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Germany

National Dementia Strategies (diagnosis, treatment and research)

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

The Ministry for Families, Senior Citizens, Women and Youth (BMFSFJ) gave an order to a research institute to evaluate national dementia plans in other countries. In a workshop with various experts the results of the research report were discussed. Most of the experts held the opinion that Germany also needed a dementia strategy. The secretaries of state of BMFSFJ and the Ministry for Health (BMG) arranged for another meeting to build a “national alliance for people with dementia”. It took place on 21 June 2012. On 19 September 2012, the fields of actions for this Alliance were adopted. The work should consist of a cooperative process between the actors of the Alliance

Involvement of the Alzheimer association (and/or people with dementia)

The German Alzheimer Association is involved in all these events. It was one of the actors that took the initiative to discuss the necessity of a National Dementia Plan in writing a letter to the German chancellor asking for such a plan. The German Alzheimer association thinks that a National Dementia Plan for Germany is necessary to coordinate the activities in several fields and to provide standards in medical treatment and care.

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

GPs are allowed to diagnose and prescribe medication without the need to refer to a specialist. In some areas, especially in rural areas, there are not many specialists. Consequently, it can take about three to five months to see a specialist (e.g. a psychiatrist or neurologist).

Whilst it is up to the GP how long s/he takes to see a patient, it can sometimes be a problem because the money the GP receives per visit is fixed in that it is based on a contract between the healthcare insurance and the doctor’s association.  From the point of view of the German Alzheimer Association, people go too late to the doctor and when they do go it is not because of a memory problem but for a different reason.

Required tests to diagnose dementia

Consensual guidelines have been drawn up by the national medical and scientific associations concerning the diagnosis and treatment of Alzheimer’s disease. These include the S3-guidelines of the Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) and the Deutsche Gesellschaft für Neurologie (DGN) and the  Guidelines of the Deutschen Gesellschaft für Allgemeinmedizin (DEGAM).

The guidelines lay down the tests which need to be done and in which cases a CT should be carried out. Their implementation would represent great progress, also concerning early diagnosis. Unfortunately, for different reasons the guidelines don’t seem to be considered very important in daily practice.

Issues relating to medical treatment

General issues related to treatment

Since 2004 the Institute of Quality and Economy of the Health System (IQWiG) has been evaluating the efficiency of medical and non-medical therapies of Alzheimer’s disease. It does not evaluate the extent to which medical treatment is provided to those who need it.

The availability of medicines in general

In Germany, patients generally pay 10% of the cost of medicines with a minimum contribution of EUR 5 per product and a maximum contribution fixed at EUR 10[1]. Nevertheless, the system also makes exceptions for children and hardship cases for whom no contributions are required.

For some products, the system sets fixed prices. If the cost of the product exceeds this fixed price, a patient is required to also cover the difference in addition to the set prescription charge.

The availability of Alzheimer treatments

All AD drugs are available in Germany and are part of the reimbursement system.

Conditions surrounding the prescription and reimbursement of AD drugs

There are no specific examinations which are required for medicines to be reimbursed nor does the system provide upper or lower MMSE limits for the treatment with different AD drugs. There are no restrictions as to the access of people living alone or in nursing homes to available Alzheimer treatments. The German system does not limit treatment initiation or continuation decisions to specialist doctors. The German Alzheimer Association underlines that due to the introduction of medicines budgets for individual doctors, some doctors are less inclined to prescribe Alzheimer treatments.

Prescription and reimbursement

Donepezil

Rivastigmine

Galantamine

Memantine

Available

Yes

Yes

Yes

Yes

Reimbursed

Yes

Yes

Yes

Yes

Initial drug reimbursed if prescribed by

No restrictions

No restrictions

No restrictions

No restrictions

Continuing treatment reimbursed if prescribed by

No restrictions

No restrictions

No restrictions

No restrictions

Required examinations

None

None

None

None

MMSE limits

None

None

None

None

People living alone

No restrictions

No restrictions

No restrictions

No restrictions

People in nursing homes

No restrictions

No restrictions

No restrictions

No restrictions

Issues related to research

The Ministry for research 2009 started to build up the German centre for neuro-degenerative diseases (DZNE) and supports it with EUR 66 million per year. The centre is situated in Bonn and coordinates the cooperation with several other university institutes all over Germany.

Research into Alzheimer’s disease and other forms of dementia is carried out in the medical, biological, psychological, epidemiological and other departments of several universities, Max Planck Institutes and other institutions. In Witten/Herdecke care science is carried out as a part of the DZNE.

Germany is involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) but not in the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

Acknowledgements

Sabine Jansen, Executive Director, Deutsche Alzheimer Gesellschaft e.V. Selbsthilfe Demenz

Hans-Jürgen Freter, Vice Executive Director, Deutsche Alzheimer Gesellschaft e.V. Selbsthilfe Demenz

[1] European Commission (2011): MISSOC – Mutual information system on social protection : Social protection in the Member States of the European Union, of the European Economic Area and in Switzerland: Comparative tables

 

 
 

Last Updated: Tuesday 14 May 2013

 

 
  • Acknowledgements

    The above information was published in the 2012 Dementia in Europe Yearbook as part of Alzheimer Europe's 2012 Work Plan which received funding from the European Union in the framework of the Health Programme. Alzheimer Europe gratefully acknowledges the support it has received from the Alzheimer Europe Foundation for the preparation and publication of its 2012 Yearbook.
  • European Union
 
 

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