Clinical Review

Dementia

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b75 (Published 05 February 2009) Cite this as: BMJ 2009;338:b75
  1. Alistair Burns, professor of old age psychiatry1, honorary consultant psychiatrist2,
  2. Steve Iliffe, professor of primary care for older people3
  1. 1University of Manchester Psychiatry Research Group, Manchester M13 9PL
  2. 2Manchester Mental Health and Social Care Trust, Manchester
  3. 3Department of Primary Care & Population Health, University College London, London NW3 2PF
  1. Correspondence to: A Burns alistair.burns{at}manchester.ac.uk

    Summary points

    • Dementia is a global health and social care crisis

    • In the United Kingdom 700 000 people have dementia, and the annual cost of care is £17bn a year; these values are set to rise

    • People with mild cognitive impairment are up to 15 times more likely to develop Alzheimer’s disease than those with normal cognition

    • Complaints of memory loss often indicates the presence of depression

    • Trazodone, clomethiazole, and selective serotonin reuptake inhibitors are suitable alternatives to antipsychotic drugs in people with dementia who are agitated

    • Interventions by carers can be as powerful as drug treatment in terms of outcome

    • Apathy and withdrawal in people with dementia can be as distressing to carers as agitation and aggression

    Dementia is a clinical syndrome characterised by a cluster of symptoms and signs manifested by difficulties in memory, disturbances in language, psychological and psychiatric changes, and impairments in activities of daily living. Alzheimer’s disease is a specific disease entity and is the commonest cause of dementia. In this, the first of two articles, we will review the clinical and service implications of dementia syndrome; the second will concentrate on Alzheimer’s disease.

    What is the burden of disease?

    About 12 million people worldwide have dementia, and this total is likely to increase to 25 million by 2040.1 The Dementia UK report2 estimated that about 637 000 people in the UK have dementia syndrome and the annual cost of their care is £17bn (€18.7bn; $24.7bn), which is more than heart disease (£4bn), stroke (£3bn), and cancer (£2bn). Annual costs per patient have been estimated at $57 000 in the United States and $64 000 in Italy (including estimates for informal care) and $24 000 in Sweden and $14 000 in Canada (excluding informal care).w1 Dementia is one of the main causes of disability in later life; in terms of global burden of disease, it contributes …

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