Dementia in Malta : new prevalence estimates and projected trends

Previous estimates have indicated that in 2005, there were 4,072 individuals with dementia (IWD) in the Maltese islands and that this number would almost double by the year 2050. These figures were based on the EURODEM project that analysed the results of a population-based systematic review of published studies on the global prevalence of dementia from 1980 to 2004. Since then, further dementia prevalence studies have been carried out in Europe. These were reviewed in another European funded project, the EUROCODE project, with the aim of developing consensual European age and gender specific prevalence rates that would be acceptable for all countries. Using these revised rates, the estimated number of IWD over 60 years of age in the Maltese islands in 2010 was found to be 5,198; a significant increase on previous projected data. Likewise, the number of IWD in Malta over 60 years in 2030 is projected to be close to 10,000 persons or 2.3% of the total Maltese population. Using these revised estimates, the 2% prevalence rate of dementia among the local population is expected to be reached by 2025; twenty-five years prior to what was previously reported. The data presented here include current updated estimates and projections for the number of IWD in the Maltese islands.peer-reviewe

Reframing dementia care in Maltese Hospitals

This commentary addresses the urgent need to improve the care of patients with dementia and cognitive impairment in Maltese hospitals by proposing a number of dementia-friendly hospital-based initiatives. The authors discuss the rationale for developing these interventions in view of the increase in prevalence of persons with dementia in the Maltese Islands, some of whom may require hospital care at any time. Lessons learned from initiatives abroad are reviewed and an overview of the key objectives set out in the National Strategy for Dementia in the Maltese Islands is given. Finally, this article proposes a number of dementia-friendly initiatives that can be introduced in Maltese hospitals so as to induce the required change.peer-reviewe

Nicotine : Pharmacology and therapeutic implications in neurodegenerative and psychiatric disorders

The pathophysiology of tobacco-related diseases is complex and multifactorial. Among the various compounds in tobacco smoke are carcinogens such as nitrosamines, irritants such as a variety of phenolic compounds, volatiles such as carbon monoxide, and of course nicotine. Nicotine itself has quite complex actions, mediated in part by nicotinic cholinergic receptors that may have extraneuronal, as well as neuronal distribution. Its actions have also been implicated in a variety of neurodegenerative and psychiatric disorders. This short review discusses the recent pharmacology of nicotine and recent progress on its possible therapeutic benefits.peer-reviewe

NICE 2011 recommendations on the management of Alzheimer’s disease by acetylcholinesterase inhibitors and memantine

The National Institute of Clinical Excellence (NICE) has lately overturned its decision to restrict the use of acetycholinesterase inhibitors and memantine in patients diagnosed with Alzheimer’s disease (AD). It is estimated that such a policy U-turn will offer access to a significant number of individuals who were previously denied these medications. This short article will focus on the latest developments and recommendations by NICE on the use of these pharmacological agents in the managment of AD.peer-reviewe

Effects of nicotine administration on amyloid precursor protein metabolism, neural cell genesis and acquisition of spatial memory

Nicotine is reported to improve learning and memory in experimental animals. Improved learning and memory has also been related to increased neural cell genesis in the dentate gyrus of the brain hippocampal formation. Stimulation of acetylcholine receptors has also been found to enhance the expression and secretion of amyloid precursor protein (APP) in various cell lines. Aberrent metabolism of APP generates amyloid-beta (Abeta) peptide which is the major pathological lesion found in the brains of Alzheimer’s disease (AD) patients. This paper will focus on the the results obtained in our laboratory on the effects of acute and chronic nicotine administration on the metabolism of APP, its role in spatial learning and neural cell genesis in the rat brain.peer-reviewe

Animal experimentation in Malta : regulatory processes and future perspectives

Prior to Malta’s accession to the European Union (EU) in May 2004, new legislative processes regulating the use of animals for scientific research purposes were adopted in line with the provisions found under the European Union Council Directive 86/609/EEC. The scope of these regulations is to protect animals used or intended to be used in scientific experimental procedures which may cause pain, suffering, distress or lasting harm, using evaluation procedures that promote refinement, reduction and replacement techniques.peer-reviewe

Effects of chronic buproprion and nicotine administration on cell genesis and DNA fragmentation in adult rat dentate gyrus

Previous experiments have shown that chronic subcutaneous administration of nicotine dose-dependently inhibits the acquisition and retention of a spatial task in the Morris water maze and reduces cell genesis in the dentate gyrus (DG) of adult rats.1 In the present study, the effects of nicotine and buproprion, an atypical antidepressant used in smoking cessation, on dentate gyrus cell genesis and DNA fragmentation were investigated. The results show that nicotine, chronically infused for 21 days, suppressed cell genesis and enhanced DNA fragmentation in the DG, an effect not attenuated by co-administration of buproprion.peer-reviewe

Caring for older persons with dementia : the principles of person-centred care

Dementia is not a single disease or condition but a syndrome of multiple causes. It is usually used as an ‘umbrella’ term (Moore, 2009) for more than 200 different conditions and disorders characterised by a progressive deterioration in cognitive function, some of which are considerably rare. Knopman et al. (2003) proposed different diagnostic criteria for differentiating between the most common types of dementia, namely Alzheimer’s disease (AD), Vascular Dementia, Dementia with Lewy Body and Fronto-temporal dementia. Such cognitive decline includes loss of memory and impairment in executive functions such as planning and organisational skills, accompanied by personality changes and deterioration in cognitive function sufficient to limit social activities.peer-reviewe

Child anthropomorphy in the mid-20th century in the Maltese Islands

Background: Childhood obesity is has over the last decades become a major health issue in the Maltese population. A review of the mid-20th century child health concerns in Malta would help elucidate the pathophysiology of this current epidemic and determine whether the rise is genetic or a consequence of changes in nutritional and activity habits. Methods: The present study compares the body weight data of Maltese children aged 5-14 years measured in 1949 and compares these with corresponding published standards for English children published in 1965, and to data for Maltese children aged 5 and 9 years with anthropomorphic data of comparable cohort of children measured in 2009. Results: The data suggests that in the mid-20th century, Maltese children were markedly under-nourished when compared to their British counterparts. Maltese children today are shown to be particularly overweight-obese. Conclusion: The problems related to body weight in childhood have come a full circle from concerns with under-nutrition in the mid-20th century to concerns with over-nutrition in the later part of the century. Both extremes are associated with metabolic consequences that increase the likelihood of adult-onset metabolic disease, unless controlled and catered for during childhood.peer-reviewe

Pharmacotherapeutic aspects of dementia care in Malta

Dementia is the most common neurodegenerative disorder of old age affecting one percent of the local general population. It is a major predictor of morbidity and mortality in the elderly, adding a significant burden on health and social care systems across Europe. The financial impact of caring for individuals with dementia is considerable and progressive loss of cognitive function does not only pose challenges to the patients but also adds significant strain on the well-being of caregivers and family members. Although no cure is available, disease progression can be delayed by early intervention and by the use of pharmacotherapeutic agents that interfere with central neurotransmitter systems involved in cognitive processes. This review presents current trends in pharmacotherapeutic intervention in dementia care together with caregiver perceptions on treatment expectations in Malta.peer-reviewe