In the upcoming NEJM, a large prospective study makes the case for the consideration of dementia as a certain cause of death for the mostly elderly patients who suffer from it. Ever since the disorder was first described by its namesake Alois Alzheimer, MD 102 years ago; it has always been thought of as an unfortunate comorbid “condition” of which advancing age itself was a risk factor. The complexity of the diagnosis made early attempts to formulate effective treatments virtually impossible. Toward the middle of the 20th century the focus of caring for the patient who suffered from dementia shifted to palliation and suppression of other comorbidities which could hasten its clinical effects.

At the end of the last century, breakthroughs in neurobiological research opened the doors to classes of drugs that have largely been successful for controlling debilitating symptoms — without, however, effecting retardation of the disease, or even a cure. Thus the stage was set for a redefinition of sorts for this illness. Authors of the study have delineated the course of dementia (not necessarily following Alzheimer patients, but studying the constellation of disorders that make up its syndrome — Parkinson’s, stroke related dementia, and other organic causes) as one of a terminal nature. They are sounding a clarion call for re-education of the public on what they call a termainal condition which requires effective palliation, at the very least.

At the moment, treatment (which may include some reversal of the pathology) of Alzheimer dementia is being heavily researched. Until the time comes for a certain cure for all causes of dementia, the importance of accurately diagnosing and crafting essential care plans for those who suffer from its horrible effects is the most effective treatment there is. Hopefully, by mid century, the estimated 17 million who will fall prey to dementia will have not only the treatments but also the resources to prevent its early mortality so prevalent in this population today. | LINK

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