Wednesday 18 September 2019 ★ FINANCIAL TIMES 3

Penn, a clinical research fellow at the

UCL Dementia Research Centre, devel-

oped a personal finance product called

Kalgera after one of his patients lost the

moneytofundhisplaceinacarehome.

Kalgera uses AI and neuroscience to

detect vulnerability and provide the

secure sharing of this information with

trusted family and friends who can

identifyproblemsandactaccordingly.

There is no charge for the service,

which has been funded by private

investment and grants, as well as being

partofUCL’sincubatorprogramme.

The Alzheimer's Society is funding

the development of more new products

through the Dementia Research Insti-

tute. It interviews members and their

families and tests the resulting products

in the community. Anonymised feed-

back is then passed to manufacturers

and suppliers who use it to improve

theirproducts.

FT HealthBusiness & Dementia

Thesmall,well-tendedvillageof

Hogeweyk,15kmsouthofAmsterdam,

wouldbeunremarkablewereitnotfor

thefactthatitsentirepopulationhas

late-stagedementia.

Residentsgoabouttheirbusinessas

inanyrun-of-the-millDutch

neighbourhood:theymightgraba

pastryfromabaker,gotothebarber

andshopforgroceriesatthe

supermarket.

Excepthere,thebakerandthe

butcheraregeriatricnursesand

specialiststrainedtodealwiththe

symptomsofAlzheimer’sdiseaseand

dementia,whichcanmanifest

themselvesasdisorientationand

occasionallyaggressivebehaviour.

Thereareahandfulofsuchplaces

scatteredroundtheworld,although

theyrepresentadropintheocean—

Hogeweykishometoamere152

residentsamongthe50msufferers

worldwide.

Rapidlyageingpopulationsposea

hugechallengetosociety,governments

andpublicservices.Olderpopulations

putanimmensestrainonhealthcare

expenditure,andthefinancialcostsof

dementiaarelargeandgrowing.

Accordingtothemostrecent

statistics,spendingonlong-term

conditionssuchasAlzheimer’svaries

widelybetweenrichnations,from

4.3percentofnationalincomeinthe

Netherlandsto0.3percentinPoland.

Thevariationismuchgreaterthanin

healthspendingingeneralandreflects

largedifferencesintheprovisionof

care,fromformaltoinformal—thekind

providedbyfamily,friendsandthe

widercommunity.Thecostsattachedto

informalcarerepresentabout40per

centofthetotalworldwidecostof

dementia.Ontopofthefinancialcost—

feltveryacutelybythoseunabletofind

full-timeworkbecauseofcaringduties

—lookingafterapersonwithdementia

ismentallyandphysicallytaxing.

Informalcarershavea20percent

higherprevalenceofmentalhealth

problemscomparedwithnon-carers,

accordingtotheOECD.

HealthministersfromG7countries

haveidentifiedthisgroupasapriority.

Austria,forexample,nowoffersrespite

holidaycareprogrammes,whichallow

carerstorelaxwiththeassurancethat

someoneelseislookingaftertheirloved

ones.

Yetonly19oftheOECD’s36member

countriesoffersomeformofpaidleave

forinformalcarers.

Althoughmanypeoplewithdementia

prefertoliveathome,whenthisisnot

possibletheyareplacedincare

facilities:about70percentofnursing

homeresidentshaveacognitive

impairment.

TheOECDhaspointedoutthat“the

vastmajorityoflong-termcarefacilities

remainpoorlydesignedforpeoplewith

dementia”.AccordingtotheParis-based

group,staffareseverelyundertrained:

onaverage,only12hoursoftuitionat

medicalschoolarededicatedto

dementiacare.

Thiscanresultinanover-relianceon

antipsychoticmedicationstotreatthe

behaviouralandpsychological

symptomsofdementia.

Theuseofantipsychoticdrugs

increasedbyathirdbetween2011and

2015,despite“widespreadclinical

agreementthatantipsychotic

medicationsshouldnotbeusedto

managemostdifficultbehaviourin

dementia”,saysElinaSuzuki,authorof

theOECDreport.

The good, the bad, and the ugly: from special villages to drug abuse

Global spending

Fewerthan half of OECD

countries offer paid leave for

carers, writesFederica Cocco

Dementia costs more than it should.

With better, earlier diagnosis and the

clever use of technology, the UK could

save £100bn in the next 15 years,

according to the International Longev-

ityCentre.

The alternative: do nothing, put Brit-

ain's health and social care system

under intolerable strain and leave hun-

dreds of thousands of families to cope

alone,withouttheresourcestheyneed.

The £26bn spent each year on demen-

tia care in the UK would be significantly

reduced if the symptoms of the disease

were delayed by five years, according to

theAlzheimer’sSociety.Thiswouldena-

ble those diagnosed to retain their inde-

pendenceandstayinthefamilyhome.

TheUKhascommittedtothetargetof

helping people live independently for

longer and is encouraging innovation to

helpbringitabout.

