The Alzheimer illness La Maladie d'Alzheimer

Liste des liens utilisees

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The illness itself La Maladie

Alzheimer's disease is the most common cause of dementia6 affecting around (436$$$ people in the 78. The term 'dementia' descri2es a set of s*mptoms which can include loss of memor*6 mood changes6 and pro2lems with communication and reasoning. These s*mptoms occur when the 2rain is damaged 2* certain diseases and conditions6 including Alzheimer's disease. Alzheimer's disease6 first descri2ed 2* the 9erman neurologist Alois Alzheimer6 is a ph*sical disease affecting the 2rain. !uring the course of the disease6 protein 'pla:ues' and 'tangles' de1elop in the structure of the 2rain6 leading to the death of 2rain cells. &eople with Alzheimer's also ha1e a shortage of some important chemicals in their 2rain. These chemicals are in1ol1ed with the transmission of messages within the 2rain.Alzheimer's is a progressi1e disease6 which means that graduall*6 o1er time6 more parts of the 2rain are damaged. As this happens6 the s*mptoms 2ecome more se1ere.Alzheimer's disease is the most common cause of !ementia6a word that defines a group of s*mptoms associated with a decline in the wa* *our 2rain functions6 affecting *our memor* and the wa* *ou 2eha1e.Alzheimer's disease causes a progressi1e loss of 2rain cells. Who is affected Alzheimer's disease is most common in people o1er 3- *ears of age6 and affects slightl* more women than men.The Alzheimer;s 0ociet* estimates that dementia affects around 3-$6$$$ people in <ngland6 with Alzheimer;s disease responsi2le for around 3+= of dementia cases.!ementia in people under 3- *ears of age6 known as earl*%onset dementia6 is less common. n the 786 around += of all dementia cases are earl*%onset dementia. The risk increases with age6 and people who are o1er >$ *ears of age are thought to ha1e a one in si' chance of de1eloping the condition. What causes Alzheimer's disease? 0o far6 no one single factor has 2een identified as a cause for Alzheimer's disease. t is likel* that a com2ination of factors6 including age6 genetic inheritance6 en1ironmental factors6 lifest*le and o1erall general health6 are responsi2le. n some people6 the disease ma* de1elop silentl* for man* *ears 2efore s*mptoms appear. Age Age represents the greatest risk factor for de1eloping Alzheimer's disease and other t*pes of !ementia. !ementia affects one in #( people o1er the age of 3- and one in si' o1er the age of >$. /owe1er6 !ementia is not onl* restricted to older people: in the 78 there are o1er #)6$$$ people under the age of 3- with dementia6 a figure though that is likel* to 2e an underestimate. Genetic inheritance Man* people fear that the* ma* inherit Alzheimer's disease from famil* mem2ers and other

relati1es and scientists are currentl* in1estigating the genetic 2ackground to Alzheimer's.There are certainl* a few families where there is a 1er* clear inheritance of the disease from one generation to the ne't. This is often the case in families where the disease appears relati1el* earl* in life. n the 1ast ma?orit* of cases6 howe1er6 the influence of inherited genes for Alzheimer's disease in older people seems to 2e small. f a parent or other relati1e has Alzheimer's6 *our own chances of de1eloping the disease are onl* a little higher than if there were no cases of Alzheimer's in the immediate famil*. Environmental factors The en1ironmental factors that ma* contri2ute to the onset of Alzheimer's disease ha1e *et to 2e identified. A few *ears ago6 there were concerns that e'posure to aluminium might cause Alzheimer's disease. /owe1er6 these fears ha1e largel* 2een discounted. Other factors @ecause of the difference in their chromosomal make%up6 people with !own's s*ndrome who li1e into their -$s and 3$s are at particular risk of de1eloping Alzheimer's disease. &eople who ha1e had se1ere head or whiplash in?uries also appear to 2e at increased risk of de1eloping dementia. @o'ers who recei1e continual 2lows to the head are at risk too.Aesearch has also shown that people who smoke6 and those who ha1e high 2lood pressure6 high cholesterol le1els or dia2etes6 are at increased risk of de1eloping Alzheimer's. Alzheimer;s disease is a progressi1e condition6 which means that it will continue to get worse as it de1elops. <arl* s*mptoms include: minor memor* pro2lems difficult* sa*ing the right words These s*mptoms change as Alzheimer;s disease de1elops6 and it ma* lead to: disorientation personalit* changes 2eha1ioural changes There is no single test that can 2e used to diagnose Alzheimer;s disease. Bour 9& will ask *ou :uestions a2out an* pro2lems *ou are e'periencing and ma* do some tests to rule out other conditions. f Alzheimer's disease is suspected6 *ou ma* 2e referred to a specialist to confirm the diagnosis and organise a treatment plan. Preventing Alzheimer's disease There are se1eral steps *ou can take which ma* help dela* the onset of dementia6 such as: :uitting smoking and cutting down on alcohol eating a health* 2alanced diet ha1ing regular health tests as *ou get older sta*ing ph*sicall* fit and mentall* acti1e

