Trevor Plunkett: Dementia is not a disease

Recently I read in at least three daily newspapers that dementia is now the leading cause of death in the UK. It appears that such statements arise from figures supplied by the Office of National Statistics (ONS), which wrote, “Dementia and Alzheimer’s (sic) has replaced ischaemic heart disease as the leading cause of death in England and Wales.”

The inference from these articles is that dementia itself is a death causing disease. I make the point pedantically, because I wish to be clear when I say, I wholeheartedly disagree with these statements. Newspaper journalists and editors seem unable to differentiate between disease and symptom, and the ONS is not helping.

Dementia is manifested by a group of symptoms which may be produced by any one of a number of diseases, such as Lewy body, Parkinson’s, Alzheimer’s, and cerebrol-vascular arteriosclerosis, which affect the ability of the brain to function normally, while producing symptoms recognised by doctors and lay persons as making up the condition dementia. The forms of dementia differ according to the underlying disease. For example, loss of cognition seems to be more apparent in Alzheimer’s and loss of memory with cerebro-vascular arteriosclerotic disease.

No physician would confuse dementia symptoms as being a disease. They recognise them as symptoms defining the disease, much as a rash defines measles, chicken pox, or shingles.

We will learn, no doubt, to put together different presenting symptoms of dementia to diagnose with certainty, the underlying brain disease. As I understand, present day knowledge only allows a definitive diagnosis of the underlying disease after post mortem, by biopsy of differing parts of the brain.

Currently, symptoms cannot be stated as the cause of death on a death certificate, unless the patient is older than 80, when “senility” is allowable. To my mind senility is but a synonym for dementia. Thus a symptom as a cause of death now seems to be included in ONS statistics, and this inclusion is driving death rates from brain disease above those for heart disease.

My contention is that this is a misuse of symptoms. Why not include “pyrexia” in the definitive causes of death to be incorporated into the statistics? Perhaps that is a facetious suggestion.

So my plea is to those involved with death certificate guidance: stick with the original rules of allowing only recognised diseases to be causes of death. And to newspaper editors: realise that we are not looking for a cure for dementia, per se, but for the underlying diseases. Until every disease causing dementia is conquered, the symptom will always be with us.

Trevor Plunkett is a retired GP.