Strategies For Tackling Dementia In Hampshire: Central Government And Local Efforts

Background and Rationale for the Study

Examine the central government and local strategies for tackling Dementia in Hampshire.

Alzheimer’s disease is a general source of dementia, which affects human brain and further causes memory loss, difficulty in problem-solving ability and thinking. During this disease, brain contain high rate of protein and form structures named ‘plaques’ and ‘tangles’, which create barriers in the connection of brain with nerve cells (Alzheimer’s Society, 2016). This disease is mostly noticeable among older people with certain symptoms. In order to evaluate the situation the research will concentrate on Hampshire a county in UK (BBC, 2009). As the disease generates from family members and relatives among others, therefore preventing the disease has become further important practice for the UK government. Hence, these practices and further implemented policies need to be evaluated (Dementia Action Alliance, 2016). In this context, the research proposal will determine the appropriate research methodology based on which further analysis will be conducted. The objectives and ethical issues that might occur while conducting the research will be further explained in the proposal.

Kayed, Jackson, Estes & Barrett (2011) has defined Alzheimer’s disease as the most general neurodegenerative disorder of dementia. Additionally, Alzheimer’s disease has two different principles, which include generating Aβ peptide and tau protein from Amyloid Precursor Protein (APP), and Neurofibrillary Tangles (NFT) respectively. An abnormal increase of tau protein causes neurodegenerative diseases, which distract the communication of nerve cells (Kayed, Jackson, Estes & Barrett, 2011). According to Alzheimer’s Society (2016), the symptoms of the disease vary based on individuals. Not every patient with the disease will experience similar symptoms, however, in most cases the basic symptom is memory lapse. The patient might face huge difficulties to remember any events or implement decision on any other action (Saharan & Mandal, 2013). Alzheimer’s disease do not only affects to a person, it further affect their families (Seneff, Wainwright & Mascitelli, 2011). The increasing rate of the disease has become huge concern for government. Alzheimer’s disease further makes people confused about their action (Seneff, Wainwright & Mascitelli, 2011). Although Alzheimer’s disease has affected in the worldwide context, however the U.K. has been evident to be affected more seriously. As the brain affected in the first stage, therefore these symptoms are noticeable in the patients (Seneff, Wainwright & Mascitelli, 2011). Less ability in visuospatial skills, orientations, difficulty in concentrating or organizing are the other symptoms of Alzheimer’s disease those are noticeable after certain period. With time, these symptoms become more severe, as the disease started to progress (Seneff, Wainwright & Mascitelli, 2011).

Alzheimer’s Disease: Causes and Symptoms

Neurodegenerative disorders generally regarded as conformational diseases. In the report presented by Alzheimer’s Association (2016), it has been mentioned that according to the National Institute for Health and Care Excellence (NICE), general diagnostic criteria is NINCDS/ADRDA. However, McKhann, Knopman, Chertkow, Hyman, Jack, Kawas, Klunk, Koroshetz, Manly, Mayeux, Mohs, Morris, Rossor, Scheltens, Carillo, Thies, Weintraub, Phelps (2011) have argued that in the current scenario this diagnosis might not meet every criteria of Alzheimer’s disease, therefore re-evaluation of patients is recommended. Additionally, it can further established by neuropsychological tests and clinical examinations (McKhann, Knopman, Chertkow, Hyman, Jack, Kawas, Klunk, Koroshetz, Manly, Mayeux, Mohs, Morris, Rossor, Scheltens, Carillo, Thies, Weintraub, Phelps, 2011). The disease is treatable by medication as well as without drugs by providing care to the patients, although certain drugs are for preventing other symptoms temporarily. However, a patient of mild stage often prescribed with drugs such as galantamine, donepezil, or rivastigmine (McKhann, Knopman, Chertkow, Hyman, Jack, Kawas, Klunk, Koroshetz, Manly, Mayeux, Mohs, Morris, Rossor, Scheltens, Carillo, Thies, Weintraub, Phelps, 2011). On the other hand, the NHS Constitution (2016) has provided certain probable ways through which Alzheimer’s disease expected to prevent, as the accurate cause of the disease is yet uncertain. By staying mentally active, routine health tests and reducing smoking or alcohol, people can prevent the disease (Hassan, Toumpas & Montero, 2013).         

