Misplaced Pages

#5994

112-540: The studies, named after the Whitehall area of London and originally led by Michael Marmot , found a strong association between grade levels of civil servant employment and mortality rates from a range of causes: the lower the grade, the higher the mortality rate. Men in the lowest grade (messengers, doorkeepers, etc.) had a mortality rate three times higher than that of men in the highest grade (administrators). This effect has since been observed in other studies and named

224-429: A brain biopsy to become final, but this is rarely recommended (though it can be performed at autopsy ). In those who are getting older, general screening for cognitive impairment using cognitive testing or early diagnosis of dementia has not been shown to improve outcomes. However, screening exams are useful in 65+ persons with memory complaints. Normally, symptoms must be present for at least six months to support

336-403: A disruption in thought patterns , the most common symptoms of dementia include emotional problems, difficulties with language , and decreased motivation . The symptoms may be described as occurring in a continuum over several stages. Dementia ultimately has a significant effect on the individual, their caregivers , and their social relationships in general. A diagnosis of dementia requires

448-407: A mild or major neurocognitive disorder with varying degrees of severity and many causative subtypes. The International Classification of Diseases ( ICD-11 ) also classifies dementia as a neurocognitive disorder (NCD) with many forms or subclasses. Dementia is listed as an acquired brain syndrome, marked by a decline in cognitive function, and is contrasted with neurodevelopmental disorders . It

560-490: A 2024 new study published in Nature Mental Health. Researchers found that loneliness was associated with a 31% higher likelihood of developing any form of dementia, and it also raised the risk of cognitive impairment by 15%. Symptoms are similar across dementia types and it is difficult to diagnose by symptoms alone. Diagnosis may be aided by brain scanning techniques. In many cases, the diagnosis requires

672-612: A clinical examination and self-report questionnaire. Since then, thirteen waves of data collection have been completed: phase 1 (1984-1985; age 35 to 55), phase 2 (1989-1990), phase 3 (1991-1993), phase 4 (1995-1996), phase 5 (1997-1999), phase 6 (2001), phase 7 (2002-2004), phase 8 (2006), phase 9 (2007-2009), phase 10 (2011), phase 11 (2012-2013), phase 12 (2015-2016), phase 13 (2019-2022). The thirteenth wave began in February 2019 and finished in January 2023. It took longer as usual due to

784-528: A cohort study similar to Whitehall, but with greater analysis of the worker's stress. The study determined that decision autonomy was not a significant contributing factor to coronary heart disease, but that lack of predictability in the workplace was a significant factor. In the Finnish study, "predictability" was defined as high stability of work and lack of unexpected changes, and was found to correlate closely to employment grade. Others argue that because there

896-425: A comparable age without dementia; they are three times more likely to have urinary incontinence and four times more likely to have fecal incontinence . The course of dementia is often described in four stages – pre-dementia, early, middle, and late, that show a pattern of progressive cognitive and functional impairment. More detailed descriptions can be arrived at by the use of numeric scales. These scales include

1008-431: A continuous rate over several stages, and they vary across the dementia subtypes. Most types of dementia are slowly progressive with some deterioration of the brain well established before signs of the disorder become apparent. There are often other conditions present, such as high blood pressure or diabetes , and there can sometimes be as many as four of these comorbidities. Signs of dementia include getting lost in

1120-401: A diagnosis. Cognitive dysfunction of shorter duration is called delirium . Delirium can be easily confused with dementia due to similar symptoms. Delirium is characterized by a sudden onset, fluctuating course, a short duration (often lasting from hours to weeks), and is primarily related to a somatic (or medical) disturbance. In comparison, dementia has typically a long, slow onset (except in

1232-476: A familiar neighborhood, using unusual words to refer to familiar objects, forgetting the name of a close family member or friend, forgetting old memories, and being unable to complete tasks independently. People with developing dementia often fall behind on bill payments; specifically mortgage and credit cards, and a crashing credit score can be an early indicator of the disease. People with dementia are more likely to have problems with incontinence than those of

SECTION 10

#1732793271006

1344-467: A hormone produced by the body as a response to stress. An effect of cortisol release is a reduction in the immune system's efficacy through lymphocyte manipulation. One theory explaining the connection between immune-efficiency and CHD is that infectious pathogens, such as herpes or Chlamydia , are at least partially responsible for coronary diseases. Therefore, a body with a chronically suppressed immune system will be less able to prevent CHD. A study of

1456-630: A hot stove; or may not realize that they need to use the bathroom and become incontinent . They may not want to get out of bed, or may need assistance doing so. Commonly, the person no longer recognizes familiar faces. They may have significant changes in sleeping habits or have trouble sleeping at all. Changes in eating frequently occur. Cognitive awareness is needed for eating and swallowing and progressive cognitive decline results in eating and swallowing difficulties . This can cause food to be refused, or choked on, and help with feeding will often be required. For ease of feeding, food may be liquidized into

1568-566: A late stage from HIV infection , and mostly affects younger people. The essential features of HIV-associated dementia are disabling cognitive impairment accompanied by motor dysfunction, speech problems and behavioral change. Cognitive impairment is characterised by mental slowness, trouble with memory and poor concentration . Motor symptoms include a loss of fine motor control leading to clumsiness, poor balance and tremors. Behavioral changes may include apathy , lethargy and diminished emotional responses and spontaneity. Histopathologically , it

