[Memory clinics in Germany-structural requirements and areas of responsibility]

[Alzheimer's Dementia and Anti-Dementia Medication Prescriptions 2010-2021 in 357 GP Practices and 71 Specialist Practices]

BACKGROUND

The predicted prevalence of people with dementia (PWD) in Germany has risen to 1.8 million since 2010. In the near future, we will see the approval of antibody therapies. The study aims to demonstrate the recent anti-dementia medication prescriptions and diagnosis prevalence.

METHODS

Data from 357 general practitioner (GP) and 71 specialist practices (SP) (1.1 Mio. patients) were analyzed to demonstrate the prevalence of dementia diagnoses and anti-dementia drug prescriptions between 2010 and 2021.

RESULTS

The diagnosis prevalence of PWD (Alzheimer's dementia) remained relatively constant in GP practices at 1.0-1.3% (0.19-0.21%). Among SP, the prevalence increased from 4.9% (2.8%) to 5.9% (3.6%). The anti-dementia prescription rate decreased in GP (from 0.14% to 0.10%) and increased in SP practices (from 2.1% to 2.4%).

DISCUSSION

The diagnosis and prescription rate, especially in GP practices, remained below the prevalence forecasts and the expected prescriptions.

[Travel time to memory clinics in Bavaria: A geographical analyses within the framework of digiDEM Bayern]

BACKGROUND

Memory clinics can contribute significantly to a qualified diagnosis of dementia. Since the accessibility of medical facilities is an important predictor for their utilisation, the aim of this study was to determine the accessibility of memory clinics for persons with dementia in Bavaria.

METHODS

We used a Geographic Information System (GIS) to determine travel times to the nearest memory clinic for all Bavarian municipalities based on OpenStreetMap road network data.

RESULTS

The majority of the modelled persons with dementia in Bavaria (40%; n = 93,950) live in communities with an average travel time of 20 to 40 minutes to the nearest memory clinic. Almost 7,000 (3%) require more than one hour. Especially persons from rural communities have to travel significantly longer distances than people from urban areas.

CONCLUSION

In view of demographic developments, there is an urgent need for memory clinics to be accessible throughout the country for all persons with dementia, regardless of where they live. The systematic development of memory clinics in areas with long travel times or the establishment of mobile diagnostic services could help to improve dementia care.

The Profile of the Italian Centers for Cognitive Disorders and Dementia in the Context of New Drugs in Alzheimer's Disease

Background

The wait for the upcoming disease-modifying therapies (DMT) for Alzheimer's disease in Europe is raising questions about the preparedness of national healthcare systems to conduct accurate diagnoses and effective prescriptions. In this article, we focus on the current situation in Italy.

Objective

The primary goal is to propose a profile of the Italian Centers for Cognitive Disorders and Dementias (CCDDs) that could be taken into consideration by regional and autonomous provincial authorities when deciding on the prescribing centers for DMT.

Methods

Based on responses to a national survey on CCDDs in Italy, we identified the CCDDs that meet the requirements for effective prescription: 1) Multidisciplinary team; 2) Minimum Core Test for the neuropsychological assessment; 3) PET, CSF, and Brain MRI assessments. Univariate and multivariate comparisons were conducted between CCDDs that met the criteria and the others.

Results

Only 10.4% of CCDDs met the requirements for effective DMT prescription, mainly located in Northern Italy. They are also characterized by longer opening hours, a higher number of professionals, a university location, and a higher frequency of conducting genetic tests, and could potentially result in prescribing centers.

Conclusions

The findings suggest that the Italian national healthcare system may benefit from further enhancements to facilitate the effective prescription of DMTs. This could involve initiatives to reduce fragmentation, ensure adequate resources and equipment, and secure sufficient funding to support this aspect of healthcare delivery.

[Mild cognitive impairment in geriatric practice: patient orientation, diagnostics, treatment and ethics]

Mild cognitive impairment (MCI) is a common problem in old people, which can be distressing for patients and their families. The main feature of MCI is a decrease in cognitive performance with activities of daily living still unimpaired. The identification of treatable risk factors, recognition of early cognitive changes and a timely differential diagnosis, comprehensive information and counselling are important tasks in geriatric medicine. The aim of this article is to present practical recommendations to support physicians working with geriatric patients in recognizing cognitive deficits at an early stage, provide high-quality care focusing on counselling, treatment, and comorbidity management and to maximize the potential of the available treatment options.

[The German National Dementia Strategy]

English In 2019, key players from politics, society, social insurance providers, care and medicine initiated the process of developing the National Dementia Strategy under the leadership of the Federal Ministry of Health, the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth and the German Alzheimer's Association, and in 2020, the strategy was officially adopted. The National Dementia Strategy aims to improve the lives and care of people with dementia in Germany. To this end, four fields of action were defined, covering the areas of social participation, support and advice for people with dementia and their relatives, nursing and medical care, and research. A total of 27 goals with 162 concrete individual measures were formulated. An evaluation of the implementation is to take place in 2026. The breadth of the topics and also of the stakeholders involved are the the strengths of the dementia strategy. Unfortunately, there are no claims for improvement of inpatient geronto-psychiatric, neurological and geriatric care structures nor for adequate funding and integration of outpatient memory clinics into care. In connection with this, there is a conceptual lack of reference to the current medical understanding of dementia as a consequence of specific brain diseases with preclinical and mildly symptomatic courses before the dementia stage as well as to biomarker-based early diagnostics and to future molecular-specific disease-modifying treatments. Furthermore, there is a lack of a package of measures to exploit prevention potentials by reduction of risk factors for dementia at the population levels. Irrespective of this, the National Dementia Strategy is of great importance for patients and their caregivers. It can sustainably improve the living situation of people with dementia in Germany.

Trends in Dementia and Mild Cognitive Impairment Prevalence and Incidence in German General and Specialist Practices Between 2015 and 2019

BACKGROUND

The number of patients with dementia is forecast to grow continuously. However, there are indications that the incidence and prevalence is falling in high-income countries.

OBJECTIVE

To examine whether any effects of declining incidence and prevalence rates of dementia and mild cognitive impairment (MCI) were evident in Germany between 2015 and 2019.

METHODS

The analysis was based on 797 general and 132 specialists (neurological/psychiatric) practices and included 10.1 million patients aged 18 years and older who visited between January 2014 and December 2019 one of the practitioners. The prevalence and incidence of dementia and MCI were demonstrated descriptively.

RESULTS

Between 2015 and 2019, the prevalence (incidence) of dementia decreased from 2.18%(0.44%) in 2015 to 2.07%(0.35%) in 2019. A relatively large decrease in the prevalence (incidence) of dementia was observed in patients aged 80 and older, at -1.47%(-0.62%), compared to younger patients, at -0.40%(-0.18%). By contrast, the prevalence and incidence of MCI have remained constant over the years (0.19%to 0.22%and 0.06%, respectively). Overall, the number of patients diagnosed with dementia decreased slightly by 1%while the number of patients diagnosed with MCI increased by 17%.

CONCLUSION

Our results confirmed the reduction in the prevalence and incidence of dementia and revealed a decrease in the number of patients with dementia despite continued demographic changes. Future studies are warranted to determine whether the results are caused by changing risk and lifestyle factors or changes in medical diagnosis and treatment behavior of the practitioners.