Since the late 1970, the disease has dramatically increased and if the rate of increase continues then by the year 2050, it will exceed around 100 million in the global context (Korolev, 2014). Sorensen (2009) has mentioned in this context, that approximately 18% of neuroscientists in worldwide have conducted research of Alzheimer’s disease. Hampshire has been the top most regions suffering from Alzheimer’s disease with around 22,000 people above 60 years (Sorensen, 2009). According to the Community Mental Health Profiles (CMHP), dementia has mostly evident in older people, where Hampshire includes 0.65% of people in the worldwide context (Figure 1) (BBC, 2009). The survey conducted by BBC (2009) has revealed that currently people above 60 years in around 0.6 to 0.8 million in the UK are suffering with dementia, which can further reach to 1.7 million by the year 2050.

Figure 1: Increase of Alzheimer’s, by Age and Years

Source: (BBC, 2009)

One of the reasons for higher range of Alzheimer’s patients in Hampshire is the huge number of older population. Additionally, in this rate, almost 60-80% patients are suffering for Alzheimer’s disease in the region (BBC, 2009). Thus, it has become more interesting field to research, and Sorensen (2009) suggested that around 135,000 research papers has been published within the period of 1997-2007. In these research studies, scientists have clearly mentioned the importance of further research on neurodegenerative disorders (Sorensen, 2009). Alzheimer’s disease on the other hand is highly coordinated with the variation of social and economic aspects in several nations. Therefore, further development of therapies to modify this disease is an urgent requirement of research (Cao, Loewenstein, Lin, Zhang, Wang, Duara, Wu, Giannini, Bai, Cai, Greig, Schofield, Ashok, Small, Potter & Arendash, 2012). Furthermore, the disease mostly evident among women with high age as mentioned in the following chart (Figure 2). Several studies have further ascertained that the increasing evidences of the disease has reduced in the past two decades due to high awareness and control on risk factors regarding cardiovascular (Alzheimer’s Association, 2015).

Increase of Alzheimer’s in Hampshire

Figure 2: Estimated Lifetime Risk for Alzheimer’s, by Age and Sex

Source: (Alzheimer’s Association, 2015)

The Hampshire government has introduced Dementia Challenge in the year of 2012, which aimed to develop the care groups and research by 2015. The government has further committed to create dementia friendly communities across the county (Dementia Action Alliance, 2016). The dementia patients can openly live and further participate in community, where on the other hand they will have adequate support and care. This practice was first implemented in Hampshire, as it includes most of patient with Alzheimer’s disease (Dementia Action Alliance, 2016). The Dementia Friendly Hampshire Project (DFHP) initiated in 2013 and Hampshire County Council has further been recruiting diverse employees in Hampshire Dementia Action Alliance (HDAA) (Dementia Action Alliance, 2016). There are around 14 firms those providing services to the patients who are suffering from this disease (Dementia Action Alliance, 2016). Furthermore, the Bureau of Elderly and Adult Services has implemented several programs that concentrate on providing care to adults and children such as National Family Caregiver Support Program among others (Dementia Action Alliance, 2016). 

On the other hand, Alzheimer’s disease is an increasing concern for people and their families because of which care-providers, researchers, family members, and patients face huge ethical issues. It is a lifetime disease, which affect the brain with time and the patients steadily lose their capability to take decisions (Leuzy & Gauthier, 2012). The disease is often evident to become genetic and rarely reveal before 65. During the process of diagnosis Alzheimer’s, certain drugs are mandatory to provide such as NMDA Receptor Antagonist Memantine and Cholinesterase Inhibitors (CIs), which is although comparatively simple, but has limited accessibility to certain countries (Leuzy & Gauthier, 2012). Arguably, Hampshire has developed policies, which indicate that the caregivers will access these drugs for patients. Furthermore, the care providing authorities face issues in managing the patients in the final stage of dementia where they are almost treated as end-stage cancer patients (Leuzy & Gauthier, 2012). In future, more drugs will be introduced to delay the growth prodromal stages to Alzheimer’s (Leuzy & Gauthier, 2012). Thus, the rationale behind this research is also to determine these ethical issues and further practices that the care providing authorities are implementing to develop diagnosis process.

The aim of the study is to examine the strategies and policies implemented by the central government to prevent or manage dementia in Hampshire. In order to attain the aim of the study in a systematic and comprehensive manner, some of the objectives have been framed that are depicted hereunder.

