On Tuesday March 1st 2016, QS Enterprises and their colleagues of the National Hospital for Neurology and Neurosurgery welcomed GPs, primary carers and charitable organisations to its educational evening in Queen Square. The topic for this month’s seminar was Dementia, and the way various specialties and disciplines contribute to the diagnostic and therapeutic pathway
The evening was opened by Peter Sutton, QS Enterprises’ Manager for Marketing and New Business Development, who explained the vital clinical service that QS Enterprises provides in Queen Square, as well as explaining the charitable model it operates which sees all profits donated back to the UCLH charity. He then welcomed the evening’s speakers.
Dr Catherine Mummery, Consultant Neurologist and Clinical Lead for the Dementia Service in Queen Square, opened the evening’s presentations, giving a comprehensive overview of current challenges, aims and hopes for Dementia diagnosis and treatment. She explained that it is an exciting time for dementia research since we are now entering a ‘treatment age’, just over 100 years since Dr Alois Alzheimer’s death. She explained that dementia research remains a key priority, with 50% of females (32% of males) likely to develop dementia by the age of 90. The problem will grow as the population ages with an increasing emotional and financial burden on families, carers and the health system.
She proceeded to explain the problems associated with diagnosis. Up until now, diagnosis of dementia has only been possible once symptoms are well established. The average time to diagnosis is years, not months, with clinical assessment often problematic due to potentially unreliable self-assessment and third person accounts. Therefore, Dr Mummery explained how there has recently been an increase in the use of biomarkers in addition to clinical assessment in order to identify physiological signs of dementia. MRI and lumbar puncture for CSF analysis has become a common diagnostic tool. Structural changes in brain volume on MRI, as well as quantifiable changes to CSF biomarkers can lead to a diagnosis of dementia with a specificity and sensitivity of 85%, providing great comfort to those who are concerned that they may be developing the condition. In addition, current research which uses PET imaging to identify amyloid deposition has been shown to identify early physiological changes of Alzheimer’s disease in brain parenchyma, 15 years before the first onset of symptoms. Therefore, Dr Mummery explained that the use of biomarkers such as these may be able to identify those at risk, decades in advance of symptom onset, providing a new opportunity to trial new treatments and potentially discover ways of preventing symptoms starting. A key message given by Dr Mummery was that developments such as these deliver hope, in a setting which has up until now offered little optimism.
Dr Mummery closed with a summary of proposed interventions for dementia. A body of evidence now exists which advocates a healthy diet, physical exercise and not smoking to prevent or at least delay the onset of dementia. There is also early evidence to support the use of vaccines, although Dr Mummery stated that more research was required in this area. Dr Mummery emphasised the importance of undertaking more phase III trials at earlier and earlier stages as only this could lead to trials aimed at prevention. An enhanced interest for promotion of dementia research from the media can be seen as a positive move.
Dr Indran Davagnanam, Consulting Neuroradiologist at the National Hospital for Neurology and Neurosurgery than spoke on the use of medical imaging, and in particular, MRI, for the diagnosis and follow up of dementia.
Dr Davagnanam echoed what Dr Mummery had previously said, stating that the primary reason to conduct imaging in patients who display cognitive decline is to exclude organic causes for the cognitive symptoms which could in fact be treatable and reversible. Many patients presenting with cognitive decline remain undiagnosed for many years and therefore, the likelihood of missing potentially treatable causes, such as tumour, stroke, and infection is high unless imaging is used in conjunction with accurate clinical assessment. Serial imaging has been shown to be most useful when monitoring gradual cognitive decline.
Dr Davagnanam also presented a number of interesting case studies demonstrating the use of imaging as a biomarker to predict Alzheimer’s disease. Both PET imaging (for amyloid deposition) and volumetric MRI (for the identification of neuronal damage) show great promise in demonstrating subtle signal changes much earlier than the appearance of significant symptoms.
Finally, Dr Susie Henley, Clinical Psychologist at the National Hospital and for the Dementia service spoke about her invaluable work in the use of psychological intervention for patients with dementia, and their families. She explained that psychologists have a key role to play in the care of dementia patients, being responsible for the assessment and management of patients and their families, providing education on the signs and symptoms and providing support at such a difficult time. Through the use of a number of interesting case studies, she emphasised the importance of working with carers and families, as well as the patients in order to assess needs, provide education and support as well as therapy. She explained that the greatest challenge is often increasing the understanding and acceptance on a partner’s behalf, as they watch their loved one decline.
A growing evidence base shows that psychological input can be a clinically and cost effective therapeutic tool in cases of dementia, and indeed, as one audience member stated, psychological intervention is currently one of only a few methods of treatment available to these patients. Dr Henley explained that through her own audit, she has identified that 95% of patients strongly agreed that sessions were helpful, with 100% recommending them to friends and family. There is a growing body of evidence to suggest more should be done in order to provide psychological intervention at all stages of the dementia journey for both patients and carers.
Following the presentations, audience members were invited to the Queen Square Private Consulting Rooms where they enjoyed a drinks and canapes reception and the chance to meet with their colleagues and the speakers in order to draw on their expertise further.