Dying on Time

The human brain is neither prepared nor capable of crossing a certain age limit without a gradual deterioration of mental faculties. The older a person gets, the greater the threat of dementia, which is defined as a terminal decline in intellectual faculties, mainly associated with cognitive functions – thought, memory, and behavior. Even if it were possible to find a cure to stop human ageing, such a discovery would simply not come soon enough to prevent the ultimate fate of mankind.

Dementia presents a serious pandemic in this millennium. Since the 1960s, the incidence of dementia has doubled every ten years: in people around sixty-five, the rate is 6 percent, at 85 years, it is 25 percent. With the extension of the human lifespan, dementia is becoming the most common medical condition.

In the Czech Republic, precise figures are hard to come by, but on the basis of European data, one can assume that today, around 120,000 people are afflicted with medium or severe dementia. Dementia has tremendous medical, sociological and economic consequences. In 2003, the global costs of caring for people with this affliction were approximately 160 billion US dollars. One can only speculate how high these costs will rise by 2050.

No Cure

Dementia ultimately causes a worsening and eventually a complete loss of functionality in both work and social spheres. In more advanced cases, a person not only cannot remember names and facts, but also forgets also how to dress and eat. Such patients become completely detached from physical and mental reality and thus become completely dependant on external care.

Dementia is actually a symptom of a process which has many pathological causes. However, all of them have one thing in common- they affect the parts of the brain, which are important for memory and behavior. Only 15% of cases of dementia can be cured. Examples include the removal of certain toxic chemicals which damage the brain i.e,. CO2, correcting a lack of B12, compensating for a dysfunctional thyroid gland, or surgically removing a blood clot under the skull. The other 85 % belong to a category called neuro-degenerative diseases, in which a certain part of the brain begins to gradually lose its functionality. These processes can be combined with other diseases, or they can arise by themselves.

Into this unfortunate category belongs a disease which in the industrialized world represents the largest share of all forms of dementia – namely Alzheimer’s disease. At present, Alzheimer’s has no clear cause, simple diagnosis, or satisfactory cure. Estimates suggest that around twenty million people suffer from Alzheimer’s disease globally. In the Czech Republic, around 76,000 people are afflicted.

The first symptoms are unspecific – a slight loss of memory, problems with undertaking routine domestic chores, worsening orientation, a change of personality and mood. The disease is usually age-related. With age, for reasons that we do not entirely fully understand, certain parts of the brain begin to degenerate with certain pathological proteins that begin to embed themselves around nerve cells, disrupting the neurological interconnections between them. At the same time, there is a corresponding loss of acetylcholine, which is the main chemical responsible for the transmission of impulses between brain cells. The brain begins to slowly die, while at the same time shrinking.

For people older than 85, every fifth person is affected. Smoking, alcohol, head injuries, depression, high blood pressure, high levels of cholesterol or lipids and diabetes all increase the risk of the onset of dementia. A recent discovery of a group of drugs that increase the level of acetylcholine only slows down the process. In the end, the result is the same – after five years, the patient ends up needing full-time care. There is some evidence that there are other drugs that may protect the nervous system against such a fate, such as those that lower cholesterol, and maybe even non-steroidal anti-inflammatory drugs. However, no dramatic effect of their usage has yet been proven.

Taken purely scientifically, we are a biological organism which has as its main goal to survive, transfer its genes and then die. Dementia thus serves as another evolutionary mechanism. To die at the “right” time is as advantageous as being born. ?

Martin Jan Stránsky is a neurologist and is the publisher of this magazine. Translated and abridged from an article that first appeared in the Czech daily Lidové Noviny.

Martin Jan Stránský


The New Presencewinter 2008

My priority is that patients recieve
and have access to the best care possible.