Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy – details needed

The Italian Ministry of Health has created a 10-point working document aimed at the future development of a National DementiaStrategy similar to that of France. The document has been held up for many months at the level of the Conferenza Stato-Regione(the official meeting that deals with the relationship between the State and the Regions)because of the problem in Italy that healthcare is managed by the regions. Each region in Italy has its own model of healthcare.

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

Alzheimer Uniti Onlus Italy has participated in many technical groups of the Ministry of Health involved in the development of a strategy and some of its fellow associations have actively participated in the development of their own regional plans.

Diagnosis, treatment and research

Timely diagnosis in the future National Dementia Strategy

Timely diagnosis is one of the 10 points addressed in the working document mentioned earlier aimed at the future development of National Dementia Strategy. The 10 points are still only a recommendation but the exact phrase regarding timely diagnosis is: “Optimization of the diagnostic process and upgrading of the social welfare process.”

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

There are about 500 UVAs (Alzheimer Evaluation Units) in Italy. These are specialist services for the diagnosis and treatment of Alzheimer’s disease and other forms of dementia. GPs can diagnose dementia privately but not officially.  If the GP suspects Alzheimer’s disease or dementia, the GP then sends the person to a UVA, as described above.

Geriatricians, neurologists and psychiatrists can diagnose dementia and/or Alzheimer’s disease. It is the geriatricians, neurologists and sometimes (but not often) the psychiatrists who are responsible for each Alzheimer Evaluation Unit.

GPs do not have a fixed consultation time. They can decide for themselves how much time to spend with each patient. There are no incentives for GPs to improve or increase timely diagnosis.

Type and degree of training of GPs in dementia

All medical students study dementia whilst at medical school but those who specialise in geriatrics or neurology study it in greater depth. Continuing education is an obligation for GPs. GPs and all doctors must be re-accredited through official courses. Each course carries a number of credits and a doctor must obtain a certain number of credits per year.

Required tests to diagnose dementia

The criteria of the NINCDS-ADRDA must be used in order to diagnose dementia and/or Alzheimer’s disease.

Issues relating to medical treatment

The availability of medicines in general

Medicines in Italy are included in one of two groups:

Group A is for medicines termed essential or for serious diseases and are free of charge. However, in the case where there is a generic form available but the patient prefers a brand name, the patient pays the difference.

Group C is for other medicines for which the full costs must be borne by the patient.

Each region has its regional tax (“ticket”) on medicines and the rate varies from region to region. However, the tax is waived for people over 65 years of age or for those with an income below EUR 35,000 per year or for a person with an officially recognised disability.

The availability of Alzheimer treatments

The AIFA (Italian Medicines Agency), as the national authority responsible for drug regulation, has authorised current medical treatments for dementia. All AD drugs are therefore available in Italy. Each region has autonomy over healthcare matters.

Conditions surrounding the prescription and reimbursement of AD drugs

In order to be reimbursed for AD drugs in Italy, the drug must be included on the specified list (please see above). However, this list is continually changed by the government. Moreover, the health system has been split into around 20 regions and each operates differently.

Treatment with acetylcholinesterase inhibitors is available for people with an MMSE score between 26 and 10. Memantine is available for people with an MMSE score between 18 and 10.

There are no specific restrictions as to the access of people living alone or in nursing homes to available Alzheimer treatments.

Issues relating to research

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

Research is one of the 10 points addressed in the working document mentioned earlier aimed at the future development of National Dementia Strategy. As mentioned above, the 10 points are only a recommendation but the exact phrase is: “Development of clinical guidelines and promotion of scientific research.”

Acknowledgements

Professor Luisa Bartorelli, Geriatrician and President of Alzheimer Uniti Onlus