Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

There is no state-developed or state-confirmed national strategy and there are no plans underway in Turkey to develop a National Dementia Strategy.

In a few cities, some local politicians are thinking along these lines. Some politicians are nevertheless becoming aware of the benefit of social programmes. In Istanbul, two municipalities have small-scale Alzheimer Care Facilities but these are rare examples and do not represent in any way a national strategy.

In 2010, the Turkish Alzheimer Society, Alzheimer Dernegi, developed a national strategy (http://www.alzheimerdernegi.org.tr). The main pillars are: a) to enhance efforts for increasing awareness at all levels of society b) to support development of respite care, day care centres and nursing homes in terms of care, c) better training of primary care physicians, in particular of newly established family physicians in terms of diagnosis and d) to increase co-operation with legislators in order to improve legislation in support of people with Alzheimer’s disease and their families.

Diagnosis, treatment and research

Issues relating to diagnosis

General issues

Which healthcare professionals are responsible for diagnosing dementia

GPs are permitted to diagnose dementia and AD but the majority of GPs refer their patients to secondary or tertiary healthcare facilities. Neurologists, psychiatrists and geriatricians are the main healthcare professionals who diagnosis dementia and AD.

GPs do not have fixed consultation times and there are no incentives for GPs to improve or increase timely diagnosis.

Type and degree of training of GPs in dementia

The Turkish Alzheimer Association has initiated the organisation of the teaching courses about the diagnosis of Alzheimer’s disease, mainly targeting the education of the general practitioners (GPs). 

The Turkish Association of Neuropsychologists also holds nationwide courses about how to conduct a neuropsychological evaluation, another important instrument in the early diagnosis.

GPs in Turkey are medical doctors who have completed 6 years of education at a medical faculty. During this education, training in dementia is limited to that provided in the modules on neurology. GPs are not obliged to undergo continuing education. However, it is envisaged that in the future there will be a credit system for GPs and they will need to ensure that they obtain sufficient credit.

Required tests to diagnose dementia

The Turkish Association of Neurology has published guidelines relating to the timely diagnosis of the dementia. However, these guidelines are not obligatory and there are no other guidelines or recommendations which are obligatory.

Although there are no obligatory tests which must be carried out in order to make a diagnosis of dementia and/or AD, nearly all specialists perform at least an MMSE as part of the diagnostic procedure.

Issues relating to medical treatment

The availability of medicines in general

There is a list of drugs which are refundable under the social coverage system known as the SGK (http://www.sgk.gov.tr).

The availability of Alzheimer treatments

The Ministry of Health has approved all four AD drugs.  

Conditions surrounding the prescription and reimbursement of AD drugs

All four AD drugs are part of the reimbursement system. Patients must have a medical report showing that they have Alzheimer’s disease. These reports can only be given in clinical centres and by specialists, but once there is such a report other physicians can also prescribe. The Turkish system does not require any specific examinations to be carried out, nor does it impose upper or lower MMSE scores for reimbursement. There are no restrictions for the reimbursement of people living alone or in nursing homes.

Issues relating to research

The Scientific and Technological Research Council of Turkey (http://www.tubitak.gov.tr), the Turkish Association of Neurology (http://www.noroloji.org.tr) and some other organisations provide initiations and funding. The Turkish Alzheimer Association has started to organise a nationwide scientific congress (annually). There are also satellite meetings for caregivers and GPs. Turkey is involved in EU projects on the harmonization of the biomarkers in AD.

Acknowledgements

Başar Bilgiç, Neurologist and member of the Executive Committee of the Turkish Alzheimer Association, Istanbul University and the Turkish Alzheimer Association