If dementia is now a leading cause of death in England and Wales (Report, 15 November), this is partly due to increasing awareness and diagnosis of dementia, along with improving treatments for general medical disorders. These figures highlight the need for science-driven, clinically oriented research to improve diagnosis and treatment. There is currently research investigating the earliest brain changes associated with dementia, and development of novel pharmacological and psychotherapeutic interventions to improve outcomes.
However, these figures also highlight the urgent need to improve access to advance care planning and palliative care for patients who have end-stage dementia. Patients with advancing dementia experience significant psychiatric and medical comorbidities, which can pose difficult management issues for relatives and attending physicians. Advance care planning is a targeted intervention that promotes autonomy in end-of-life decisions, before individuals lose decision-making capacity.
Multidisciplinary working, involving psychiatrists, physicians and other health professionals, is required to facilitate holistic and dignified care. Service development, as well as research, is required to tackle the challenges that dementia poses, especially at the end of life.
Dr Kethan D Jethwa
Leicester
• Alzheimer’s dementia increases in incidence with age, and there is no effective treatment. It is therefore inevitable that, as longevity increases, more cases will be reported. As a consequence, more people die with the disease, but this does not mean that it was necessarily the cause of death, nor that the underlying incidence of Alzheimer’s is increasing.
Dr Bob Bury
Leeds
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Integrated care is key for dementia patients | Letters
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