’s population currently suffering with this terminal condition – a proportion that’s expected to double within three decades – I find it staggering that more has not been done to spread awareness of the illness. To be fair, these statistics haven’t fallen entirely on deaf ears. Alan Johnson MP, former Secretary of State for Health, has himself admitted that ‘Dementia is not an illness we can ignore,’ and more recently David Cameron has pledged to increase funding for dementia research to £66m by 2015. Despite the fact that this is triple what the government set aside for such research in 2010, £66m seems rather insignificant considering dementia currently costs the British taxpayer £17 billion annually. I would imagine that we are all agreed £66m would be a very small price to pay to save annual costs well in excess of this figure, especially considering that this would massively improve our current economic climate in the long run; so why don’t we up the stakes a little, invest even more in research and find a cure sooner? UK
Unfortunately, it’s not quite that simple. The bulk of past (and current) research into dementia has been neuroscientific on the cellular and molecular level – to little avail, I’m afraid. After all, how can we expect to find our miracle cure when following stab-in-the-dark lines of inquiry as specific as the role of PGC-1α protein in dementia? To date, neuropharmacological research has only provided clinicians with one subtype of NICE (National Institute for Health and Clinical Excellence) licensed drugs to combat dementia. Dubbed acetylcholinesterase inhibitors (a hardly-snappy, but self-explanatory, name) such drugs seek to prevent further breakdown of acetylcholine – a neurotransmitter essential for the communication between neurons and hence cognitive function. Subsequently, this treatment is exclusively symptomatic and has no effect on reversing neurodegeneration. What’s more, such biomedical research wholly neglects the complex psychiatric dimension of the illness, which pathological changes of neuronal structure cannot necessarily explain.