1. NHPA’s Chapter 3

2. National Health Priority Areas A collaborative initiative endorsed by the Commonwealth and all state and territory governments, which seeks to focus the health sector’s attention on diseases or conditions that have a major impact on the health of Australians. The NHPAs represent the disease groups with the largest burden of disease and potential costs (direct, indirect and tangible) to the Australian community.

3. NHPA: Dementia Dementia is the most recent addition to the NHPA initiative being included in 2012. Dementia is not a specific disease, but a term used to describe over 100 conditions that are characterised by progressive and irreversible loss of brain function.

4. NHPA: Dementia As brain function deteriorates, dementia interferes with normal behaviours and functions including memory, language, speech, attention and personality. As brain cells continue to die, dementia will eventually lead to complete dependency on others and ultimately death. The most common forms of dementia include: Alzheimer disease, Vascular dementia, Dementia with Lewy bodies, and Frontotemporal dementia.

5. The most common forms of dementia include: Alzheimer disease, Vascular dementia, Dementia with Lewy bodies, and Frontotemporal dementia.

6. Alzheimer disease Alzheimer Disease Alzheimer disease is the most common form of dementia, accounting for around two thirds of all dementia cases. Alzheimer disease is most commonly reported in those aged 65 and over, but can occur at younger ages.

7. Alzheimer disease Alzheimer disease is characterised by the build-up of proteins both in and around the brain cells that limit the ability of messages to be transmitted between them. As a result, brain function becomes impaired. Figure 1: In these brain scans, the yellow and red sections reflect brain activity. The brain scan on the left shows a healthy brain, the scan on the right shows a brain affected by Alzheimer disease. The first signs of Alzheimer disease often include memory loss and general vagueness in conversation. As the deterioration of brain cells continues, the symptoms become worse and impact on memory, thinking skills, emotions, behaviour and mood.

8. Vascular Dementia Vascular dementia is a form of dementia that occurs as a result of reduced blood flow to the brain. This can occur due to a stroke or series of small strokes, or other damage to blood vessels and circulation. As the amount of oxygen and nutrients to the brain is reduced, brain cells die and function is impaired. The main symptoms of vascular dementia include problems with attention, spatial awareness, planning, reasoning and judgement (compared to Alzheimer disease where the main symptoms relate to memory loss),

9. Dementia with Lewy bodies Dementia with Lewy bodies is a common form of dementia that is caused by spherical proteins known as Lewy bodies inside the nerve cells the brain, that cause the degeneration and death of these cells. Dementia with Lewy bodies has many similarities to Alzheimer disease and accurate diagnoses can often be difficult. Symptoms of dementia with Lewy bodies include issues with concentration and attention, confusion, visual hallucinations, tremors and stiffness (similar to that seen in Parkinson's disease), variations in mental state and alertness.

10. Frontotemporal dementia Frontotemporal dementia is a disease characterised by progressive damage to two specific parts of the brain, the frontal lobe and the temporal lobe (see figure XX). Frontotemporal dementia may affect the frontal or temporal lobe, but often both lobes are affected (see figure 2).

11. Frontotemporal dementia The frontal lobe is responsible for judgement and social behaviour, so people with this type of dementia can have problems maintaining appropriate behaviour in social situations. Figure 2: The different lobes of the brain. In frontotemporal dementia, the frontal and temporal lobes are affected. The temporal lobe is responsible for language and symptoms occurring when this part of the brain is affected include the loss of the meaning of words, the inability to speak fluently, and difficulty understanding language.

12. Why is it an NHPA? In 2010, dementia was the third most common cause of death accounting for 6% of all deaths nationally and contributing significantly to morbidity rates. Dementia accounts for around 4% of the total burden of disease in Australia and is the fourth largest contributor to burden of disease overall. For those aged over 65, dementia is the second largest contributor to burden of disease behind cardiovascular disease.

13. Why is it an NHPA? Dementia affects many Australians and rates are predicted to increase significantly in the future as Australia’s population ages. Around 222 000 people in Australia were estimated to have dementia in 2011 and this number is expected to increase to around 400 000 by 2020 and 900 000 by 2050. Dementia accounted for around $5 billion in health-related costs in 2009-10. This includes GP visits and the cost of care. Those with advanced dementia may require constant care. This places a large strain on the government in terms of providing formal care and on the tens of thousands of Australians who provide informal care for family and friends suffering from these conditions.