Taking these steps also has other health 2enefits6 such as lowering *our risk of cardio1ascular disease and impro1ing *our o1erall mental health. Many of the symptoms of Alzheimers disease are similar to those of other conditions The s*mptoms of Alzheimer;s disease progress slowl* o1er se1eral *ears. /owe1er6 the rate at which the* progress will differ for each indi1idual. .o two cases of Alzheimer's disease are e1er the same 2ecause different people react in different wa*s to the condition. /owe1er6 generall*6 there are three stages to the condition:

 mild moderate se1ere These stages are descri2ed 2elow. Mild Alzheimer's disease Common s*mptoms of mild Alzheimer's disease include: forgetfulness mood swings speech pro2lems These s*mptoms are a result of a gradual loss of 2rain function. The first section of the 2rain to start deteriorating is often the part that controls the memor* and speech functions. Moderate Alzheimer's disease As Alzheimer's disease de1elops into the moderate stage6 it can also cause: disorientation difficult* performing spatial tasks Dsuch as ?udging distances or finding *our wa* aroundE pro2lems with e*esight which could lead to poor 1ision6 or in some cases6 hallucinations Dwhere *ou hear or see things that are not thereE delusions F 2elie1ing things that are untrue o2sessi1e or repetiti1e 2eha1iour a 2elief that *ou ha1e done or e'perienced something that ne1er happened distur2ed sleep incontinence F where *ou unintentionall* pass urine Durinar* incontinenceE or stools Dfaecal or 2owel incontinenceE !uring the moderate stage6 *ou ma* ha1e difficult* remem2ering 1er* recent things. &ro2lems with language and speech could also start to de1elop at this stage. This can make *ou feel frustrated and depressed6 leading to mood swings. !evere Alzheimer's disease 0omeone with se1ere Alzheimer's disease ma* seem 1er* disorientated and is likel* to e'perience hallucinations and delusions. The* ma* think that the* can smell6 see or hear things that are not there6 or 2elie1e that someone has stolen from them or attacked them when the* ha1e not. This can 2e distressing for friends and famil*6 as well as for the person with Alzheimer's disease. The hallucinations and delusions are often worse at night6 and the person with Alzheimer's disease ma* start to 2ecome 1iolent6 demanding6 and suspicious of those around them. As Alzheimer's disease 2ecomes se1ere6 it can also cause a num2er of other s*mptoms such as: d*sphagia Ddifficult* swallowingE difficult* changing position or mo1ing from place to place without assistance weight loss or a loss of appetite increased 1ulnera2ilit* to infection complete loss of short%term and long%term memor*

t is important to note that infections or medication can sometimes 2e responsi2le for an increase in s*mptoms of disorientation or distur2ed 2eha1iour. &eople with an* stage of Alzheimer's disease with s*mptoms that rapidl* increase should 2e in1estigated to rule out these causes. !uring the se1ere stage of Alzheimer's disease6 people often start to neglect their personal h*giene. t is at this stage that most people with the condition will need to ha1e full%time care 2ecause the*

