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Although the jazz singer George Melly suffered from vascular dementia and lung cancer during his final months, neither stopped him from continuing to appear in public. Shortly before he died in July he cooperated in making a film for BBC Four that is to be shown on Wednesday November 7. Melly was looked after at home by Diana, his wife, with the help of the Admiral Nurses, who work with the charity For Dementia.

Diana wrote about her 44 years with Melly in her biography Take a Girl Like Me. The book chronicles their unusually open marriage – even for a bohemian couple – from their first meeting, which led to their union being consummated later the same evening on Hampstead Heath, to their joint campaign to support the Admiral Nurses and For Dementia. An exhibition of Melly’s artwork is to be on show at the East West Gallery in Notting Hill from Friday until November 10.

In Britain at least 600,000 people have dementia, and the number is increasing as more people live longer. Alzheimer’s is the most common cause and accounts for more than 60 per cent of the cases diagnosed. Vascular dementia is a condition that results from a series of small, very often undetected, strokes, each of which damages the brain tissue slightly so that there is progressive loss of intellect. A similar number of patients suffer from mixed dementia. With this condition there is evidence of brain damage from small strokes and from Alzheimer’s. There are other forms of dementia including Parkinson’s disease and Lewy Body dementia, which has features of both Parkinson’s and Alzheimer’s.

The speed of progress of Alzheimer’s disease is variable. Its first signs show at a later age in highly educated people. Once established, the downhill path of the formerly bright, high achiever seems to be faster. Whatever the speed of the decline, the symptoms can be divided into early (mild), middle (moderately severe) and late-stage (severe) symptoms. This classification is important. NICE-approved drugs that, in some cases, slow the progress of dementia but don’t cure it, will be paid for by the NHS only for patients with middle-stage, moderately severe symptoms. Even more surprisingly, if the patient’s condition improves so much that he or she is reclassified as having only mild symptoms, the drug is discontinued. If a patient’s condition degenerates into severe, end-stage symptoms, treatment is also discontinued even if it seems to be helping.

Few of NICE’s decisions have caused such widespread discontent and seemed so lacking in human understanding. Previously it had always been considered that the most important time to treat dementia was early. If early treatment is prescribed, an appreciable number of patients are able to continue as happy and helpful members of their family and of society.

Although mild, early-stage symptoms don’t sound troubling, patients can suffer depression, loss of concentration, an inability to make decisions and an avoidance of responsibility as well as being forgetful, confused, moody, irritable and upset by the frustrations engendered by intellectual incompetence. Early middle-stage symptoms include being unable to remember time, day and place, recognise familiar surroundings or follow a conversation. Melly kept going and even took part in a performance at the 100 Club in aid of the charity For Dementia and their nurses only weeks before he died.

There are three drugs, Exelon rivastigmine, Aricept donepezil and Reminyl galantamine, that may be useful in mild to moderately severe dementia. There is also evidence that a fourth drug, Ebixa memantine, is helpful in some cases of late-stage Alzheimer’s. The good news is that even though the NHS won’t pay for treatment except for those who are euphemistically referred to as being moderately severely demented, Exelon is now available as a skin patch. As the Exelon is absorbed more smoothly through the skin there is less likelihood that a patient will suffer any mild side-effect.

For Dementia, tel 0845 2573310 or visit www.fordementia.org.uk

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