The £98m Healthy Ageing Pro-

gramme,fundedbytheIndustrialStrat-

egy Challenge Fund and led by UK

Research and Innovation, has opened

its first tranche of competitions to stim-

ulatenewideas.

The projects will have to show that

they tackle the challenges of older life

including “living well with cognitive

impairment.”

Unforgettable was set up four years

ago by James Ashwell. He had been

caring for his mother after her diagnosis

of young-onset dementia and had

struggled to find products to help her to

liveindependently.

His first item was a two-in-one calen-

dar and day clock, which is still one of

the company's best-sellers. An easy-to-

read typeface allows the level of

information to be adjusted as an

individual’s dementia progresses, and

preset reminders tell people with

dementia when their meal times are

imminent, give them a schedule for

Tech leads the charge to protect people’s independence

New products

There is a host of technology

available, from door sensors

to clocks,writes Lindsay Cook

D

iagnosis plays a key role in

the battle against dementia.

Although the world still

lacks a proven treatment

for Alzheimer’s or, indeed,

any form of dementia, many people

who may be developing symptoms —

andtheirfamilies—appreciateknowing

the likely course of the disease, for plan-

ningandotherpurposes.

At the same time, scientists develop-

ing dementia drugs need a reliable diag-

nosis, preferably before the onset of

symptoms, to identify participants best

suitedfortheirclinicaltrials.

“Globally, dementia is grossly under-

diagnosed,” says the World Dementia

Council. In the UK, where the National

HealthServicehasmadedementiadiag-

nosis a priority, around 67 per cent of

the estimated number of people with

the disease have received a diagnosis —

oneofthehighestratesintheworld.

According to Alzheimer’s Disease

International, only 25 to 50 per cent of

dementia cases are recognised and doc-

umented in many other high-income

countries, and the rate is much lower in

poorer ones. “Approximately three-

quarters of people with dementia

[worldwide]havenotreceivedadiagno-

sis,”ADIestimates.

Fiona Carragher, chief policy and

research officer for the Alzheimer’s

Society in the UK, gives two main rea-

sonsfortheunder-diagnosis.“Thebrain

is the most complex organ in the human

body and dementia is a complex set of

diseases, so it is not surprising that we

don’t have a simple test for the earlier

stages,” she says. “Linked to that is the

gap in research funding in dementia,

including diagnosis, compared to other

diseasesoverthepast20to30years.”

Although research into new tech-

niques — including blood tests, brain

scans and electronic methods such as

virtual reality and speech-pattern

matching—isgatheringpace,mostclin-

ical diagnosis today relies on traditional

methods such as cognitive and memory

tests combined with interviews with

patients and their families. These may

be supplemented with additional tests

tohelpidentifythetypeofdementia.

Scansforexamplecanshowtheshape

ofthebrainanditsbiochemicalactivity.

Another option is a lumbar puncture to

take a sample of the cerebrospinal fluid

from the lower back and measure levels

of proteins characteristic of Alzheimer’s

disease.

Many researchers are looking for

biomarkers — molecules characteristic

of a particular form of dementia — in

blood. This is challenging, because the

blood-brain barrier prevents much

leakage from the brain into the blood-

stream but the increasing sensitivity of

biochemical tests is making biomarkers

easiertodetect.

Researchers at Washington Univer-

sity in St Louis last month reported they

could identify people with brain

changes characteristic of early Alzhe-

imer’s with 94 per cent accuracy. They

used mass spectrometry to measure the

level of amyloid beta protein in blood —

and combined this with each subject’s

ageandgeneticanalysis.

“While the idea of an Alzheimer’s

blood test feels like it has been around

for decades, advances in technology

overthelastcoupleofyearsmeanthatit

is now a becoming a reality, and fast,”

says Dr James Pickett, Alzheimer’s Soci-

ety head of research. “But it’s important

to note this isn’t a blood test for demen-

tia — it tells us that amyloid deposits are

in the brain, which are a hallmark of

Alzheimer’s disease, but they are also

foundinhealthyolderpeopletoo.”

Brain scans are another fertile field

for diagnostics research. Last month

Oxford university launched Oxford

Brain Diagnostics, a spinout using new

computer algorithms to analyse MRI

scans of the cerebral cortex for changes

characteristicofAlzheimer’s.

Adding to the diagnostic challenge is

growing evidence of the sheer complex-

ity of neurological conditions that can

lead to dementia — and the difficulty of

distinguishingbetweenthem.

An international research team

recently published evidence in the jour-

nal Brain for a new type of disease that

produces dementia symptoms very

similar to those of Alzheimer’s, which

they call late limbic-predominant age-

related TDP-43 encephalopathy or

LATE. Unlike Alzheimer’s, in which two

toxic proteins, tau and amyloid beta,

accumulateinthebrain,LATEiscaused

by another protein, TDP-43, which is

usually present in the centre of nerve

cells but may change form and spread

outintothecellbodyaspeoplegetolder.

