Anxiety, Dementia and evolving holistic care

Guest Blog by Dr Iseult Roche

Last year I wrote a blog, (dementia..what’s  in a name) considering the importance and implications of labeling someone with “Dementia”. I  know still from many anecdotal conversations, that some older people are very worried about attending their GP in case they should be met with a Cognitive based assessment, rather than their repeat prescription review.

Recent research has assessed the link between anxiety, Alzheimer’s and Dementia.  The Baycrest Health Sciences Rotman Research Institute  has  highlighted that people with mild cognitive impairment,  decline significantly faster towards dementia from Alzheimer’s disease, when they also suffer from anxiety. Researchers evaluated material from the Alzheimer’s Disease Neuroimaging Initiative, and evaluated  anxiety and depression, with cognitive function and the structural brain cortical changes – in nearly  400 adults between 55-91 years ( all had  amnestic MCI and were not depressed)  each person was monitored at 6 monthly intervals over a 36-months. 

The results identified that in  mild, moderate, or severe anxiety, the risk of progressing to dementia from Alzheimer’s was increased by 33%, 78%, and 135%.

Notably, patients  who reported anxiety symptoms had greater atrophy. It waold womans concluded that this suggests  anxiety is a predictive factor for converting to Alzheimer’s, however, Medscapes recent choice of title ” Anxiety: Speeding the decline to Dementia?” is poignant and does beg for consideration – which comes first?

This is yet another issue that patients with MCI may worry about and yet another ethical and real concern for physicians and their teams, when balancing the all important holistic long term care in such chronic conditions.

‘My Name is…’ – Why its not enough?

A Patients Personal Perspective:
In the weeks before Christmas I went for my flu and pneumonia jabs.  I had been phoned by the surgery to go and was seen by the doctor’s assistant.  The relevant jabs were given and then with no warning I was told I had to have a memory test.  No rationale was given; the assistant launched into her script and then the questioning began.  I answered as best I could reciting the months of the year backwards from December, counting back from twenty to one and being questioned on a name and various details given before the questions were asked.  I have no idea how I did.  No result was given to me.  No explanation was offered as to why I had been chosen to have the test. I presume this was due to the fact that I am in my late 60s.  I had certainly not asked for this test, nor had its implications been outlined to me.

Do I have a bad memory?  Well it is not perfect but I manage pretty well most of the time.  If I had gone to the doctor with a problem or a relative had taken me because I was worried about my memory then I would have been grateful for such a test.  Now I feel I am just part of a money raising exercise by my practice and worried about my score! On this day where terminally ill NHS Doctor Kate Granger’s campaign – to have staff all greet us with #HelloMyNameIs – has hit the national headlines, it seems that having some manners and giving people the dignity of respect is where the NHS needs to start.


References
Mah L, Binns MA, Steffens DC; Alzheimer’s Disease Neuroimaging Initiative. Anxiety symptoms in amnestic mild cognitive impairment are associated with medial temporal atrophy and predict conversion to Alzheimer disease. Am J Geriatr Psychiatry. 2014 Oct 29. http://www.medscape.com

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About Julia Manning

Julia Manning is a social entrepreneur, writer, campaigner and commentator. She is based in London and is the founder and Chief Executive of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal. Through networking, technology, research, relationships and campaigning 2020health has influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. Julia studied visual science at City University and became a member of the College of Optometrists in 1991. Her career has included being a visiting lecturer at City University, a visiting clinician at the Royal Free Hospital, working with south London Primary Care Trusts and as a Director of the UK Institute of Optometry. She specialised in diabetes (University of Warwick Certificate in Diabetic Care) and founded Julia Manning Eyecare in 2004, a home and prison visiting practice for people with mental and physical disabilities using the latest digital technology, which she sold to Healthcall (now part of Specsavers) in 2009. Experiences of working in the NHS, contributing to policy development, raising two children in the inner-city and standing in the General Election in Bristol in 2005 led to Julia forming 2020health at the end of 2006. Julia is a regular guest on TV and radio shows such as BBC News, ITV’s Daybreak/ GMB, Channel 5 News, BBC 1′s The Big Questions, BBC Radio, LBC and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week. She is mum to a rugby-mad son, a daughter passionate about Shakespeare, and wife of a comprehensive school assistant head-teacher. She loves gardening, ballet, Zimbabwe, her Westies Skye and Angus, is an honorary research associate at UCL and a Fellow of the RSA.
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