1680-446: A loss of appetite leading to poor nutrition. It is suggested that this dysfunction may come about because the olfactory epithelium is exposed to the environment, and the lack of blood–brain barrier protection allows toxic elements to enter and cause damage to the chemosensory networks. Pre-dementia states considered as prodromal are mild cognitive impairment (MCI) and mild behavioral impairment (MBI). Signs and symptoms at

1792-517: A matter of course where dementia is suspected. Many other medical and neurological conditions include dementia only late in the illness. For example, a proportion of patients with Parkinson's disease develop dementia, though widely varying figures are quoted for this proportion. When dementia occurs in Parkinson's disease, the underlying cause may be dementia with Lewy bodies or Alzheimer's disease , or both. Cognitive impairment also occurs in

1904-716: A memorial for both World Wars. It is the main war memorial in Britain and an annual service is held here on Remembrance Sunday , led by the reigning monarch and leading politicians. In 2005, a national Monument to the Women of World War II was erected a short distance north of the Cenotaph in the middle of the Whitehall carriageway. The Royal Tank Regiment Memorial is at the north east end of Whitehall, where Whitehall Court meets Whitehall Place. Erected in 2000, it commemorates

2016-400: A mixture of old age, high blood pressure, and damage to blood vessels in the brain. Diagnosis of mixed dementia can be difficult, as often only one type will predominate. This makes the treatment of people with mixed dementia uncommon, with many people missing out on potentially helpful treatments. Mixed dementia can mean that symptoms onset earlier, and worsen more quickly since more parts of

2128-578: A reason for the importance of these studies, was to understand the causes of this social distribution of so many disorders. Whitehall II is a longitudinal, prospective cohort study of 10,308 women and men, all of whom were employed in the London offices of the British Civil Service at the time they were recruited to the study in 1985. The Study is led by Professor Mika Kivimaki at University College London. The initial data collection included

2240-539: A residential street by the 16th century, and had become a popular place to live by the 17th, with residents including Lord Howard of Effingham and Edmund Spenser . The Palace of Whitehall, to the east of the road, was originally named York Palace, but was renamed during the reign of Henry VIII . The palace was redesigned in 1531–32 and became the King's main residence later in the decade. He married Anne Boleyn here in 1533, followed by Jane Seymour in 1536, and died at

2352-425: A result of excessive use of alcohol particularly as a substance abuse disorder. Different factors can be involved in this development including thiamine deficiency and age vulnerability. A degree of brain damage is seen in more than 70% of those with alcohol use disorder . Brain regions affected are similar to those that are affected by aging, and also by Alzheimer's disease. Regions showing loss of volume include

SECTION 20

#1732793271006

2464-574: A route connecting Charing Cross to Westminster since the Middle Ages ; the 12th-century historian William Fitzstephen described it as "a continued suburb, mingled with large and beautiful gardens, and orchards belonging to the citizens". The name Whitehall was originally only used for the section of road between Charing Cross and Holbein Gate ; beyond this it was known as The Street as far as King Street Gate , then King Street thereafter. It had become

2576-399: A similar gradient in morbidity in women as well as men. The name Whitehall II was derived from the previous Whitehall study. The Whitehall Studies revealed this social gradient for a range of different diseases: heart disease, some cancers, chronic lung disease, gastrointestinal disease, depression, suicide, sickness absence, back pain and general feelings of ill-health. A major challenge, and

2688-503: A study of working age people and investigated the relationships between work, stress, and health. Whitehall II found that the way work is organised, the work climate, social influences outside work, influences from early life, and health behaviours all contribute to the social gradient in health. As participants in this study continue through adult life, the research focuses on inequalities in health and functioning in an aging population. With an increasingly large population of older citizens in

2800-1025: A thick purée. They may also struggle to walk, particularly among those with Alzheimer's disease . In some cases, terminal lucidity , a form of paradoxical lucidity , occurs immediately before death; in this phenomenon, there is an unexpected recovery of mental clarity. Many causes of dementia are neurodegenerative , and protein misfolding is a cardinal feature of these. Other common causes include vascular dementia, dementia with Lewy bodies, frontotemporal dementia, and mixed dementia (commonly Alzheimer's disease and vascular dementia). Less common causes include normal pressure hydrocephalus , Parkinson's disease dementia , syphilis , HIV , and Creutzfeldt–Jakob disease . Alzheimer's disease accounts for 60–70% of cases of dementia worldwide. The most common symptoms of Alzheimer's disease are short-term memory loss and word-finding difficulties . Trouble with visuospatial functioning (getting lost often), reasoning, judgment and insight fail. Insight refers to whether or not

2912-404: Is a strong correlation between low employment grade and domestic stress, stress from a lack of control at work cannot be the whole story. In this line of reasoning, the size of one's paycheck alone could significantly contribute to overall stress. Those with fewer resources have a harder time making ends meet, a situation that can be a tremendous source of chronic anxiety. Adding to the controversy

3024-414: Is a type of dementia that primarily affects people in their 80s or 90s and in which TDP-43 protein deposits in the limbic portion of the brain. Hereditary disorders that can also cause dementia include: some metabolic disorders such as lysosomal storage disorders , leukodystrophies , and spinocerebellar ataxias . Persistent loneliness may significantly increase the risk of dementia according to

3136-477: Is about to fall asleep or wake up. Other prominent symptoms include problems with planning (executive function) and difficulty with visual-spatial function, and disruption in autonomic bodily functions . Abnormal sleep behaviors may begin before cognitive decline is observed and are a core feature of DLB. RBD is diagnosed either by sleep study recording or, when sleep studies cannot be performed, by medical history and validated questionnaires. Parkinson's disease

