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Medical and research aspects

2020: European Dementia Monitor, Comparing and benchmarking national dementia strategies and policies

3 Medical and research aspects

3.1 Treatment

3.1.1 What did we look at and why?

There are currently four drugs recommended for the treatment of Alzheimer’s disease: Donepezil, rivastigmine and galantamine all work in a similar way and are known as acetylcholinesterase inhibitors (AChEI). They are indicated for the treatment of mild to moderate Alzheimer's disease. Memantine works in a different way[1] to the other three and has an indication for the treatment of moderate to severe Alzheimer’s disease.

In our survey, we asked whether the above mentioned four medicines are available and whether and at what level they are reimbursed or covered by the national health system. In addition, we enquired whether the combination therapy of an AChEI and memantine was covered by the national health system and if so, at what level.

Another treatment-related question concerned the use of antipsychotic drugs. People with dementia who experience behavioural and psychological symptoms of dementia are often, and inappropriately, prescribed antipsychotic drugs. These drugs have been linked to serious side effects and research has shown that inappropriate prescription of antipsychotic drugs can be extremely harmful. For that reason, we questioned countries on whether a strategy for the reduction of the use of antipsychotics for people with dementia had been put in place.

3.1.2 Results

The detailed answers regarding the reimbursement of medicines and of combination therapy can be found in table 4.

There has been little change from the Dementia Monitor in 2017, with most countries offering some level of reimbursement for at least one or more acetylcholinesterase inhibitors.

The most striking change from 2017 was the decision in France to stop funding all dementia-related medications which was announced in 2018. The decision was surprising given France’s previously strong record in relation to dementia policy and raised significant concerns from persons with dementia and their carers in France. Only France and Latvia offer no reimbursement for any dementia medications.

With regard to strategies aimed at reducing the inappropriate use of anti-psychotics, 10 countries (seemap 4) have such a strategy, namely Belgium (Flanders and Wallonia), Finland, France, Ireland, Luxembourg, Netherlands, Sweden, Switzerland, Turkey and the United Kingdom (England and Scotland).

Figure 5shows that there is an overall positive picture in relation to the number of countries providing partial or full reimbursement of medications. However, there are significantly fewer countries reimbursing combination therapy with ACHI’s and memantine.

3.1.3 How did we score countries?

Countries could score a maximum of 12 points. For each of the four medicines and for the combination therapy, countries were scored 2 points if they were reimbursed/covered at least at 75%, 1 point if they were reimbursed/covered at a lower level and 0 points if they were not part of the reimbursement/coverage system.

Countries also scored 2 points if they had a strategy in place for the reduction of anti-psychotics.

In this section, six countries (Ireland, Luxembourg, Sweden, Turkey and the UK (England and Scotland)) receive full marks as all medicines and combination therapy are reimbursed/covered at a high level and the countries have an anti-psychotic strategy in place. Only one country (Latvia) receives no points, since none of the medicines are reimbursed and no strategy is in place.

Based on the results, it is possible to rank European countries as indicated in figure 6, which shows the points expressed as percentages of the maximum possible score.

3.2 Clinical Trials

3.2.1 What did we look at and why?

There is currently no cure or disease modifying treatment for Alzheimer’s disease, with the current available treatments having limited efficacy on in mitigating the symptoms of dementia. As such, dementia researchers continue to conduct clinical trials and research into drug development, in an effort to find a breakthrough in treating the underlying diseases. At the conclusion of 2019, Alzheimer Europe had identified six phase III trials which were actively recruiting to investigate different compounds (COR388, Gantenerumab, Omega-3, Guanfacine and AVP-786) and their affect on dementia. Ongoing clinical trials no longer recruiting were not included in this overview.

In detail, we looked at the following six studies:

  • GAIN, investigating COR-388
  • GRADUATE 1, investigating Gantenerumab
  • GRADUATE 2, investigating Gantenerumab
  • LO-MAPT, investigating Omega-3
  • NORAD, investigating Guanfacine
  • 17-AVP-786-305, investigating AVP-786

 

3.2.2 Results

The detailed answers regarding the possible participation of research participants in clinical trials can be found intable 5,showing the significant differences between European countries as to the number of clinical trials open for recruitment in different countries.

In a marked change from the 2017 Dementia Monitor, there were no countries in which it was possible to participate in all of the openly recruiting trials. Only in three countries was it possible to access four or more phase-III trials (France, Spain and the UK – England). In 17 countries, it was not possible for volunteers to enrol in clinical trials (as none of the identified clinical trials were recruiting in those countries), up from nine in the 2017 Dementia Monitor.

3.2.3 How did we score countries?

Countries could score a maximum of 6 points and were given 1 point for each clinical trial which was recruiting research participants in the country.

Based on the results, it is possible to rank European countries as indicated in figure 6, which shows the points expressed as percentages of the maximum possible score.

3.3 Involvement in European Dementia Research

3.3.1 What did we look at and why?

Since dementia cannot be solved by any country on its own, more and more countries are collaborating and are contributing to pan-European research initiatives. As part of the European Dementia Monitor, Alzheimer Europe looked at the participation of countries in the following research collaborations at EU level:

  1. Representation on the Management Board of the EU Joint Programme on Neurodegenerative Diseases Research (JPND)
  2. Participation in the 2nd Joint Action on Dementia (DEM2)

In addition, Alzheimer Europe checked whether the country had participated in the following calls:

  1. Active and Assisted Living (AAL) 2016 call “Providing integrated solutions based on ICT to support the wellbeing of people living with dementia and their communities”
  2. JPND 2019 call on “personalized medicine for neurodegenerative disease”
  3. JPND 2018 call on “health and social care for neurodegenerative diseases”
  4. JPND 2017 call on “pathway analysis across neurodegenerative diseases”
  5. JPND 2016 call on “harmonisation and alignment in brain imaging methods for neurodegeneration”
  6. JPND 2015 call on “risk and protective factors, longitudinal cohort approaches and advanced experimental models”
  7. JPND 2014 call for “working groups to inform cohort studies in neurodegenerative disease research”

For this section, Alzheimer Europe used the information publicly available on: www.neurodegenerationresearch.eu, www.aal-europe.eu, and www.actondementia.eu.

3.3.2 Results

The detailed answers showing each country’s participation in European dementia research collaborations and funding of pan-European dementia research initiatives can be found intable 6.

In relation to the JPND research calls, 2019 saw the highest number of participating countries compared to previous years. Additionally, 29 out of the 36 surveyed countries are on the Management Board of the JPND, however, participation in the pan-European research calls varied considerably. The Active and Assisted Living call (AAL) had the fewest participating countries with only eight countries involved.

Italy and Spain were the most collaborative countries, participating in all programmes and research calls. France, Germany, Luxembourg, Netherlands, Norway, and the UK-England, also participated in a high number of calls. Only Jersey and Lithuania were not involved in any of the above research collaborations, with all other countries involved in at least one of them.

3.3.3 How did we score countries?

Countries could score a maximum of 9 points. For participation in each of the aforementioned categories, countries scored 1 point. Based on the results, it is possible to rank European countries as indicated in figure 8, which shows the points expressed as percentages of the maximum possible score.

[1] Memantine acts on the glutamatergic system by blocking NMDA receptors

 

 
 

Last Updated: Tuesday 30 March 2021

 

 
 

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