Dementia Care: Beyond a Diagnosis | A Bioscience Publishing Platform

Dementia Care: Beyond a Diagnosis

Published:08 Dec.2022 Source:The LANCET Infectious Diseases

Enormous progress has been made over the past two decades in dementia research. In particular, the identification of biomarkers is a landmark development in the diagnosis of Alzheimer's disease. However, this progress so far has not translated into improvements in patient care, with a staggering 85% of the over 55 million people living with dementia not receiving any post-diagnosis care, according to Alzheimer's Disease International's 2022 World Alzheimer Report.

The 2022 World Alzheimer Report comes 5 years after the WHO global dementia action plan was published, in which targets to be achieved by 2025 were set in seven action areas, one of which covers diagnosis, treatment, care, and support, but there has been little or no progress towards these targets in the past few years, particularly in low-income and middle-income countries (LMICs). In fact, fewer than a third of WHO member states have a national dementia plan to achieve these goals. The World Alzheimer Report urgently calls for governments to build robust models of post-diagnostic support using key action areas of the WHO global dementia action plan as their framework. This approach should be feasible, even in LMICs, although perhaps not straightforward. For example, Indonesia established a national dementia action plan in 2016, which was followed in 2019 by regulation of essential services for the elderly by the Minister of Health, including screening for cognitive decline. However, these policies have not been implemented, with a key barrier being the stigma surrounding dementia. In Indonesia, dementia is only briefly discussed during training of health-care workers, among whom the belief that dementia is a normal part of ageing compounds low awareness of the need for early detection and treatment. Furthermore, misconceptions remain about the symptoms of dementia, which are attributed to spiritual or supernatural causes in some communities. The World Alzheimer Report suggests that stigma must be tackled not only through education but also by development of a higher quality, more equitable service system and stronger national policies than those available at present. Systematic evaluation of the execution of Indonesia's national plan, which has been lacking so far, will be essential to monitor success.

For many other countries, progress in the development of a national plan for dementia has stalled. For example, in 2018, Jamaica became involved in the 4-year STRiDE Dementia Project, which brought together, for the first time on a large national scale, research groups targeting gaps in dementia care provision. The STRiDE Jamaica team has raised awareness among primary-care doctors and other health and social care practitioners about the need for continued dementia-specific training. They have also been involved in the development of education and awareness activities and have offered information for carers on what to expect in terms of disease progression. However, the STRiDE project ended in March, 2022, meaning that government funding and support is now essential for the continuation of the training and services provided to date. Timely and accurate diagnosis is a prerequisite for ensuring person-centred care pathways, and Jamaica is one of six countries to have joined the Davos Alzheimer's Collaborative flagship project on early detection of Alzheimer's disease—the pilot phase of which is due to complete in August 2023. If successful, the initiatives in these six countries will serve as a blueprint for health-care systems globally to prepare for and expedite the latest treatments and innovations.