3248-519: Is also described as a spectrum of disorders with causative subtypes of dementia based on a known disorder, such as Parkinson's disease for Parkinson's disease dementia , Huntington's disease for Huntington's disease dementia, vascular disease for vascular dementia , HIV infection causing HIV dementia , frontotemporal lobar degeneration for frontotemporal dementia , Lewy body disease for dementia with Lewy bodies , and prion diseases . Subtypes of neurodegenerative dementias may also be based on

3360-493: Is associated with Lewy body dementia that often progresses to Parkinson's disease dementia following a period of dementia-free Parkinson's disease. Frontotemporal dementias (FTDs) are characterized by drastic personality changes and language difficulties. In all FTDs, the person has a relatively early social withdrawal and early lack of insight. Memory problems are not a main feature. There are six main types of FTD. The first has major symptoms in personality and behavior. This

3472-518: Is called behavioral variant FTD (bv-FTD) and is the most common. The hallmark feature of bv-FTD is impulsive behavior , and this can be detected in pre-dementia states. In bv-FTD, the person shows a change in personal hygiene, becomes rigid in their thinking, and rarely acknowledges problems; they are socially withdrawn, and often have a drastic increase in appetite. They may become socially inappropriate. For example, they may make inappropriate sexual comments, or may begin using pornography openly. One of

Whitehall Study - Misplaced Pages Continue

3584-448: Is called non-fluent agrammatic variant primary progressive aphasia (NFA-PPA). This is mainly a problem with producing speech. They have trouble finding the right words, but mostly they have a difficulty coordinating the muscles they need to speak. Eventually, someone with NFA-PPA only uses one-syllable words or may become totally mute. A frontotemporal dementia associated with amyotrophic lateral sclerosis (ALS) known as (FTD-ALS) includes

3696-428: Is due to the fact that, historically, brain tissue from patients with the disease could only be studied after the person's death. Brain scans can now help diagnose and distinguish between different kinds of dementia and show severity. These include magnetic resonance imaging (MRI), computerized tomography (CT), and positron emission tomography (PET). However, it is known that one of the first aspects of Alzheimer's disease

3808-419: Is ideal to ensure that advance care planning has occurred to protect the person's wishes. Advance directives exist that are specific to sufferers of dementia; these can be particularly helpful in addressing the decisions related to feeding which come with the progression of the illness. Mild cognitive impairment has been relisted in both DSM-5 and ICD-11 as "mild neurocognitive disorders", i.e. milder forms of

3920-494: Is identified by the infiltration of monocytes and macrophages into the central nervous system (CNS), gliosis , pallor of myelin sheaths , abnormalities of dendritic processes and neuronal loss. Creutzfeldt–Jakob disease is a rapidly progressive prion disease that typically causes dementia that worsens over weeks to months. Prions are disease-causing pathogens created from abnormal proteins. Alcohol-related dementia, also called alcohol-related brain damage, occurs as

4032-524: Is no universally-accepted cause for the phenomenon brought to light by the Whitehall studies. Clearly, stress is associated with a higher risk of coronary heart disease, but so are many other non-traditional factors. Furthermore, "stress" seems to be too nonspecific. There are different kinds of stress in one's day-to-day life and each kind could contribute differently. Vaananen, et al., are making great headway in this regard by researching which components of stress are responsible and which are not. Regardless of

4144-635: Is one of three purple squares on the British Monopoly board, along with Pall Mall and Northumberland Avenue . All three streets converge at Trafalgar Square. Dementia This is an accepted version of this page Dementia is a syndrome associated with many neurodegenerative diseases , characterized by a general decline in cognitive abilities that affects a person's ability to perform everyday activities . This typically involves problems with memory , thinking , behavior , and motor control . Aside from memory impairment and

4256-403: Is overproduction of amyloid . Extracellular senile plaques (SPs), consisting of beta-amyloid (Aβ) peptides, and intracellular neurofibrillary tangles (NFTs) that are formed by hyperphosphorylated tau proteins, are two well-established pathological hallmarks of AD. Amyloid causes inflammation around the senile plaques of the brain , and too much buildup of this inflammation leads to changes in

4368-401: Is the mini–mental state examination . Although the greatest risk factor for developing dementia is aging, dementia is not a normal part of the aging process; many people aged 90 and above show no signs of dementia. Several risk factors for dementia, such as smoking and obesity , are preventable by lifestyle changes. Screening the general older population for the disorder is not seen to affect

4480-463: Is the disagreement over the cortisol explanation in the first place. The theory is based on a pathogenic contribution to coronary heart disease and the stressed body's inability to fight it. Follow-up studies on the Whitehall II cohort failed to demonstrate a correlation between pathogen burden and socioeconomic status, whereas other studies in different parts of the world have. An alternative to

4592-410: Is the final stage. Pre-dementia includes pre-clinical and prodromal stages. The latter stage includes mild cognitive impairment (MCI), delirium-onset, and psychiatric-onset presentations. Sensory dysfunction is claimed for the pre-clinical stage, which may precede the first clinical signs of dementia by up to ten years. Most notably the sense of smell is lost, associated with depression and

Whitehall Study - Misplaced Pages Continue

4704-530: Is used as a metonym for the British civil service and government , and as the geographic name for the surrounding area. The Palace of Whitehall previously occupied the area and was the residence of Kings Henry VIII through to William III , before it was destroyed by fire in 1698; only the Banqueting House has survived. Whitehall was originally a wide road that led to the gates of the palace;