will 2e a2le to do 1er* little on their own. Alzheimer's disease affects a person's a2ilit* to look after themsel1es when the* are unwell6 so another health condition can de1elop rapidl* if left untreated. A person with Alzheimer's ma* also 2e una2le to tell someone if the* feel unwell or uncomforta2le. Alzheimer's disease can shorten life%e'pectanc*. This is often caused 2* those affected de1eloping another condition6 such as pneumonia Dinflammation of the lungsE6 as a result of ha1ing Alzheimer's disease. n man* cases6 Alzheimer's disease ma* not 2e the actual cause of death6 2ut it can 2e a contri2uting factor . Mild cognitive impairment Aecentl*6 some doctors ha1e 2egun to use the term mild cogniti1e impairment DMC E when an indi1idual has difficult* remem2ering things or thinking clearl* 2ut the s*mptoms are not se1ere enough to warrant a diagnosis of Alzheimer's disease. Aecent research has shown that indi1iduals with MC ha1e an increased risk of de1eloping Alzheimer's disease. /owe1er6 the con1ersion rate from MC to Alzheimer's is low Da2out #$%+$ per cent each *earE6 and conse:uentl* a diagnosis of MC does not alwa*s mean that the person will go on to de1elop Alzheimer's.

Treatment Medicamental
"iagnosis of Alzheimer's disease Alzheimer's disease can 2e difficult to diagnose6 especiall* in the earl* stages. Bour 9& ma* ask *ou a series of :uestions designed to test *our memor* and thinking6 for e'ample6 using a test called the Mini%Mental 0tate <'amination. /e or she ma* also test *our urine or do 2lood tests to see whether an* other condition ma* 2e causing *our s*mptoms6 which ma* 2e treata2le. f *our 9& thinks that *ou ma* ha1e Alzheimer's disease6 he or she is likel* to refer *ou to a Memor* Assessment 0er1ice to see specialist doctors and nurses for more tests. These ma* include further tests to check *our memor* and thinking6 and o2ser1ation of *our 2eha1iour. Bou ma* 2e asked to ha1e a CT or MA 2rain scan.

