An insight into dementia villages

A dementia village in Berlin

A new report gives an encouraging insight into the benefits of residential villages specially designed for those with Alzheimer’s and other forms of dementia, benefits that outweigh those of traditional nursing homes.

The report follows the recent positive news about trials into a drug capable of slowing cognitive decline. Now comes information from the Bloomberg Media Company describing much better community environments for dementia patients. It’s all good news at a time when developing better ideas is imperative as the number of people suffering various types of cognitive disease are predicted to triple over the next 30 years. That would mean an increase to 150 thousand in Portugal and 150 million worldwide.

The residential villages are small, enclosed and safe with public spaces to allow those with dementia, their families and friends, professional workers and volunteers to mix freely and enjoy a relatively high quality of life. Such villages have been built in parts of Europe and as far afield as Japan and New Zealand.

“The concept is resonating as societies grapple with aging populations, with rising fundamental questions about what care for Alzheimer’s and other degenerative disorders should look like, and whether the traditional nursing home model is outdated,” according to the Bloomberg report.

It quotes Jannette Spiering, one of the founders of the village idea first convened in the Netherlands: “We said, what do we have to change to make this more of a home? How could we create a community where you can go on with your own life?”  

The Netherlands project, located in Amsterdam, has about 160 inhabitants divided into various groups housed in 23 personalised residences.

In Japan, elderly people already make up almost a third of the population, compared to almost a quarter in Portugal. Japan has been working to ensure those with dementia can stay at home for as long as possible by training more social workers and others to personally engage with those with the disease, but the village concept takes that further by recreating the real world within safely enclosed spaces.

Those living in small village communities may be able to join together in pairs or small groups in doing some everyday things. In New Zealand, for example, the six or seven residents sharing individual rooms in a house can, with help if necessary, make shopping lists, wash clothes, go for walks, do a little gardening or just sit quietly chatting in the village square.

Research is being conducted in a village in the south of France into which safe but open liberties can lessen some dementia symptoms and, if so, how. If researchers succeed in showing that the holistic approach can slow cognitive decline, it could lead to a different approach for dementia care at a time when much of the medical profession and many members of the public have pinned their hopes  - and financial investments – on new but so far moderately effective medication.

People in the French pilot project, launched in the middle of the COVID pandemic, can stroll or be pushed in wheelchairs down walkways and under vaulted arches, stopping to chat with other residents or welcome visitors outside a supermarket, play scrabble outside a cafe, engage in an exercise class on park benches or have a haircut in the local salon.

“Here you are making people better, not by giving them medication, but simply because the environment is nicer,” says Paola Barbarino, CEO of Alzheimer’s Disease International, an umbrella organisation with no financial ties to any of the villages. 

Not everyone is happy with the village concept. The main criticism is that residents are trapped in a make-believe environment. Nor are the villages cheap to build, but proponents say they are less expensive to operate than nursing homes.

A French village with 120 residents could cost nearly €30 million to construct.  Building a nursing home in the same region with a similar number of beds would cost €10 million less. The maximum amount for village residents without any state or regional aid is about €2,000 a month. With subsidies it can be as low as €250 a month. A private room in a nursing home meanwhile would be about €9,000 a month, according to the international Alzheimer’s association.  

Alzheimer’s: reason for hope

Reports of a breakthrough in the treatment of Alzheimer’s have given hope to countless people close to the estimated 50 thousand people in Portugal and 50 million worldwide suffering from this disease.

There is still no cure for Alzheimer’s, the most common form of dementia. The latest reports refer to positive results from trials conducted on a drug that can slow the early stages of the disease. It is being described as the first drug to provide a real treatment option for Alzheimer’s patients.

The scientific committee of the organisation Alzheimer’s Portugal immediately issued a statement saying, “this news encourages us, and all of those on the side of Alzheimer’s patients, because it is a positive step in the fight against the disease.”

The statement went on to summarise the trials and results so far as reported in the New England Journal of Medicine.

A drug called lecanemab has been shown to reduce patients’ overall mental decline by 27% over 18 months. This may seem modest after more than 20 years of research by many specialists to fund significant remedies, but the new therapy is already being hailed as “momentous” and the start of a new era of Alzheimer’s treatment.

“While the clinical benefits seem somewhat limited, it can be expected they will become more apparent over time," says Dr Bart De Strooper, director of the UK Dementia Research Institute at  University College London. “it’s such a win for our field,” says Dr Liana Apostolova, a neurologist at the Indiana University School of Medicine in Indianapolis.

