This guest blog was contributed by Caroline Lee from the Cambridge Institute of Public Health, University of Cambridge.
The most debilitating symptoms of dementia affect a person’s ability to carry out daily activities, yet are also some of the most difficult to treat with medication.
As the health and social care burden of dementia increases, so does interest in alternatives to medication. However, the widespread take up of alternative treatments must be grounded in robust analysis both of health outcomes and of cost-effectiveness.
An off the shelf product claiming to improve memory in early Alzheimer’s disease seems to offer both hope and convenience. However, some of these, including Souvenaid, are governed by the food rather than the drugs industry and, as such, regulated differently.
While these new ‘non-pharmacological products’ are already on the market, potential new drugs remain in clinical trial, and the scientific community continues to strive for new knowledge based on robust evidence of ‘what works’.
Lack of consensus
Currently, there is a lack of consensus over how to measure whether an intervention for dementia is working or not. There is a variety of things that matter to people with dementia and their carers – not limited to memory and cognitive impairment.
Without agreement on what the most important of these is, it remains difficult and controversial to compare interventions and assess where best to invest public (and private) funds.
The effects of dementia vary by person, over time, and according to stage of progression of the syndrome. As such, a range of treatments capable of managing a variety of symptoms and tailored to meet the needs and wishes of individuals and their carers is desirable.
Medication may help some by improving symptoms and slowing down progression, but do not work for everyone. It’s hoped that non-drug interventions might have a positive effect on people’s experience of dementia, in a way that is beneficial to quality of life.
However, we don’t yet know how well some of these treatments have been evaluated, nor how effective they may be.
The Cambridgeshire and Peterborough CLAHRC is undertaking a review of the research literature to identify non-drug interventions that have been shown to have a positive impact on important outcomes (such as function and quality of life) for people with dementia living in the community.
This new research will help scientists to identify priority outcomes to focus on in measuring whether an intervention works for a person with dementia, carer or professional.
Where strong evidence can be found that treatments are of benefit, we can welcome policies that aim to make these interventions more widely available. If benefit is shown instead to be limited, then why invest resources in supporting their use?
Commissioning decisions in health and social care for dementia patients can be better informed. In the same way, where evidence on the value of new products arriving on the open market is limited, either in scope or in strength, individuals should be encouraged to pay heed to Professor Clive Ballard’s advice: act as informed consumers, and invest instead in exercise classes (which has been shown to have a positive effect).
Age UK aims to be a centre of expertise on ageing issues and a knowledge hub for all information relating to older people. Find out more about Age UK’s Knowledge Hub