4816-854: The City of Westminster . It is part of the A3212 , a main road in Central London that leads towards Chelsea via the Houses of Parliament and Vauxhall Bridge . It runs south from Trafalgar Square , past numerous government buildings, including the old War Office building, Horse Guards , the Ministry of Defence , the Cabinet Office , and the Department of Health . It ends at the Cenotaph ,

4928-640: The Cognitive Abilities Screening Instrument (CASI), the Trail-making test , and the clock drawing test . The MoCA ( Montreal Cognitive Assessment ) is a reliable screening test and is available online for free in 35 different languages. The MoCA has also been shown somewhat better at detecting mild cognitive impairment than the MMSE. People with hearing loss , which commonly occurs alongside dementia, score worse in

5040-566: The Department of Health since 1987. The building is scheduled to be a temporary debating chamber from 2025, while the Houses of Parliament undergo a refurbishment and modernisation programme. Statues and memorials have been built on and around Whitehall, commemorating military victories and leaders. The Cenotaph was designed by Sir Edwin Lutyens and erected at the southern end in 1919, commemorating victory in World War I and later used as

5152-546: The Earl Haig Memorial ), Field Marshal Montgomery (commander of the 8th Army , the 21st Army Group and Chief of the Imperial General Staff ), William Slim, 1st Viscount Slim , Commander of the 14th Army and Governor-General of Australia , and Alan Brooke, 1st Viscount Alanbrooke , Chief of the Imperial General Staff . The Whitehall Theatre opened in 1930 at the north west end of

5264-915: The Office of the Parliamentary Counsel at No. 36, the Horse Guards , the Ministry of Defence Main Building , Dover House (containing the Scotland Office ), Gwydyr House (containing the Wales Office ), the Cabinet Office at No. 70, the Foreign and Commonwealth Office and the Government Offices Great George Street ( HM Treasury , HM Revenue and Customs and parts of

5376-564: The Provisional IRA fired mortars from a van parked in Whitehall towards No. 10 , one of which exploded in the gardens. Additional security measures have been put in place along Whitehall to protect government buildings, following a £25 million streetscape project undertaken by Westminster City Council . The project has provided wider pavements and better lighting, along with installing hundreds of concrete and steel security barriers. Richmond House , at No. 79, has held

5488-592: The Trafalgar Studios ) was formerly associated with a series of farces . The name Whitehall was used for several buildings in the Tudor period . It either referred to a building made of light stone, or as a general term for any festival building. This included the Royal Palace of Whitehall , which in turn gave its name to the street. The street is about 0.4 miles (0.64 km) long and runs through

5600-665: The blood supply to the brain , typically involving a series of mini-strokes . The symptoms of this dementia depend on where in the brain the strokes occurred and whether the blood vessels affected were large or small. Repeated injury can cause progressive dementia over time, while a single injury located in an area critical for cognition such as the hippocampus, or thalamus, can lead to sudden cognitive decline. Elements of vascular dementia may be present in all other forms of dementia. Brain scans may show evidence of multiple strokes of different sizes in various locations. People with vascular dementia tend to have risk factors for disease of

5712-548: The cortisol awakening response (the difference between cortisol levels upon awakening and thirty minutes later) further supports the significance of cortisol. Workers showed no significant difference in cortisol levels upon awakening, regardless of socioeconomic position. However, the lower employment grades showed significantly higher levels thirty minutes later, particularly if it was a workday. Researchers concluded that to be caused by chronic stress and its anticipation. This seems counter-intuitive: one usually thinks of those with

SECTION 50

#1732793271006

5824-430: The mini mental state examination (MMSE) is the best studied and most commonly used. The MMSE is a useful tool for helping to diagnose dementia if the results are interpreted along with an assessment of a person's personality, their ability to perform activities of daily living, and their behaviour. Other cognitive tests include the abbreviated mental test score (AMTS), the, "modified mini–mental state examination" (3MS),

5936-503: The "status syndrome". The first Whitehall Study compared mortality of people in the highly stratified environment of the British Civil Service . It showed that among British civil servants, mortality was higher among those in the lower grade when compared to the higher grade. The more senior one was in the employment hierarchy, the longer one might expect to live compared to people in lower employment grades. The first of

6048-591: The 1820s, which allowed Sir Robert Peel to use it as the main headquarters when forming the police in 1829. It was formally named the Metropolitan Police Office, but became quickly known as Great Scotland Yard, and eventually Scotland Yard. The buildings were damaged in a series of bombings by Irish nationalists in 1883, and an explosion from a Fenian terrorist attack on 30 May 1884 blew a hole in Scotland Yard's outer wall and destroyed

6160-533: The 18th century, traffic was struggling along the narrow streets south of Holbein Gate, which led to King Street Gate being demolished in 1723. Holbein Gate, in turn, was demolished in 1759. Meanwhile, Parliament Street was a side road alongside the palace, leading to the Palace of Westminster . After the Palace of Whitehall was destroyed, Parliament Street was widened to match Whitehall's width. The present appearance of

6272-494: The 1950s and '60s, and 1981's satirical Anyone for Denis , written by John Wells and Private Eye editor Richard Ingrams . The venue was Grade II listed in 1996 and renamed the Trafalgar Studios in 2004. Because of its importance as the centre of the British government, several political comedies are based in and around Whitehall. These include the BBC television series Yes Minister and The Thick of It . Whitehall

