Craig Ritchie

Craig Ritchie

Director of Brain Health Scotland & Professor of Psychiatry of Ageing (University of Edinburgh). My research explores links between risk factors & expression of Alzheimer's diseases in midlife.

Location Scotland

Activity

  • Thanks everyone for posting such insightful comments - several themes emerged not least the sense that the community perception of neurodegenerative disease is a long way distant from the scientific understanding. Also - many have conveyed frustration (which I share) about the primacy of memory as a symptom and that these conditions (1) only affect older...

  • Hi Susan - you were the first to comment and the last post for me to read at the end of week 1 - what a great place to finish - "a source of great hope" - see you all next week at the end of week 2.

  • There are a lot of posts about 'luck' and 'fatalism' - I wonder how we address this without also creating too much responsibility and agency which can inadvertently lead to blame

  • Thats a good point about the use of the term 'Alzheimer's" in many organisations - we went generic with Brain Health Scotland and had some push back about the vagueness but I think its worth sticking with as its about 'health' and can be seen as relevant across the life course

  • Craig Ritchie replied to [Learner left FutureLearn]

    @JoanneSaltfleet - We know that even when dementia is diagnosed in the elderly then the disease will have started in mid-life

  • Countering that fatalism is key to prevention - you need to believe that the actions you take can have benefit - how we create that virtuous cycle is something we are discussing a lot at Brain Health Scotland - any thoughts?

  • I think we need to move the detection of disease even earlier - the earlier we detect disease the more we can do to change its course - once anything develops momentum its harder to stop

  • Agree - and have posted earlier the need to get away from the primacy of 'memory' as the cardinal feature of neurodegenerative diseases - later in the condition many other symptoms predominate and early in the course of disease memory will be absolutely normal.

  • I wonder how we will perceive people when we detect disease very early before symptoms develop - I hope one day that people will say that they have early Alzheimer's disease just like they might say they have high blood pressure today

  • There is certainly a disconnect between science and practice and public perception - this is a small problem with academia - in general the impact on practice is not how we are judged - but in this area, organisations like Brain Health Scotland are seeking to bridge the gap between science and practice

  • Thanks - and agree - I'd hope that this course works to help a little with the education you refer to - please (if you think it is a good course) share widely with your friends/colleagues/family - if you dont like it - let us know and we can hopefully fix it :-)

  • May be even earlier than that - in the PREVENT Dementia programme we are seeing changes 20-30 years before expected age of onset - very subtle but maybe very amenable to intervention.

  • Sometimes I wonder about 'celebrity patients' telling their stories as each person is so different and maybe even worries if their illness doesn't look like what they see in TV or in the media - the course of disease will be very variable but hopefully with better science we can be more accurate at detecting disease really early and giving a meaningful...

  • I 100% agree with the role that the medical profession has played in this narrative. There is always going to be uncertainty in a diagnosis and in a prognosis - but being uncertain is not the same as being confused. Mixed messaging and poor communication between clinician and patient is crucial - we will be working very very hard on this in Brain Health Services

  • I agree too and have seen several posts saying the same thing - when we set up Brain Health Services in the near future - they will be community based and though psychiatrists (like me) may provide expert consultation - they will NOT be run by mental health services - they are brain diseases

  • I agree (and say this as a psychiatrist) - but cant fathom why neurodegenerative diseases are conceptualised as mental illnesses

  • @LindsayD - I agree 100% - I have no idea why we have allowed ourselves to see neurodegenerative diseases through the lens of 'memory clinics/drugs/disorders' - this will be a hard ship to turn around though

  • I agree that there is always a lack of resource BUT we can use the money in the budgets more wisely - good care pathways and high profile public health work can make a huge difference - if the public is fatalistic though then these wont work so creating a Brain Health Optimism is a crucial foundational step.

  • I agree that being fatalistic about neurodegenerative disease reduces the sense of agency and autonomy - many people expect to get it when they get older - I sometimes worry when people in their 60's say - 'well its my age' - I think we need to do better to counter the sense of inevitability and provide information and support to help reduce risk

  • @CarolynHill - I agree that we need to be empowered to take action as and when we can - the first step though is having a risk assessment and then having expert and credible advice to what may help (and follow up) - we call this a personalised prevention plan - more of that later in the course :-)

  • I am sorry to hear of your diagnosis of TLE - as Alzheimer's disease is a chronic and multifactorial condition - no one strictly speaking is immune - though we have some research ongoing looking at why some people don't ever seem to progress with Alzheimer's disease even when it starts - a bit like if you have cancer and it never spreads - if we can work out...

