Alzheimer’s Disease as a Model for Palliative Care

By Claudia Burlá, MD, PhD

Dementia is a model disease for palliative care, which should begin at the time of diagnosis.

Worldwide, the age group increasing the most is that of people aged 60 and over, which is growing at a rate of 3% a year and currently accounts for 13% of the world’s population1.

As populations age, the pattern of diseases that people suffer from and die of also changes. Increasingly, more people die as a result of serious chronic and degenerative conditions than from acute diseases. A typical condition for which age is a risk factor is dementia. Dementia is a syndrome, usually of a chronic and progressive nature, caused by a variety of brain illnesses that affect memory, thinking, behavior, and the ability to perform everyday activities. Therefore, dementia is one of the major causes of disability and dependency among older persons worldwide, posing an increasingly heavy burden on family members and caregivers throughout the course of the disease until the death of the patient.

A major achievement of humankind has been the increase of life expectancy. Advances in medical technology, improvement of living conditions, and greater access to health care services (such as vaccination) have resulted in a change from high fertility and high mortality rates to one of low fertility and low mortality. It is the triumph of life over time.

1 new case diagnosed every 3 seconds

Over time, the pattern of diseases that people suffer from and die of also changes. Nearly 10 million people develop dementia each year (an average of one new case every three seconds)2,4. The number of people currently living with dementia worldwide is estimated at 50 million; Alzheimer’s disease is the most common form of dementia, accounting for approximately 60% to 70% of cases4.

A major cause of global deathsRisk factors for the development of dementia include ageing, midlife hypertension, poor formal education, diabetes mellitus, tobacco use, physical inactivity, obesity, unbalanced diets, excessive use of alcohol, mid-life depression, social isolation, and cognitive inactivity.

Dementia rose swiftly to become the fifth leading cause of global mortality in 2016, more than doubling since 20003.

According to the 2018 IAHPC definition of palliative care, palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness, and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers, and addresses the need to provide support to the family and the caregivers during the patient’s illness, and in their own bereavement.

PC as part of the continuum of care

Palliative care should be applied as a continuum, in step with other treatments pertaining to the case, based on the diagnosis of an incurable and progressive illness. Considering that dementia is incurable from the time of diagnosis, albeit available therapies aimed at slowing the rate of progression — it may take years until death — and managing related symptoms, it is a model disease for palliative care, which should begin at the time of diagnosis. Palliative care is, indeed, the necessary therapeutic approach to persons with dementia evolving towards the end of life.

References

1. United Nations, Department of Economic and Social Affairs, Population Division. 2017. World Population Ageing 2017 (ST/ESA/SER.A/408).
2. Alzheimer’s Disease International (ADI). London, 2018. World Alzheimer Report 2018. Accessed online on March 17, 2019.
3. World Health Organization. Fact Sheet, May 2018. The Top 10 Causes of Death.
4. World Health Organization. December 2017. Dementia: Key Facts.