6384-524: The 19th century, as private leases ran out on residential buildings, ownership reverted to the Crown, which began to use them as public offices. The name "Whitehall" is now used as a metonym to refer to that part of the civil service which is involved in the government of the United Kingdom . The street's central portion is dominated by military buildings, including the Ministry of Defence , with

6496-656: The Cabinet Office). Scotland Yard , the headquarters of London's Metropolitan Police Service , was originally located in Great Scotland Yard off the north-eastern end of Whitehall. The buildings had been lodgings for the Kings of Scotland, on part of the old Palace of Whitehall's grounds; by the 19th century, Little and Middle Scotland Yard had been merged into Whitehall Place, leaving only Great Scotland Yard. No. 4 Whitehall Place had become vacant by

6608-613: The Covid-19 pandemic. More information about this table at the Data Collection (external link) page of the project. Research continues to explore the pathways and mechanisms through which social position influences health. The research group aims to build a causal model leading from social position through psychosocial and behavioural pathways to pathophysiological changes, sub-clinical markers of disease, functional change, and clinical disease. The Whitehall II study began as

6720-536: The Department of Epidemiology and Public Health at University College London initiated the Whitehall II study. It is now directed by Professor Mika Kivimaki. Marmot was the commissioner of the World Health Organization 's Commission on Social Determinants of Health. Whitehall Whitehall is a road and area in the City of Westminster , Central London , England. The road forms

6832-705: The Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS or Reisberg Scale), the Functional Assessment Staging Test (FAST), and the Clinical Dementia Rating (CDR). Using the GDS, which more accurately identifies each stage of the disease progression, a more detailed course is described in seven stages – two of which are broken down further into five and six degrees. Stage 7(f)

SECTION 60

#1732793271006

6944-514: The MoCA test, which could lead to a false diagnosis of dementia. Researchers have developed an adapted version of the MoCA test, which is accurate and reliable and avoids the need for people to listen and respond to questions. The AD-8 – a screening questionnaire used to assess changes in function related to cognitive decline – is potentially useful, but is not diagnostic, is variable, and has risk of bias. An integrated cognitive assessment ( CognICA )

7056-608: The Neuropsychiatric Inventory or the Geriatric Depression Scale . Physicians used to think that people with memory complaints had depression and not dementia (because they thought that those with dementia are generally unaware of their memory problems). However, researchers have realized that many older people with memory complaints in fact have mild cognitive impairment the earliest stage of dementia. Depression should always remain high on

7168-570: The Palace of Whitehall in 1658. During the Great Plague of London in 1665, people boarded coaches at Whitehall, then at the edge of urban London, in an attempt to escape. The King and court temporarily moved to Oxford to avoid the plague, while Samuel Pepys remarked in his diary on 29 June, "By water to Whitehall, where the Court is full of waggons and people ready to go out of town. This end of town every day grows very bad with plague". By

7280-475: The Parkinson-plus syndromes of progressive supranuclear palsy and corticobasal degeneration (and the same underlying pathology may cause the clinical syndromes of frontotemporal lobar degeneration ). Although the acute porphyrias may cause episodes of confusion and psychiatric disturbance, dementia is a rare feature of these rare diseases. Limbic-predominant age-related TDP-43 encephalopathy (LATE)

7392-492: The UK, there is an urgent need to identify the causes of social inequalities and to study the long-term effects of previous circumstances on people's ability to function and stay healthy during retirement. Researchers in the Whitehall II team are also considering the role of social inequalities in relation to dementia risk. The Whitehall II team have a data sharing policy, allowing researchers from other institutions to use data from

7504-453: The Whitehall II cohort. There is a slightly different data sharing policy for projects that involve genetic information. This policy suggests that the team are engaging with the open access movement , a social movement which is gaining momentum in academia. The social gradient in health is not a phenomenon confined to the British Civil Service. Throughout the developed world, wherever researchers have had data to investigate, they have observed

7616-834: The Whitehall studies, or Whitehall I, found higher mortality rates due to all causes for men of lower employment grade. The study also revealed a higher mortality rate specifically due to coronary heart disease for men in the lower employment grade when compared to men in higher grades. The initial Whitehall study found lower grades, and thus status , were clearly associated with higher prevalence of significant risk factors. These risk factors include obesity , smoking, reduced leisure time, lower levels of physical activity, higher prevalence of underlying illness, higher blood pressure , and shorter height. Controlling for these risk factors accounted for no more than forty percent of differences between civil service grades in cardiovascular disease mortality . After controlling for these risk factors,

7728-404: The blood vessels , such as tobacco use , high blood pressure , atrial fibrillation , high cholesterol , diabetes , or other signs of vascular disease such as a previous heart attack or angina . The prodromal symptoms of dementia with Lewy bodies (DLB) include mild cognitive impairment , and delirium onset. The symptoms of DLB are more frequent, more severe, and earlier presenting than in

7840-437: The brain that cannot be controlled, leading to the symptoms of Alzheimer's. Several articles have been published on a possible relationship (as an either primary cause or exacerbation of Alzheimer's disease) between general anesthesia and Alzheimer's in specifically the elderly . Vascular dementia accounts for at least 20% of dementia cases, making it the second most common type. It is caused by disease or injury affecting