#reatment of Alzheimer's disease There are no drug treatments a1aila2le that can pro1ide a cure for Alzheimer's disease. /owe1er6 medicines ha1e 2een de1eloped that can impro1e s*mptoms6 or temporaril* slow down their progression6 in some people. . All drugs ha1e at least two names: a generic name6 which identifies the su2stance and a proprietar* DtradeE name6 which ma* 1ar* depending upon the compan* that manufactures it. This factsheet uses generic names and gi1es the most common trade names in 2rackets. What are the main drugs used? There are two main t*pes of medication used to treat Alzheimer's disease % cholinesterase inhi2itors and .M!A receptor antagonists % which work in different wa*s. Cholinesterase inhi2itors include donepezil h*drochloride DAriceptE6 ri1astigmine D<'elonE and galantamine DAemin*lE. The .M!A receptor antagonist is memantine D<2i'aE. $o% do they %or&? "onepezil 'Aricept() rivastigmine 'E*elon( and galantamine '+eminyl( Aesearch has shown that the 2rains of people with Alzheimer's disease show a loss of ner1e cells that use a chemical called acet*lcholine as a chemical messenger. The loss of these ner1e cells is related to the se1erit* of s*mptoms that people e'perience. !onepezil6 ri1astigmine and galantamine pre1ent an enz*me known as acet*lcholinesterase from 2reaking down acet*lcholine in the 2rain. ncreased concentrations of acet*lcholine lead to increased communication 2etween the ner1e cells that use acet*lcholine as a chemical messenger6 which ma* in turn temporaril* impro1e or sta2ilise the s*mptoms of Alzheimer's disease. All three cholinesterase inhi2itors work in a similar wa*6 2ut one might suit an indi1idual 2etter than another6 particularl* in terms of side%effects e'perienced. DCurrent guidance for ./0 treatment is that the cheapest of these drugs is generall* tried first6 see '. C< guidance' 2elow.E Memantine 'E,i*a( The action of memantine is :uite different from6 and more comple' than6 that of donepezil6 ri1astigmine and galantamine. Memantine 2locks a messenger chemical known as glutamate. 9lutamate is released in e'cessi1e amounts when 2rain cells are damaged 2* Alzheimer's disease and this causes the 2rain cells to 2e damaged further. Memantine can protect 2rain cells 2* 2locking these effects of e'cess glutamate. Are these drugs effective for everyone %ith Alzheimer's disease? The latest D+$##E guidance from the .ational nstitute for /ealth and Clinical <'cellence D. C<E recommends that donepezil6 ri1astigmine and galantamine are a1aila2le as part of ./0 care for people with mild%to%moderate Alzheimer's disease. There are also now se1eral studies G including work supported 2* Alzheimer's 0ociet* G which suggest that cholinesterase inhi2itors ma* also help people with more se1ere Alzheimer's disease. /owe1er6 these drugs are not licensed in the 78 for the treatment of se1ere Alzheimer's disease. @etween ($ and )$ per cent of people with Alzheimer's disease 2enefit from cholinesterase inhi2itor treatment6 2ut it is not effecti1e for e1er*one and ma* impro1e s*mptoms onl* temporaril*6 2etween si' and #+ months in most cases. According to an Alzheimer's 0ociet* sur1e* of (6$$$ people6 those using these treatments often e'perience impro1ements in moti1ation6 an'iet* le1els and confidence6 in addition to dail* li1ing6 memor* and thinking. t is not clear whether the cholinesterase inhi2itors 2ring 2enefits for 2eha1ioural s*mptoms such as agitation or aggression. Trials ha1e gi1en mi'ed results here. Aesearch does suggest that these drugs Dand memantineE 2ring some relief from the carer's perspecti1e.

Memantine is licensed for the treatment of moderate%to%se1ere Alzheimer's disease. t can temporaril* slow down the progression of s*mptoms6 including e1er*da* function6 in people in the middle and later stages of the disease. There is e1idence that memantine ma* also help 2eha1ioural s*mptoms such as aggression and agitation Dsee our factsheeets ($>6 !rugs used to relie1e depression and 2eha1ioural s*mptoms and -$46 !ealing with aggressi1e 2eha1iourE. The +$## . C< guidance Dsee 2elowE recommends use of memantine as part of ./0 care for se1ere Alzheimer's disease and for patients with moderate disease who cannot take the cholinesterase inhi2itor drugs. -an memantine ,e ta&en at the same time as donepezil) rivastigmine or galantamine? A few studies ha1e looked6 with a range of conclusions6 at whether com2ining donepezil with memantine is more effecti1e than taking donepezil alone in moderate%to%se1ere Alzheimer's disease. A recent trial pro1ides strong e1idence that6 for people alread* on donepezil6 there are important 2enefits for 2oth patient and carer of the person remaining on donepezil when their Alzheimer's disease has 2ecome se1ere and treatment with memantine is started. Memantine works in a completel* different wa* from the acet*lcholinesterase inhi2itors and6 if a person stopped taking donepezil in order to tr* memantine6 their s*mptoms could 2ecome worse6 which could then make it difficult to assess their suita2ilit* for memantine. This latest research was not reflected in the +$## guidance from . C< which does not recommend the com2ination treatment. Hhether doctors will prescri2e 2oth medicines together6 especiall* on the ./06 is unclear. Are there any side.effects? 9enerall*6 cholinesterase inhi2itors and memantine can 2e taken without too man* side%effects. .ot e1er*one e'periences the same side%effects6 or has them for the same length of time6 if the* ha1e them at all. The most fre:uent side%effects of donepezil6 ri1astigmine and galantamine are loss of appetite6 nausea6 1omiting and diarrhoea. Ither side%effects include stomach cramps6 headaches6 dizziness6 fatigue and insomnia. 0ide%effects can 2e less likel* for people who start treatment 2* taking the lower prescri2ed dose for at least a month Dsee 'Taking the drugs' sectionE.The side%effects of memantine are less common and less se1ere than for the cholinesterase inhi2itors. The* include dizziness6 headaches6 tiredness6 increased 2lood pressure and constipation. t is important to discuss an* side%effects with the doctor and/or the dispensing pharmacist..one of these drugs are addicti1e. $o% can these drugs ,e o,tained? n the first instance6 these drugs can onl* 2e prescri2ed 2* a consultant. A 9& will need to refer the person to a hospital for a specialist assessment. A consultant will carr* out a series of tests to assess whether the person is suita2le for treatment and will write the first prescription6 if appropriate. 0u2se:uent prescriptions ma* 2e written 2* the 9& or the consultant. 0ome people ma* wish to o2tain these drugs pri1atel*. &ri1ate prescriptions can 2e o2tained through a consultant6 a 9& or a pri1ate hospital. &ri1ate prescriptions are su2?ect to consultation fees6 prescription charges and dispensing fees6 which 1ar*. The current cost of these drugs to the ./0 ranges from J>$$ to J#6$$$ per patient each *ear. /owe1er6 the 78 patents for all these drugs are e'piring during +$#+ and prices will start to fall dramaticall* as competing 'generic' 1ersions are introduced. Hhether these drugs are o2tained on the ./0 or pri1atel*6 the patient must 2e willing to take the treatment6 and should discuss an* possi2le 2enefits6 risks or side%effects with the doctor. Are these drugs effective for other types of dementia?