  • We share that hope Sarah :-)

  • @ShelleyGibson - as well as what Neil says - I think we need to start thinking differently about neurodegenerative diseases - they are brain diseases with cognitive symptoms NOT 'cognitive disorders' - people can have impaired cognition for a thousand and one reasons and that is not synonymous with neurodegenerative disease

  • I'm sorry about your mum's friend - I agree though that the science is pointing us in a very optimistic direction and in 10 years or less we will see noticeable reductions in the number of people with late stage disease

  • Awareness is certainly being raised and now with that awareness raising comes actions people can take to reduce risk and maintain well being

  • We certainly need a very simple message on the distinction - I'd advocate dropping the term 'dementia' - that would help with clearing up the confusion

  • I posted earlier about the need to distinguish between delirium and dementia - if you are a member of the SDRC (scottish dementia research consortium) www.sdrc.scot there is an excellent talk tomorrow evening (7th April 2021) from Prof Alistair MacLullich - you can still (all) register and if you miss it you can catch it in about a week on the SDRC YouTube...

  • Agree - outside of a small (but growing) 'echo chamber' - sharing this course may help that growth but credible awareness raising of the issues we are discussing here is certainly happening - at least in Scotland

  • We think that 1/3 of risk is unmodifiable (genetics and family history), 1/3 is down to other illnesses (e.g. heart disease) and lifestyle so 1/3 we don't full understand - this is maybe where 'luck' or 'bad luck' comes in but I'd hope that over time we'd get closer to understanding 100% of what causes these conditions - once we know the enemy fully we can...

  • All the things you do/suggest are brilliant - see week 2. I am not aware of any specific research findings on cannabis in neurodegenerative disease BUT we have all the data we need to do this analysis in the PREVENT Dementia programme - early findings suggest that recreational drugs across the board may lead to brain changes in mid life similar to...

  • The perception in the academic world has changed a lot - I agree though that at a clinical and public level these advances have not come through - maybe this course will help - please share it with friends/family/colleagues if you think it may help address this (mis)perception

  • In week 3 we talk a lot about imaging and other biomarkers and its likely that these tests will pick up the disease before symptoms develop - I am personally a huge advocate of neuroimaging in almost all the people I see - I very rarely get a scan back which doesn't have an impact on my management plan with the patient. Also - longitudinal changes in...

  • Just like in cancer care - the fear can be reduced substantially by better support and care - I fear that the drive for early diagnosis has in many places reduced the capacity to provide the clinical care people very often benefit from as the dementia stage of illness progresses. Alzheimer's disease need not be inevitable and 'suffering' from Alzheimer's...

  • While funding will always be an issue - I also think that getting the research that has been completed into practice is as important - we can also have our cake and eat it by setting up easier mechanisms for people (and their data) to get into research a win:win

  • This is a condition that will affect all parts of the world - in many ways public health approaches to brain health may mitigate the need for expensive treatment and care packages in later life

  • Like Cancer from 30 years ago - there is real optimism that the disease course can be changed significantly - medicine is really quite simple: early detection = better prognosis

  • The scientific knowledge is decades ahead of what is happening in 'memory' clinics all over the world - getting the research into practice and public health policy is the main objective of Brain Health Scotland - public awareness, advocacy and pressure will help for sure

  • Consistent and credible information about what Alzheimer's disease is and how this is not the same as dementia is so important. With Brain Health discussions we have a bit of a blank canvas to start from so we need to be clear, consistent and credible with all the language that we use - dropping the term 'dementia' would be a good starting point for me...

  • Maybe if we can detect it earlier we can cure it? Think about early detection of cancer as an analogy.

  • Dementia Friends and Volunteers have been crucially important in improving the quality of life for people living with dementia and their loved ones - although people themselves may not need this level of support when they have early disease and no symptoms - I do wonder that 'our' movement may be helped by setting up Brain Health Friends/Ambassadors to help...

  • You mention the dementia strategy - we are planning to produce a Brain Health Strategy for Scotland by the end of 2021 - I'd expect that many countries will follow suit in the years ahead - at least I hope so :-)

  • Although I am a psychiatrist - I really struggle massively with neurodegenerative diseases being thought of as mental illnesses - maybe this will lead to some discussion