Anguish of an age-old affliction

Dementia is a complex clinical syndrome caused by a wide range of diseases affecting the brain and afflicting the young and the old. It is not a new illness but one that was first described in early Roman, Greek and Egyptian writings. It is, however, a condition that has received insufficient attention from researchers in the neurosciences and related disciplines. Dementia care is now entering a new and exciting era, driven by advances in the neurosciences and technology and a growing understanding of the relationship between the brain and behaviour. The advanced imaging techniques that are now available, including positron emission tomography and functional magnetic resonance imaging, are allowing researchers to explore disordered brain function. Alzheimer's disease is just one condition that is receiving particular attention.

A further driving force behind the growing interest in dementia care is the ever-increasing numbers of people afflicted by this condition. Below the age of 65 the incidence is between 0.5 and 1 per cent, primarily as a consequence of traumatic head injuries or spontaneous brain insults. After age 65 the incidence increases dramatically until by the mid to late 90s the incidence is more than 40 per cent. Furthermore, an increase in the number of elderly people is accompanied by an increase in the number of those requiring care for dementia. As life expectancy rises at a faster rate in developing countries, so does the number of people afflicted by dementia. It is, therefore, not surprising that developed countries are paying greater attention to conditions affecting their elderly populations.

The increasing prevalence of dementia is having an immense impact on the cost of healthcare provision. This would be reason enough for greater research interest in dementia, but there is also greater recognition of the need to investigate the multifaceted impact of dementia on individuals and society. This belief has fostered a growth of interest in the social impact of dementia on individuals and their families. Dementia, after all, occurs within a family context and affects the lives of many people. This is a notion that is admirably reflected in the aims, objectives and content of this innovative journal.

In the light of the growing number of people affected by dementia and the new focus on searching for causes, potential treatments and appropriate care strategies, the time is right for such a journal. It is noteworthy, however, that the focus of Dementia is on the social aspects of dementia and clinical practice. This focus is important but also problematic. Assessing quality of care and exploring strategies that might further advance the quality of care provided for those with dementia is relatively straightforward because there are accepted standards that can be assessed by those affected, professional carers and family members. By contrast, quality of life is a uniquely personal experience that can be expressed only by the individual involved.

One interesting and effective strategy adopted here is the use of the personal accounts from those afflicted by dementia. Two papers stand out. Gloria Stein and Morris Friedell provide well written and provocative papers that recall and explore their own experiences of being diagnosed and living with dementia. Reading these recollections will reinforce the fact that dementia is not an illness that can be treated in isolation. It is a condition that has an impact on the mental and physical wellbeing of real people, their families and society. As healthcare drives forward with new drugs and ever-advancing technology, the personal and social impact can too easily be neglected.

The journal's clinical relevance and desire to bridge the research-practice gap is further demonstrated by the excellent "Innovative practice" section. Jo Moriarty is correct to state that "the relationship between research and practice has often been uneasy" and that without a link there is a risk that research will become "disengaged" from the day-to-day clinical and social needs of people with dementia and their families. Paper journals usually have little space devoted to the sharing of ideas about existing or innovative practice. In the first edition of Dementia , two organisations are described that offer innovative approaches to dementia care, in Ealing, London, and the Netherlands.

A further strength of this journal lies in the interdisciplinary and international approach, which is reflected in the composition of the editorial board and associate editors. It is too soon to say if the journal will be successful in meeting its objectives but the first three issues have set the journal off firmly in the right direction.

Dementia will be of interest to all clinical disciplines involved in dementia research and the care of individuals with dementia and will be a valuable addition to many libraries and personal collections. It undoubtedly fills a gap among the mass of journals and will make a significant contribution to the effective dissemination of research and the development of high-quality clinical practice.

Leslie Gelling is nurse researcher, Academic Neurosurgery Unit, University of Cambridge.