The acet*lcholinesterase inhi2itors were de1eloped specificall* to treat Alzheimer's disease. He do not *et know whether the* can 2e helpful for people with other forms of dementia6 although there is e1idence that the* ma* 2e effecti1e in dementia with Lew* 2odies and dementia related to &arkinson's disease6 for which ri1astigmine is licensed. . C< guidelines allow acet*lcholinesterase inhi2itors to 2e offered to people with Lew* 2od* or &arkinson's disease dementia if the* ha1e distressing s*mptoms or challenging 2eha1iours. D0ee factsheet ($,6 Hhat is dementia with Lew* 2odies? and ((+6 Aarer causes of dementia.E There are se1eral trials e'amining cholinesterase inhi2itors for the treatment of 1ascular dementia6 2ut the 2enefits are 1er* modest6 e'cept in the indi1iduals with a com2ination of 2oth Alzheimer's disease and 1ascular dementia. Cholinesterase inhi2itors are not licensed for the treatment of 1ascular dementia. D0ee factsheet ($+6 Hhat is 1ascular dementia?E Aesearch is continuing. #a&ing the drugs . C< guidelines D+$##E recommend that the consultant seeks the 1iews of the carer on the condition of the person with dementia 2efore treatment and during follow%up appointments. The* should also seek the patient's 1iews. The person must take the drugs as prescri2ed and the consultant will need to 2e sure that this is the case. !osages 1ar*. 7suall* a patient will start on a low dose6 which will 2e increased later to ma'imise effecti1eness. 0ome people ma* not 2e a2le to take the highest dose due to side%effects. The doctor will prescri2e the 2est dose for each indi1idual. nformation a2out doses is gi1en 2elow. !onepezil DAriceptE is administered once a da* at 2edtime. t is a1aila2le in -mg or #$mg ta2lets. Treatment is started at -mg a da* and then increased to #$mg a da* after one month if necessar*. The ma'imum licensed total dail* dose is #$mg. Ai1astigmine D<'elonE capsules or oral solution is taken twice a da*6 normall* in the morning and e1ening. &eople start with ,mg a da* in two di1ided doses6 which will usuall* increase to a dosage of 2etween 3mg and #+mg a da*. An <'elon patch is also a1aila2le in two 1ersions. These deli1er dail* dosages of (.3mg or 4.-mg with fewer side%effects than the capsules. &atches are suited to patients who struggle with oral medication and the* are popular with carers. The ma'imum licensed total dail* dose for ri1astigmine is #+mg. The recommended starting dose for galantamine DAemin*lE is >mg each da* for four weeks6 increased to #3mg a da* for another four weeks and then a maintenance dose of #3%+(mg dail*. 9alantamine is made in a 1ariet* of forms including a (mg/ml Dtwice%dail*E oral solution. Ta2lets of >mg and #+mg are taken twice dail* for maintenance doses. 0low% release capsules DAemin*l KLE are a1aila2le as >mg6 #3mg and +(mg. These are popular 2ecause the* need to 2e taken onl* once a da*. The ma'imum licensed total dail* dose for galantamine is +(mg. Memantine D<2i'aE comes in two forms6 as #$mg and +$mg ta2lets6 and as #$mg oral drops. The #$mg ta2lets can 2e 2roken in half6 into -mg doses6 and taken with or without food. The recommended starting dose is -mg a da*6 increasing after four weeks to up to +$mg a da*. The ma'imum licensed total dail* dose is +$mg. f the person misses a dose6 the* should take it as soon as the* remem2er6 if it is on the same da*. f it is the ne't da*6 the person should not take two ta2lets 2ut should simpl* continue with their normal dose.