7952-443: The brain will be affected. Chronic inflammatory conditions that may affect the brain and cognition include Behçet's disease , multiple sclerosis , sarcoidosis , Sjögren's syndrome , lupus , celiac disease , and non-celiac gluten sensitivity . These types of dementias can rapidly progress, but usually have a good response to early treatment. This consists of immunomodulators or steroid administration, or in certain cases,

8064-405: The cases of a stroke or trauma), slow decline of mental functioning, as well as a longer trajectory (from months to years). Some mental illnesses , including depression and psychosis , may produce symptoms that must be differentiated from both delirium and dementia. These are differently diagnosed as pseudodementias , and any dementia evaluation needs to include a depression screening such as

8176-443: The cortisol explanation is that self-esteem is the major contributing factor and that the link between professional achievement and self-esteem accounts for the health gradient. The study supporting this view correlated low self-esteem in test subjects with greater reductions in heart rate variability and higher heart rates in general—both established coronary heart disease risk factors—while performing stressful tasks. Currently there

8288-891: The elimination of the causative agent. A 2019 review found no association between celiac disease and dementia overall but a potential association with vascular dementia. A 2018 review found a link between celiac disease or non-celiac gluten sensitivity and cognitive impairment and that celiac disease may be associated with Alzheimer's disease, vascular dementia, and frontotemporal dementia . A strict gluten-free diet started early may protect against dementia associated with gluten-related disorders . Cases of easily reversible dementia include hypothyroidism , vitamin B 12 deficiency , Lyme disease , and neurosyphilis . For Lyme disease and neurosyphilis, testing should be done if risk factors are present. Because risk factors are often difficult to determine, testing for neurosyphilis and Lyme disease, as well as other mentioned factors, may be undertaken as

8400-432: The exact reason why coronary heart disease is more prevalent in lower employment grades, the results of the Whitehall studies have significantly changed the way some doctors approach the evaluation of heart disease risk. By recognizing the effects of psychosocial stressors on the body, in addition to the traditional risk factors, physicians can offer a better assessment of a patient's health. Professor Sir Michael Marmot of

8512-472: The first part of the A3212 road from Trafalgar Square to Chelsea . It is the main thoroughfare running south from Trafalgar Square towards Parliament Square . The street is recognised as the centre of the Government of the United Kingdom and is lined with numerous departments and ministries, including the Ministry of Defence , Horse Guards and the Cabinet Office . Consequently, the name "Whitehall"

8624-520: The first signs. As dementia progresses, initial symptoms generally worsen. The rate of decline is different for each person. MMSE scores between 6 and 17 signal moderate dementia. For example, people with moderate Alzheimer's dementia lose almost all new information. People with dementia may be severely impaired in solving problems, and their social judgment is often impaired. They cannot usually function outside their own home, and generally should not be left alone. They may be able to do simple chores around

8736-737: The former headquarters of the British Army and Royal Navy , the Royal United Services Institute , the Horse Guards building and the Admiralty , on the opposite side. Government buildings on Whitehall, from north to south, include The Admiralty Buildings, the Department for International Development at No. 22, the Department of Energy and Climate Change at No. 55, the Old War Office ,

8848-457: The frontal, temporal, and parietal lobes, as well as the cerebellum, thalamus, and hippocampus. This loss can be more notable, with greater cognitive impairments seen in those aged 65 years and older. More than one type of dementia, known as mixed dementia, may exist together in about 10% of dementia cases. The most common type of mixed dementia is Alzheimer's disease and vascular dementia. This particular type of mixed dementia's main onsets are

8960-539: The house but not much else, and begin to require assistance for personal care and hygiene beyond simple reminders. A lack of insight into having the condition will become evident. People with late-stage dementia typically turn increasingly inward and need assistance with most or all of their personal care. People with dementia in the late stages usually need 24-hour supervision to ensure their personal safety, and meeting of basic needs. If left unsupervised, they may wander or fall; may not recognize common dangers such as

9072-530: The issues around health inequalities within and between countries, the social determinants of health, and act to address those issues. The CSDH acted as a catalyst for change, working with countries, academics, and civil society to bring health inequalities to the fore in the national policy dialogue. The overarching goals of the CSDH were to improve population health, to reduce health inequities, and to reduce disadvantages due to ill health. Subjects of Whitehall II in

9184-418: The list of possibilities, however, for an elderly person with memory trouble. Changes in thinking, hearing and vision are associated with normal ageing and can cause problems when diagnosing dementia due to the similarities. Given the challenging nature of predicting the onset of dementia and making a dementia diagnosis clinical decision making aids underpinned by machine learning and artificial intelligence have

9296-409: The lowest employment grades were more likely to have many of the established risk factors of coronary heart disease (CHD): a propensity to smoke, lower height-to-weight ratio, less leisure time, and higher blood pressure. However, even after normalizing for those factors, the lower employment grades were still at greater risk for a heart attack; another factor was at work. Some have pointed to cortisol,

9408-535: The lowest grade still had a relative risk of 2.1 for cardiovascular disease mortality compared to the highest grade. Whitehall I was carried out by the Department of Medical Statistics & Epidemiology at the London School of Hygiene & Tropical Medicine and published in 1987. The Whitehall Study papers are available to view at the School's archives. Twenty years later, the Whitehall II study documented

9520-415: The major neurocognitive disorder (dementia) subtypes. Kynurenine is a metabolite of tryptophan that regulates microbiome signaling, immune cell response, and neuronal excitation. A disruption in the kynurenine pathway may be associated with the neuropsychiatric symptoms and cognitive prognosis in mild dementia. In the early stage of dementia, symptoms become noticeable to other people. In addition,