Kirsty McAleese, a neuropathologist

studying postmortem brain tissue from

dementia patients at Newcastle Univer-

sity, highlights the complexity. “More

than half of people with Alzheimer’s

also have some signs of additional

pathology in their brain, which may be

LATE or dementia with Lewy bodies

[abnormal groups of protein] or vascu-

lar dementia,” she says. “About 20 to 25

per cent have ‘mixed dementia’ with at

leasttwofull-blownpathologies.”

Ms Carragher sees a future combining

a variety of techniques for each patient.

These might include brain scans, blood

testsandgeneticsbutalsoanalysisofthe

way the individual talks, walks and per-

formsonspecialtests.

“With AI we’ll be able to bring all the

diagnostic data together to provide

everyone with a personalised

approach,”shesays.

Researchers

hunt for new

detection

methods

Diagnostic deficitClive Cooksonlooks at future

prospects for identifying more sufferers earlier

Brain scans can

show the shape

of the brain, its

biochemical

activity and

signs of

Alzheimer’s

disease

Alamy

Most clinical

diagnosis

relies on

traditional

methods

such as

cognitive

and

memory

tests

taking medication and remind them

when their favourite television pro-

grammesareabouttostart.

In June 2019, Unforgettable was

acquired by Live Better With, a com-

pany that aims to improve the day-to-

day life of people living with long-term

healthproblems.

“Sales have doubled or trebled every

year since the start and we can now say

that120,000peoplehaveusedourprod-

ucts,” says Adam Vaughan, head of new

product development and innovation at

LiveBetterWith.

Music has been found to be calming

for people with dementia and specially

adapted music players and radios are

big sellers. The company's challenge is

to make the machines adapt to the pro-

gression of the disease, allowing them to

be used with a number of buttons or a

singleonewiththeothershidden.

It is also important to ensure the

products are designed “so that they fit

into homes without being obvious disa-

bilityaids,”MrVaughanadds.

Other popular products monitor how

oftenapersonpicksupacuporbottleto

drink and can remind people who may

riskdehydrationtodrink.

Colin Capper, head of research, devel-

opment and evaluation at the Alzhe-

imer’s Society, has run workshops for

people with dementia to establish how

technology can help them keep their

independence. He is currently working

withtheCassBusinessSchoolonitsSelf-

Care Advice Monitoring, Planning and

Intervention researchproject.

The scheme is developing software

that will allow someone with dementia

— together with their relatives, carers

and healthcare professionals — to man-

age their condition at home. It analyses

their interests and hobbies and suggests

suitableactivities.

The Alzheimer’s Society has also

linked up with McCann Worldgroup to

launchMyCarer,softwareforAmazon's

Alexa personal assistant device. It

adapts to the user’s daily routine,

reminding them what to do and guiding

them through daily tasks — from taking

theirmedicationtopreparinglunchand

rememberingbirthdays.

Live Better With recently introduced

its Canary Home Care Monitoring

System, designed to alert carers to

fridge, kettle, tap and late-night door

use in the home of a person with a

dementia diagnosis. It works without

WiFioraphonelineanddoesnotinvade

privacy because it does not have a cam-

era.

Artificial intelligence is also being

used to enhance support. Dr Dexter

The UK could save £100bn

over the next 15 years with

better, earlier diagnosis and

Screen grab from promotional video of My Carer software from Amazon clever use of technology

Alexa/Alzheimer’s Society:— MyCarer

“Theycanincreasehealthrisks,

restrictautonomyanddonotreflecta

person-centredcareapproach,”she

adds.

Meanwhile,ashortageofqualified

medicalspecialistsisforcing

governmentstorelaxrestrictive

immigrationpoliciesandchangepublic

healthrecruitmentmodels.

AspartofJapan’s“Orangeplan”—a

packageofmeasurestotackledementia

—by2020,thecountryplanstorecruit

10,000foreigninternsinitsnursingcare

sector.Thefirstgroupof300trainees

arrivedfromVietnamjustovertwo

yearsago.

Germanyishavingtolookbeyondthe

EUtorecruitgeriatricnursesand

recentlysignedagreementswiththe

PhilippinesandSriLankatoplugthe

gap.

Ascountriesgropeforwaystodeal

withtheriseofdementia,manyremain

ill-preparedfortheconsequencesof

ageing.Inthefewsmall-scalevillages

likeHogeweyk,avacancyonlybecomes

availablewhenaresidentpassesaway.

As people live longer, the burden

of dementia is bound to increase

People with dementia per 

population (all ages)

By ageing population

Japan

Italy

Spain

Germany

Greece

France

Netherlands

Sweden

Denmark

UK

South Korea

US

China

 

    

European healthcare stretched

Specialists include psychiatrists and neurologists





Number of specialists per  year olds

       

Change in population aged over ,

percentage points (-)

Portugal

United

Kingdom

Finland

Netherlands

Germany

Lithuania

Switzerland

Source: OECD; Eurostat

SEPTEMBER 18 2019 Section:Reports Time: 13/9/2019 - 18:10 User: darren.dodd Page Name: DEM3, Part,Page,Edition: DEM, 3 , 1