/0-E guidance
The .ational nstitute for /ealth and Clinical <'cellence D. C<E re1iews drugs and decides whether the* represent good enough 1alue for mone* to 2e a1aila2le as part of ./0 treatment. n March +$##6 . C< issued new guidance recommending that people with Alzheimer's disease should now ha1e increased access to the a1aila2le drugs.

 The latest . C< guidance on drug treatments for Alzheimer's disease recommends that people in the mild%to%moderate stages of the disease should 2e gi1en treatment with donepezil DAriceptE6 galantamine DAemin*lE or ri1astigmine D<'elonE6 including indi1iduals with 2oth Alzheimer's disease and learning disa2ilities.

#al&ing therapies
Bour doctor ma* suggest other treatments that can help *ou to deal with memor* loss6 emotional s*mptoms and changes in *our 2eha1iour. 0ome of the main ones are listed 2elow. Cogniti1e stimulation therap*. This uses memor* and reasoning e'ercises6 as well as reminiscence and multisensor* stimulation to impro1e *our a2ilit* to learn6 remem2er and think. The programme helps with memor* pro2lems6 da*%to%da* acti1ities and realit* orientation. Multisensor* stimulation. This can help to impro1e *our :ualit* of life and includes music and pet therap*6 aromatherap* and massage. &s*chological inter1entions can help to reduce pro2lems such as anger6 agitation and depression. Meaningful acti1ities and engagement such as ha1ing con1ersations6 Llife stor*; work Dfocusing on the person;s pastE6 painting and drawing6 cooking and games. These can help *ou to e'press *ourself and impro1e *our :ualit* of life and sense of well2eing.

$elp and support

f *ou ha1e Alzheimer's disease6 *ou ma* 2e looked after at home6 in a care home or sometimes in hospital. The people who care for *ou can help *ou to look after *ourself and sta* health* and safe. f *ou're looking after someone with Alzheimer's disease at home6 *ou're likel* to need e'tra help and support. Looking after someone with dementia can 2e stressful and sometimes carers can neglect their own health and well2eing. As a carer6 it's important to take regular 2reaks so that *ou can look after *ourself and take some time to rela'. Aespite care is when someone comes into *our home to care for the person with dementia while *ou take a 2reak6 or when the person with dementia attends a da* centre or goes into a care home or hospital for a period of time. Irganisations such as the Alzheimer's 0ociet* and Carers 78 can gi1e *ou more information a2out respite care.

