Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

There is no approved national dementia strategy in Greece. A plan has been developed and submitted to the Greek parliament by the Greek Federation of Alzheimer’s Disease and Related Disorders. The Federation also presented a petition with the signatures of more than 15,000 people who supported its campaign for a national dementia strategy to the Mayor of Athens and representatives from the Ministry of Health in September 2010.

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

See above.

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

GPs may make a diagnosis of dementia or refer patients to a specialist for diagnosis. Some GPs are well trained in making such a diagnosis, others less so. It is mainly neurologists and psychiatrists, and to a much lesser extent geriatricians, who diagnose dementia and/or Alzheimer’s disease.

GPs do not have fixed consultation times and the time that they can dedicate to each patient is very limited. It is difficult to spend more time with patients with dementia. Some GPs manage very well in the limited time available but they are few in number.

There are no specific incentives to improve or increase timely diagnosis by GPs. Some pharmaceutical companies have helped the Greek Federation of Alzheimer’s Disease and Related Disorders to train GPs but the GPs have to find the time to participate in these training courses.

Type and degree of training of GPs in dementia

GPs do not receive official training in dementia as part of their professional training to become a GP. However, some professors give lectures on dementia at which general practitioners can attend. This is not part of a national plan to educate GPs about dementia but nevertheless provides a minimum of 1 to 3 hours’ training in dementia for those GPs who attend. Continuing education is not yet obligatory for GPs in Greece. Eight national conferences, one European and one international conference have been held in Thessaloniki.

Required tests to diagnose dementia

Established criteria, cognitive and functional tests, and a test for depression are used in the diagnosis of dementia. However, there are no specific recommendations or guidelines that must be followed and there are no obligatory tests.

Issues relating to medical treatment

The availability of medicines in general

Until today, the Greek system provides for different levels of participation of patients to the cost of medicines^[1]. Patients currently have to pay 10% of the cost of medication.

The availability of Alzheimer treatments

All four AD drugs are available to patients in Greece and are part of the reimbursement system.

Conditions surrounding the prescription and reimbursement of AD drugs

Greece requires the initial treatment decision to be taken by a neurologist or psychiatrist, but does not have any restrictions for continuing treatment decisions which can be made by any practitioner. GPs cannot write the initial prescription for AD drugs. In practice, some GPs do make the initial prescription as this is inadequately controlled.

Greece does not require any specific diagnostic examinations to be carried out, nor does the system provide upper or lower treatment limits. The Greek system reimburses medicines for people living alone or in nursing homes.

Issues relating to research

Current research programmes in Greece include, amongst others: 

(a) European projects: (BIOMARK-APD, NILVAD, Pharmacog, LLM, Dem@care (the last two are based on new technologies),

(b) National projects: (1) The Collaboration for Cognitive problems (En-NOHSHS) which has six partners which have good ideas for diagnosis, prevention and management of dementia with new technologies. (2) "Excellence" The best CV of the principal investigator (robotics, sports science and tele-education of caregivers).

(c). Doctoral theses (PhD): (1) Virtual reality in the diagnosis of Alzheimer’s disease); (2) The ability of expression of patients’ wishes with Alzheimer’s disease; (3) Helicobacter of pylori and Alzheimer’s disease; (4) Driving and Alzheimer’s disease; (5) Non pharmacological management of BPSD;. (6)  The retinal thickness in patients with Alzheimer’s disease.

(d) Research programmes in the day care centres - different non pharmacological interventions.

Greece is involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) and is an Associate member of the “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

Acknowledgements

Magda Tsolaki MD, PhD, Neuropsychiatrist, Theologist, Professor, Aristotle University of Thessaloniki, Chair of Greek of Federation of Alzheimer Disease

[1] European Commission (2012): 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