Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

Discussions between the Ministry of Health and the Ministry of Family and Integration have commenced in order to develop a national dementia strategy for Luxembourg. The development of a “plan démence” (dementia plan) became an integral part of the coalition agreement.

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

Working groups have been set up and the national Alzheimer association (Association Alzheimer Luxembourg) will take part in the discussions.

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

GPs are permitted to diagnose dementia and/or Alzheimer’s disease, as are all medical doctors in Luxembourg. GPs do not have set consultation times and can therefore allocate as much time as they wish to their patients.

Type and degree of training of GPs in dementia

It is not possible to study to become a GP in Luxembourg. GPs who work in the country have therefore all completed their medical training elsewhere. The type and amount of training in dementia received by GPs therefore varies from one individual to another.  

Required tests to diagnose dementia

CT or MRI and MMSE are used in the diagnosis of dementia. Such tests are not obligatory but they are essential for a person to be refunded for AD drugs.

Issues relating to medical treatment

The availability of medicines in general

Medicines in Luxembourg can fall under one of four different reimbursement systems:

• Normal reimbursement of medicines amounts to 80%,
• Preferential reimbursement is 100%,
• Reduced reimbursement is 40% and
• Certain medicines are not reimbursed.[1]

The availability of Alzheimer treatments

In Luxembourg, all AD drugs are available.

Conditions surrounding the prescription and reimbursement of AD drugs

AD drugs are part of the normal reimbursement system and are reimbursed at 80%. Reimbursement is nevertheless dependent on prior approval by the medical control unit of the Social Security Ministry. Any doctor can fill in this application for reimbursement, but specific information needs to be provided in order to determine whether a patient fulfils the DSM IV definition of Alzheimer’s disease. In practice, most applications are filled in by neurologists or psychiatrists. A reimbursement decision is made for six months only, after which a follow-up examination is necessary and treatment continuation is possible.

Treatment with acetylcholinesterase inhibitors is for people with MMSE scores between 26 and 10 and memantine for MMSE scores below 15.

There are no restrictions in Luxembourg for the reimbursement of these treatments for people living alone or in nursing homes.

Issues relating to research

Luxembourg is involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) and is a Collaborator in the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

Acknowledgements

Dr Carine Federspiel, Directrice Médicale, ZithaSenior Centrale, Luxembourg

[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