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PL4. Treatment and management of dementia

Detailed programme and abstracts

PL4. Treatment and management of dementia (Wednesday 2 Nov., 16.00 - 17.30)

PL4.1. Perspectives for the future treatment of Alzheimer’s disease

KURZ Alexander

The development of novel treatments for Alzheimer’s disease (AD) is primarily based on the finding that the abnormal processing and subsequent deposition of two neuronal proteins ( amyloid and tau) are early and central events in AD pathology. Building on this evidence, the major strategies are to reduce the production of  amyloid by blocking the enzymes that generate it from a larger precursor molecule, to inhibit the self-aggregation of tau into neurofibrillary tangles, and to remove the proteins by stimulating the brain’s immune cells, using specific antibodies. The common clinical effect of these strategies is to slow the loss of neurons. The clinical correlate is a delay of symptom progression. These treatments do not improve cognitive or functional abilities nor will they the stop the disease from advancing eventually. People with AD who receive early treatment with the novel medications are likely to spend more time in prodromal, mild and moderate stages than in severe stages of dementia. They may gain years where self-determination, activity and participation in life are still maintained. To actively cope with the disease and make the best of preserved abilities the demand for concomitant non-pharmacological interventions and community support is likely to increase. While the novel medications for AD may provide clear benefits for affected individuals and their families they also raise ethical concerns. These refer to early disclosure of diagnosis, equity of access to treatment, long-term safety, point of discontinuation, and potential prolongation of suffering.

PL4.2. Exchanging and implementing best practice across Europe on timely diagnosis, post-diagnostic support, care coordination, residential care and dementia-friendly communities

HUGGINS Geoff

The provision and quality of services for people living with dementia and their carers has improved, but it is not consistently good yet.  The aim of the second EU Joint Action on dementia is to promote the implementation in Member States of coordinated actions to improve the situation of people living with dementia and their carers.  The Joint Action will focus on four key areas for action:

  • Diagnosis and post diagnostic support -The rate of dementia diagnosis varies greatly between member states and in many places post-diagnostic support is non-existent or underdeveloped.
  • Crisis and Care Coordination - People with dementia need different sorts of care and their need for care grows as the disease progresses. In most health and care systems dementia care will be provided by a range of different providers each working under different eligibility and funding rules and often without clear co-ordination with the outcome that the experience can feel fragmented. 
  • Residential Care - A large proportion of nursing and residential care home residents have dementia (in some countries up to 80% of residents). It is important to ensure high quality professional care, including palliative care, delivered with dignity and compassion is available in residential and nursing care establishments.
  • Dementia Friendly Communities -As more Member States look at the costs to society of caring for people with dementia, alternative community supports are being developed to ensure that people can live in their own homes for as long as possible.   Evidence has shown that appropriate support in the community can reduce the numbers of people with dementia being admitted to hospital, and can delay their entry into care homes.

PL4.3. Improving the access to formal dementia care: lessons from the Actifcare project

VERHEY Frans, DE VUGT Marjolein, MEYER Gabriele, WOODS Bob, WIMO Anders, SELBAECK Geir, IRVING Kate, CONÇALVES PEREIRA Manuel, ZANETTI Orazio

In absence of a cure that can alter the course of Neurodegenerative Disorders (NDD), an early diagnosis of dementia is important as it opens the way to future care and treatment, and can help people take control of their lives and plan ahead. Many EU countries have now adopted strategies to promote timely recognition of dementia. Timely access to dementia care services, such as home care, is also important for reducing health care posts by postponing nursing home placement. Despite these developments, individuals are often not receiving services of the type, quality and timing that they need. The Actifcare project (ACcess to TImely Formal Care) aims to better understand the reasons for inequalities in access to healthcare. At the macro level, we have assessed health care systems giving access to formal home care across Europe, using literature review, expert consultation and focus groups. At the individual level, we have assessed the access to and use of formal care services in 450 dyads (people with dementia and their carers) in 8 EU countries, and examine how this relates to their met and unmet needs and quality of life. In addition, costs, consequences and novel specific outcome measures are evaluated. Data are anaylysed now, and the results will be presented in our presentation.

The Actifcare project will lead to the identification of best-practice pathways to formal care, in terms of efficiency and cost-effectiveness, and optimize the care for people with moderate to severe dementia in Europe.

PL4.4. Long-term care for people with dementia

HOLMEROVÁ Iva, AUER Stefanie, TOLSON Debbie

Long-term care is generally understood as a range of services required by persons with a reduced degree of functional, physical or cognitive capacity who are consequently dependent for an extended period of time on help with basic activities of daily living. Personal care is usually combined with nursing and medical care (e.g. general, palliative, geriatric and rehabilitation).  The need for long-term care arises, as a result of disability, often due to dementia.

Most persons with long-term care needs stay in their homes. Nursing homes play also an important role in dementia care provision, especially for persons in advanced stages of dementia.  Available international studies estimate that about 80% of persons staying in different types of nursing homes live with dementia.  It is further estimated that about 30% of affected individuals are not diagnosed and consequently do not receive the appropriate support, care and medical attention they need.  Quality of care and focus on dementia care in nursing homes are therefore increasingly important. This issue has been raised at the conference “Living Well with (out) Dementia” of the NL Presidency in May, and also at The AGE Platform Conference in June.

Dementia has been identified by an international group of researchers (Morley, 2014) as the most important topic of nursing home research. Dementia care generally and psychosocial interventions in psychological and behavioral symptoms of dementia rank highest among 15 selected priorities. More information about nursing home care for persons with dementia is necessary for better organization of services and education of professionals. The Project “Palliare” has identified needs of education for dementia care in 7 European countries and provided Best Practice Statements.

Acknowledgement: Project Palliare Erasmus+ prof. Debbie Tolson and Austrian Czech LTC Project FWF GACR prof. Stefanie Auer

 

 
 

Last Updated: Tuesday 10 January 2017

 

 
  • Acknowledgements

    The 26th AE Conference in Copenhagen received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimerforeningen gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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