9632-399: The meaning of objects as well. For example, a drawing of a bird, dog, and an airplane in someone with FTD may all appear almost the same. In a classic test for this, a patient is shown a picture of a pyramid and below it a picture of both a palm tree and a pine tree. The person is asked to say which one goes best with the pyramid. In SV-PPA the person cannot answer that question. The other type

9744-410: The most common signs is apathy , or not caring about anything. Apathy, however, is a common symptom in many dementias. Two types of FTD feature aphasia (language problems) as the main symptom. One type is called semantic variant primary progressive aphasia (SV-PPA). The main feature of this is the loss of the meaning of words. It may begin with difficulty naming things. The person eventually may lose

9856-450: The most decision-making responsibility as the ones with the most stressful lives. One theory is that the lower one is on the chain of command, the less control one has over his or her life. Not having to take orders on how to perform a task, or when to do it, results in lower heart rate, stress hormones, and blood pressure than being told how and when to perform it. This theory, however, is not without its detractors. A Finnish study conducted

9968-457: The neighbouring Rising Sun pub. The headquarters was moved away from Whitehall in 1890. Downing Street leads off the south-west end of Whitehall, just above Parliament Street. It was named after Sir George Downing , who built a row of houses along the street around 1680 leading west from Whitehall. Following a number of terrorist attacks, the road was closed to the public in 1990, when security gates were erected at both ends. On 7 February 1991,

10080-425: The neurocognitive deficits may sometimes show improvement with treatment of the causative medical condition. Diagnosis of dementia is usually based on history of the illness and cognitive testing with imaging . Blood tests may be taken to rule out other possible causes that may be reversible, such as hypothyroidism (an underactive thyroid), and to determine the dementia subtype. One commonly used cognitive test

10192-451: The observation of a change from a person's usual mental functioning and a greater cognitive decline than might be caused by the normal aging process. Several diseases and injuries to the brain, such as a stroke , can give rise to dementia. However, the most common cause is Alzheimer's disease , a neurodegenerative disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) , has re-described dementia as

10304-461: The other dementia subtypes. Dementia with Lewy bodies has the primary symptoms of fluctuating cognition, alertness or attention; REM sleep behavior disorder (RBD); one or more of the main features of parkinsonism , not due to medication or stroke; and repeated visual hallucinations. The visual hallucinations in DLB are generally vivid hallucinations of people or animals and they often occur when someone

10416-417: The outcome. Dementia is currently the seventh leading cause of death worldwide and has 10 million new cases reported every year (approximately one every three seconds). There is no known cure for dementia. Acetylcholinesterase inhibitors such as donepezil are often used and may be beneficial in mild to moderate disorder, but the overall benefit may be minor. There are many measures that can improve

10528-399: The palace in 1547. Charles I owned an extensive art collection at the palace and several of William Shakespeare 's plays had their first performances here. It ceased to be the royal residence after 1689, when William III moved to Kensington Palace for his health to escape what had become dense urban surroundings. The palace was damaged by fire in 1691, following which the front entrance

10640-441: The person realizes they have memory problems. The part of the brain most affected by Alzheimer's is the hippocampus . Other parts that show atrophy (shrinking) include the temporal and parietal lobes . Although this pattern of brain shrinkage suggests Alzheimer's, it is variable and a brain scan is insufficient for a diagnosis. Little is known about the events that occur during and that actually cause Alzheimer's disease. This

10752-468: The potential to enhance clinical practice. Various brief cognitive tests (5–15 minutes) have reasonable reliability to screen for dementia, but may be affected by factors such as age, education and ethnicity. Age and education have a significant influence on the diagnosis of dementia. For example, Individuals with lower education are more likely to be diagnosed with dementia than their educated counterparts. While many tests have been studied, presently

10864-599: The prodromal stage may be subtle, and the early signs often become apparent only in hindsight. Of those diagnosed with MCI, 70% later progress to dementia. In mild cognitive impairment, changes in the person's brain have been happening for a long time, but the symptoms are just beginning to appear. These problems, however, are not severe enough to affect daily function. If and when they do, the diagnosis becomes dementia. The person may have some memory problems and trouble finding words, but they can solve everyday problems and competently handle their life affairs. During this stage, it

10976-496: The public since 1963. Oliver Cromwell moved to the street in 1647, taking up residence in Wallingford House. Two years later, Charles I was carried through Whitehall on the way to his trial at Westminster Hall . Whitehall itself was a wide street and had sufficient space for a scaffold to be erected for the King's execution at Banqueting House. He made a brief speech there before being beheaded. Cromwell died at

11088-884: The quality of life of a person with dementia and their caregivers. Cognitive and behavioral interventions may be appropriate for treating the associated symptoms of depression. The signs and symptoms of dementia are termed as the neuropsychiatric symptoms —also known as the behavioral and psychological symptoms—of dementia. The behavioral symptoms can include agitation , restlessness, inappropriate behavior, sexual disinhibition, and verbal or physical aggression. These symptoms may result from impairments in cognitive inhibition . The psychological symptoms can include depression, hallucinations (most often visual), delusions, apathy, and anxiety. The most commonly affected areas of brain function include memory , language , attention , problem solving , and visuospatial function affecting perception and orientation. The symptoms progress at