Prevention of Alzheimers disease

There are man* risk factors for Alzheimer;s disease 2ut as *et no definite wa*s to help pre1ent *ou de1eloping it. There;s nothing *ou can do a2out *our genes or *our age6 2ut aiming to li1e a health* lifest*le ma* gi1e *ou some protection. t has 2een found that the same risk factors for cardio1ascular disease can increase *our risk of Alzheimer;s disease. @* making certain health* lifest*le changes6 *ou ma* 2e protecting *ourself against 2oth diseases. Tr* to do the following to sta* health*. <'ercise regularl* F it;s recommended that *ou do #-$ minutes a week in 2outs of #$ minutes or more. !on;t smoke. Maintain a health* weight. Take measures to control high 2lood pressure or high cholesterol if *ou ha1e it. Control *our 2lood glucose if *ou ha1e dia2etes. <at a health*6 2alanced diet with lots of fruit and 1egeta2les and low amounts of saturated

fat. Inl* drink alcohol within the recommended limits. As well as making lifest*le changes6 some studies suggest that tr*ing to keep as acti1e as possi2le6 with lots of interests and ho22ies might help pre1ent Alzheimer;s disease. Ither researchers ha1e found that spending more time in education ma* also help to lower *our risk. t;s not *et known whether eating oil* fish or taking @ 1itamins can reduce the risk of Alzheimer;s disease 2ecause studies so far ha1e had mi'ed results.

0ocial and 5amil*s 0ocial et 0ocietal

Ine of the things an Alzheimer or !ementia patient has a right to is the ./0 continuing healthcare Dalso known as ./0 continuing care and full* funded ./0 careE is a package of care arranged and funded solel* 2* the ./0. t is awarded depending on whether a person's primar* need is a health need. t can 2e pro1ided in a range of settings6 including an ./0 hospital6 a care home or someone's own home. &h*llis 8night is so 2adl* affected 2* Alzheimer's that she spent four da*s li1ing with her hus2and's dead 2od* 2efore neigh2ours 2ecame aware of her plight. @ut e1en though the >-%*ear%old cannot dress herself or e1en open a 2iscuit tin6 health 2osses sa* she does not :ualif* for free ./0 care in a nursing home. The case once again highlights the unfairness of a s*stem which classes man* with dementia as eligi2le onl* for social care6 rather than nursing care for health pro2lems % which the /ealth 0er1ice has to fund 2* law. 0ocial care includes help with tasks such as dressing6 2athing or preparing meals. 0he was assessed for eligi2ilit* for ./0 'continuing care' in .o1em2er +$$>. t took Hiltshire &CT eight months to complete its report6 2efore it wrote to Mrs /oward sa*ing there was 'no e1idence of a primar* health need'. Mrs /oward then lost an appeal hearing in 0eptem2er. The 0outh Hest 0trategic /ealth Authorit* has now launched an independent panel re1iew to consider that decision on 2ehalf of the famil*. f it finds Mrs 8night is ineligi2le for continuing care6 the &CT must onl* fund her once her assets fall 2elow J+,6$$$ % the le1el a2o1e which the elderl* must pa* for their care under health ser1ice rules. 7nder <nglish law6 the elderl* must pa* for their own residential care unless their needs are considered health%related6 though it is pro1ided free in 0cotland. ./0 Horcestershire ruled that Mudith Aoe6 )(6 did not :ualif* for ./0 funding 2ecause her condition was a NsocialN rather than NhealthN pro2lem6 e1en though she was so ill she could not make a cup of tea and regularl* left the sto1e on. 0he was forced to sell her J+$$6$$$ home to pa* her J3$$%a%week nursing home fees6 which would ha1e 2een funded if she had 2een categorised correctl*. 7nder <nglish law6 elderl* people must pa* for their own residential care unless their needs are deemed health%related. 0he was assessed 2ut her needs were regarded to 2e social rather than health6 meaning she did not :ualif* for funding. n August +$$, her famil* paid for a social worker to 1isit her twice a da* and in +$$( she mo1ed into a nursing home 2ecause she was too ill to sta* at home. n +$$) she was mo1ed into another home 2ecause her condition had deteriorated. <ach ./0 trust has its own criteria for interpreting the 9o1ernment's guidelines on who :ualifies for free nursing care.