• To examine the causes, symptoms and further commonness of dementia
• To determine the affects of dementia on elderly and their relatives or families in overall
• To assess the policies implemented and further practices or programs established by the concerned authority in the local and national level

Central Government and Local Strategies for Tackling Dementia

Preparing an effective model for research can boost the outcome towards more transparent, which will help to portray an appropriate scenario. The proper use of research instruments is an essential factor in the research methodology (Choy, 2014). In the proposed research, the qualitative method will be utilized to review the literature resources that include different consequences of Alzheimer’s disease (Sorensen, 2009). Therefore, to maintain the value and quality of research, it will include the secondary data over primary researches that were conducted by other neuroscientists (Choy, 2014). As the research will be concentrated on revealing the real scenario of the disease and the actions practiced by government, therefore different literatures that include studies conducted by the neuroscientists will prove more effective. To conduct the research, certain literatures will be considered as priority, which include neurodegenerative investigation based literatures, PubMed literatures on neurodegenerative diseases, Neuroscience Journal, and other Alzheimer’s disease literatures (Sorensen, 2009). As these literatures are studied and published by authenticated neuroscientists and government authorities, therefore the information will be more valid. In case, any other research data that are not reviewed by government or valid authorities can decrease the usefulness of the research (Choy, 2014). Furthermore, the inclusion criteria of the research include the literatures that are published within 5 years will only be reviewed for this research to provide updated data about the subject. Therefore, on the other hand, exclusion criteria include the literatures before 5 years, which will not be considered as valid data for the research (Choy, 2014). Additionally, the Boolean strategy will be considered as the literature search strategy for attaining credible and relevant litterateurs (Choy, 2014).

One of the most important strengths of qualitative research is that the outcome of the research include own perception based on in-depth research of large number of relevant literatures. Therefore, this method can easily help to collect data on dementia or Alzheimer’s disease after conducting in-depth investigation on those studies (Choy, 2014). Additionally, through this method, different studies can be compared as different scientists include different dimensions as priority. The area of this research can be considered as another positive factor, as this research will include literatures reviews based on wide range of credible studies (Choy, 2014). 

In contrast, the qualitative research has further certain limitation, which cannot be overlook while conducting the research. As the research will be conducted based on others literatures therefore exploring every data correctly can be a concern. On the other hand, although the research outcome will be provided on the base of own understanding, but it will evaluate others review on Alzheimer’s disease, which might not be similar in every research. In this situation, determining a particular outcome will become difficult (Choy, 2014). Moreover, it lacks the attribute of generalisability, wherein the association between behavioural outcomes and health of different groups of population could have been made. Although, the concerned research will consider secondary sources that were based on primary researchers, but it would not conduct any statistical analysis (Choy, 2014). Furthermore, the keywords that will include in the research are the attributes of Alzheimer’s disease such as risk factors, Amyloid β-Protein Precursor, tau protein, Dementia, Vascular, Antibodies, peptide, and Syndrome among others (Sorensen, 2009). Based on these attributes, the research will aim to evaluate current scenario of Alzheimer’s and further actions practiced by central government or local authorities. Owing to the fact that the research will be conducted in both cases general and in respect of Hampshire, therefore any particular organization will not be included in the study.

Dementia-Friendly Hampshire Project

The Alzheimer’s disease journals that will be reviewed for the research have conducted studies in every possible issues regarding Alzheimer’s, based on which the research can provide a successful outcome for the future diagnosis process. In this regard, in the entire dissertation, ethical values in research will be duly upheld, wherein the possibility of data misinterpretation and inappropriate citation will be zeroed (Choy, 2014). Additionally, there will be no attempt for copyright infringement during the secondary data collection process. Moreover, ethical values in the research will be upheld by avoiding the possibility of plagiarism (Choy, 2014).  The research process based on the secondary sources will not be exploitive and discriminatory, as it will consider a sufficient number of the relevant and credible to avoid any sort of biasness. Besides, as the concerned issue of this proposed research is highly sensitive, it will be considered that the outcome does not stigmatise any particular group, especially the elderly people (Choy, 2014).