“Quite promising” is among the less enthusiastic comments from some researchers who feel more analysis is required as lecanemab has been associated with bleeding and swelling in the brain. The drug has yet to be approved by regulatory authorities.

Alzheimer’s is increasingly common, mainly among the elderly. It is a major cause of death in some countries. Many patients die within seven years of contracting the disease.

 Memory loss is the most common early indication of Alzheimer’s. This is followed in time with confusion about familiar places and people, struggling with making sensible decisions and carrying out simple tasks. Family and friends have to step in to help as early as possible.

Alzheimer’s Portugal, founded in 1988, is a member of the Alzheimer’s Europe non-governmental organisation dedicated specifically to promoting the quality of life of people with dementia along with their families and carers. Their well-qualified volunteers are continually giving advice and practical help.

The scientific committee of Alzheimer’s Portugal concluded their statement by saying: “It is not yet the solution that will solve the problem of curing the disease, but it is a small and important step in that direction.” 

Meanwhile, on a much grander scale, specialist scientists are predicting that within the next few decades there could be a second cognitive revolution that could radically change the internal mental processes that drive human behaviour. The astonishing predictions include the notion that human brains will evolve in such a way that they may be able to hugely expand their power of thinking, producing “super humans” with a much extended and perhaps indefinite lifespan.

More on this later perhaps. For now let’s keep our feet on the ground and wish Alzheimer’s and other dementia patients well.

What next for Isabel dos Santos?

The enigmatic Isabel dos Santos, arguably the most famous and infamous person in modern Portuguese history, has certainly had her ups and downs. Life for her now seems to be at an all time low and it is difficult to see what she can do about it.

The incumbent government in her homeland, the former Portuguese colony of Angola, which was returned to power in the general election in August this year, wants to finally put her behind bars for alleged corruption on a grand scale. As in Angola, the Portuguese authorities have frozen all her assets in major companies here. The Netherlands has done the same. Her reputation in the United States is such that she has been banned from entering the country.

Things became all the more serious last week when Interpol issued a red notice asking global law enforcement agencies to locate and provisionally arrest her pending extradition, surrender or similar legal actions.

This 49-year-old widow with three children is believed to be living in exile in the United Arab Emirates, though sometimes making visits to Lisbon and London. She had managed the stakes in her Lisbon companies for 12 years before immediately closing all operations when her assets were frozen in June 2020.

It is claimed she is now hiding from justice. She insists she is not and points out that she has always turned up on time when requested for questioning by the government’s investigative lawyers in Lisbon. She believes she is being politically persecuted, the victim of  false conspiracy assertions.

Despite this, she declared she would consider running for president in Angola’s general election in August. “I want to serve my country,” she said from an undisclosed location in a video interview with the German news organisation Deutsche Welle. That was a strange statement as Angola is the one place above all others she needs to steer clear of as she would be arrested on arrival for allegedly causing vast losses for the oil producing yet economically struggling nation.

With dual citizenship in Angola and Russia, it might be possible for Isabel dos Santos to go to Russia as a last ditch place to live in exile and avoid arrest, trial and likely long-term imprisonment.

Born in the former Soviet Republic of Azerbaijan, Isabel was educated in England, opened a restaurant in Angola in her early twenties and went on to create a business empire as an investment entrepreneur, thus becoming Africa’s wealthiest woman with assets worth billions of dollars.

Her life was complicated at an early age when her father, former Angolan President José Eduardo dos Santos, divorced her Russian mother, Tatiana, in 2002. Her mother took Isobel to England to attend an all-girls school in Kent and later to complete an electrical engineering degree at King’s College, London. Her mother died in 2020.  Her father, who had met Tatiana while he was studying as a young man in Azerbaijan, went on to become Angola’s president and dictator from 1978 to 2017. He married again at least twice and Isobel was the eldest of his 10 children. Her husband died in the United Arab Emirates in 2020. Her father died in Spain in July this year.

She has repeatedly denied allegations of embezzlement and money laundering, including charges in 2020 that she and her husband had stashed a billion dollars worth of Angolan state funds into their own companies while her father was president. She claims this is all false information, conspiracy lies invented by and on behalf of her father’s successor, Joao Lourenco, who has served as president since 2017.

Much of Isobel dos Santos’ alleged criminal behaviour has been exposed by the International Consortium of Investigative Journalists (ICIJ) in their ‘Luanda Leaks’ and subsequent ‘Pandora Papers’ documents.

The total value of her frozen assets is not clear. Nor is how much she has left to live on. One thing is clear, however: money does not always buy happiness.