11200-400: The road ahead being Parliament Street. Great Scotland Yard and Horse Guards Avenue branch off to the east, while Downing Street branches off to the west at the southern section of the street. The nearest tube stations are Charing Cross at the north end, and Westminster at the south. Numerous London bus routes run along Whitehall, including 12, 24, 88, 159 and 453. There has been

11312-400: The route to the south was widened in the 18th century, following the destruction of the palace, and the area was largely rebuilt for government offices. As well as government buildings, the street is known for its memorial statues and monuments, including the UK's primary war memorial, the Cenotaph . South of the Cenotaph the thoroughfare becomes Parliament Street. The Whitehall Theatre (now

11424-637: The social gradient in health. In order to address inequalities in health, it is necessary both to understand how social organisation affects health, and to find ways to improve the conditions in which people work and live. Michael Marmot chaired the World Health Organization's Commission on Social Determinants of Health (CSDH), which was established in 2005 and launched its final report in August 2008. The Commission sought to engage with policy makers, global institutions, and civil society on

11536-583: The street dates from 1899 after a group of houses between Downing Street and Great George Street were destroyed. On 8 March 1973, the IRA detonated a bomb in front of the Ministry of Agriculture building in Whitehall, injuring a number of bystanders. On 7 February 1991, the IRA launched a mortar attack on 10 Downing Street in an unsuccessful attempt to assassinate Prime Minister John Major and his cabinet. By

11648-473: The street, on a site that had previously been Ye Old Ship Tavern in the 17th century. The revue Whitehall Follies opened in 1942, which drew controversy over its explicit content featuring the stripper and actress Phyllis Dixey . The theatre became known for its series of farces , reviving a tradition on Whitehall that had begun with court jesters at the palace during the 16th century; these included several plays featuring actor-manager Brian Rix throughout

11760-1010: The symptoms begin to interfere with daily activities, and will register a score on a mini–mental state examination (MMSE). MMSE scores are set at 24 to 30 for a normal cognitive rating and lower scores reflect severity of symptoms. The symptoms are dependent on the type of dementia. More complicated chores and tasks around the house or at work become more difficult. The person can usually still take care of themselves but may forget things like taking pills or doing laundry and may need prompting or reminders. The symptoms of early dementia usually include memory difficulty, but can also include some word-finding problems , and problems with executive functions of planning and organization. Managing finances may prove difficult. Other signs might be getting lost in new places, repeating things, and personality changes. In some types of dementia, such as dementia with Lewy bodies and frontotemporal dementia , personality changes and difficulty with organization and planning may be

11872-646: The symptoms of FTD (behavior, language and movement problems) co-occurring with amyotrophic lateral sclerosis (loss of motor neurons). Two FTD-related disorders are progressive supranuclear palsy (also classed as a Parkinson-plus syndrome), and corticobasal degeneration . These disorders are tau-associated. Huntington's disease is a neurodegenerative disease caused by mutations in a single gene HTT , that encodes for huntingtin protein. Symptoms include cognitive impairment and this usually declines further into dementia. The first main symptoms of Huntington's disease often include: HIV-associated dementia results as

11984-411: The time the palace was destroyed, separation of crown and state had become important, with Parliament being necessary to control military requirements and pass laws. The government wanted to be some distance from the monarch, and the buildings around Whitehall, physically separated from St James's Palace by St James's Park , seemed to be a good place for ministers to work. The Horse Guards building

12096-650: The underlying pathology of misfolded proteins, such as synucleinopathies and tauopathies . The coexistence of more than one type of dementia is known as mixed dementia . Many neurocognitive disorders may be caused by another medical condition or disorder, including brain tumours and subdural hematoma , endocrine disorders such as hypothyroidism and hypoglycemia , nutritional deficiencies including thiamine and niacin , infections, immune disorders, liver or kidney failure, metabolic disorders such as Kufs disease , some leukodystrophies , and neurological disorders such as epilepsy and multiple sclerosis . Some of

12208-556: The use of tanks in both World Wars and depicts five World War II tank crew members. The Gurkha Memorial is to the south of this, on Horse Guards Avenue to the east of Whitehall. Whitehall is also home to six other monuments. From north to south, these are of Prince George, Duke of Cambridge ( Commander-in-Chief of the British Army ), Liberal Party , Liberal Unionist Party and Unionists leader Spencer Cavendish, 8th Duke of Devonshire , Douglas Haig, 1st Earl Haig (known as

12320-405: Was bought for the Admiralty . The Old Admiralty Buildings now sit on the house's site. Banqueting House was built as an extension to the Palace of Whitehall in 1622 by Inigo Jones . It is the only surviving portion of the palace after it was burned down, and was the first Renaissance building in London. It later became a museum to the Royal United Services Institute and has been opened to

12432-517: Was designed by William Kent , and built during the 1750s on a former tiltyard site, replacing an earlier guard-house erected during the Civil War. The building includes an archway for coach traffic and two pedestrian arches that provide access between Whitehall and Horse Guards Parade . The central archway is marked with "SMF" and "StMW", and denotes the boundary between St Martin-in-the-Fields and St Margaret's church parish boundaries. During

12544-412: Was redesigned by Sir Christopher Wren . In 1698, most of the vast palace burned to the ground accidentally after a fire started by a careless washerwoman. Wallingford House was constructed in 1572 by William Knollys, 1st Earl of Banbury along the western edge of Whitehall. The Duke of Buckingham bought the house in 1622, and it was subsequently used by Charles I. During the reign of William III, it

#5994