Activities	Months
Selection of Topic	1st
Short Research of the Identified Issue	1st
Formulation of Research Question	1st
Ascertaining Research Aims and Objectives	1st – 2nd
Ascertaining appropriate Research Methodology	2nd
Writing Proposal	2nd – 3rd
Review of Literatures	3rd – 5th
Writing Final Dissertation	4th – 8th
Consultation with the Supervisor	1st – 9th
Necessary Modification	3rd – 9th
Final Submission	9th

Prior to completing research proposal, I have studied wide range of Alzheimer’s disease literatures to attain the research aims and objectives and further area to focus. Therefore, after completing the research proposal, some of the aspects have worked well, wherein I have successfully enhanced my understanding on preparing proposals for research and the process of conducting research on any topic. Additionally, I have identified my evaluating skills and ability to provide an outcome by reviewing range of literatures has further increased. On the next time, I would rather focus on reviewing more authenticated literatures, as I have developed my knowledge regarding the selection of valid literatures. Moreover, yet, I do not find any requirement of changes in the research process, however, in the future, if situation demands certain changes might be conducted for obtaining better outcome.

References

Alzheimer’s Association, 2015, ‘Alzheimer’s disease facts and figures’, Alzheimer’s & Dementia, pp. 1-83.

Alzheimer’s Society, 2016, What is Alzheimer’s disease?, Publications, viewed 23 March 2016, <https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=100>.

BBC, 2009, Dementia: Facts and figures, News, viewed 23 March 2016, <https://news.bbc.co.uk/2/hi/health/7846930.stm>.

Cao, C., Loewenstein, D.A., Lin, X., Zhang, C., Wang, L., Duara, R., Wu, Y., Giannini, A., Bai, G., Cai, J., Greig, M., Schofield, E., Ashok, R., Small, B., Potter, H. & Arendash, G.W,  2012, ‘High Blood Caffeine levels in MCI Linked to Lack of Progression to Dementia’, Journal of Alzheimer’s Disease, vol. 30, pp. 559–572.

Choy, L. T., 2014, ‘The strengths and weaknesses of research methodology: comparison and complimentary between Qualitative and Quantitative Approaches’, IOSR Journal Of Humanities And Social Science, vol. 19, iss. 4, pp. 99-104.

Dementia Action Alliance, 2016, Hampshire Dementia Action Alliance, Local Alliances, viewed 23 March 2016, <https://www.dementiaaction.org.uk/local_alliances/4147_hampshire_dementia_action_alliance>.

Hassan, M. W., Toumpas, N. A. & Montero, J. S., 2013, ‘The burden of heart disease and stroke in New Hampshire’, Department of Health and Human Services, pp. 1-101.

Kayed, R., Jackson, G. R., Estes, D. M. & Barrett, A. D. T., 2011, ‘Alzheimers disease: Review of emerging treatment role for intravenous immunoglobulins’, Journal of Central Nervous System Disease, vol. 3, pp. 67–73.

Korolev, I. O., 2014, ‘Alzheimer’s disease: a clinical and basic science review’, Medical Student Research Journal, vol. 4, pp. 24-33.

Leuzy, A. & Gauthier, S 2012, ‘Ethical issues in Alzheimer’s disease: an overview’, Expert Rev Neurother, vol. 12, no.5, pp. 557-567.

McKhann, G.M., Knopman, D.S., Chertkow, H., Hyman, B.T., Jack, C.R., Kawas, C.H., Klunk, W.E., Koroshetz, W.J., Manly, J.J., Mayeux, R., Mohs, R.C., Morris, J. C., Rossor, M. N., Scheltens, P., Carillo, M. C., Thies, B., Weintraub, S., Phelps, C. H., 2011, ‘The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup’, The Alzheimer’s Association, pp. 1-7.

NHS Constitution, 2016, Alzheimer’s disease, Overview, viewed 23 March 2016, <https://www.nhs.uk/conditions/Alzheimers-disease/Pages/Introduction.aspx>.

Saharan, S. & Mandal, P. K., 2013, ‘The emerging role of Glutathione in Alzheimer’s disease’, Journal of Alzheimer’s Disease, vol. 40, no. 3, pp.1-11.

Saharana, S. & Mandal, P. K., 2013, ‘The Emerging Role of Glutathione in Alzheimer’s Disease, Journal of Alzheimer’s Disease’, vol. 40, no. 3, pp. 1-11.

Seneff, S., Wainwright, G. & Mascitelli, L., 2011, ‘Nutrition and Alzheimer’s disease: the detrimental role of a high carbohydrate diet’, European Journal of Internal Medicine, vol. 22, no. 2, pp.134-140.

Sorensen, A. A., 2009. ‘Alzheimer’s disease research: Scientific productivity and impact of the top 100 investigators in the field’, Journal of Alzheimer’s Disease, vol. 16, pp. 451–465.