23 Dementia: thirty years back and forth

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Professor Rossor graduated from Jesus College, Cambridge and Kings College Hospital Medical School London. He trained in Neurology at the National Hospital, Queen Square and undertook research into the neurochemistry of degenerative disease at the MRC neurochemical pharmacology unit in Cambridge.He is the NIHR National Director for Dementia Research, Director of the NIHR Queen Square Dementia Biomedical Research Unit and a NIHR Senior Investigator. He is honorary consultant neurologist at the National Hospital for Neurology and Neurosurgery where he established the specialist cognitive disorders clinic which acts as a tertiary referral service for young onset and rare dementias. Clinical research interests are in neurodegenerative disease and particularly in familial disease.In 1987 dementia was still a Cinderella subject, although a regular topic at BNPA meetings. Three years earlier the McKhann criteria for Alzheimer’s disease had been published and, whilst a major advance in standardising clinical diagnosis, created two issues that remain challenging. The first was the requirement for sufficient cognitive impairment to impair everyday function and the second was the focus on episodic memory. Revised criteria have partially addressed these issues but the problems of when to diagnose Alzheimer’s disease and the significance of imaging evidence of amyloid deposition remain. The range of cognitive deficits, apart from episodic memory, in the different dementias, including Alzheimer’s disease, is now well recognised by neuropsychiatrists but not by other clinicians. In 2047 the salience of these issues will be dictated in part by the availability of drug interventions. However, an ageing population characterised by comorbidities will test the concepts of stratified and precision medicine.

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