Dementia and its impact

Iva Holmerová

Dementia history

1907 – 1 case of dementia Über eine eigenartige Erkrankung der

Hirnrinde. Allgemeine Zeitschrift für Psychiatrie 64:146-148

ALOIS ALZHEIMER

Amyloid. plaky Neurofib. klubka

Oskar Fischer, 1876 - 1942

•OSKAR FISCHER

1876- 1942 (Slaný - KZ Teresienstadt)

Worked in the Department of Pathology, Psychiatric Department, Charles University in Prague

Oskar Fischer. Die presbyophrene Demenz. 1910. 275 cases, plaques in 56 cases older 50 let. Plaque stages I – VIII. Club – shaped neurites.Michel Goedert. Oskar Fischer and the study of dementia. Brain 2008.

Arnold Pick (1851-1925)

• Director of Mental Hospital Dobřany(1880-1886)

• Chief of Psychiatric Department, Charles University in Prague (1886-1921)

• „Relation of senile brain atrophy and aphasia“ 1892 – first description of „Pick´s disease)

Prevalence of serious diseases and age(FR PRES 2008, P.Amouyel)

0

10

20

30

40

60 70 80 90 100

Age (years)

Ca

se

s / 1

00

Stroke

Dementia

Parkinson

Disease burdenH.Brodaty (Paris Alzheimer, 2008):

- 19th century – infections- 20th century – cardiovascular and

oncological diseases- 21st century – neurodegeneration

World report on Alzheimer´s 2010

• 2010 – world´s costs of dementia – 1% GDP• The care for persons dementia being a state –

then 18th largest enomomy• Being a company then bigger than Wal-Mart or

Exxon Mobil…• One of the most important group of diseases

BUT: investment in research, prevention and therapy uncomparably lower than in other diseases…

Socioeconomic burden of AD in Europe (2007, Eurocode)

• Average costs of care of an „average“ dementia patient in EU 22- 30 thousand euro per year

• Total costs in EU-27 130 billions euros

• 56% informal care

• 44% health, social and long-term care (professional)

Persons with dementia - numbers (dle ADI 2008, EuroCoDe)

Czech Republic:2000 – 88 000 2005 – 95 0002010 – 111 000 2015 – 124 0002020 – 138 0002025 – 157 0002030 – 180 0002035 – 202 0002040 – 213 0002045 – 218 0002050 – 227 000

EU 2011

8 100 000

CZ 2011

110 000 - 140 000

Globally

39 000 000

Causes of dementia

• Alzheimer´s disease – the most frequent cause• Vascular factors – the next most frequent cause

of demetia (vascular), important co-factor of dementia manifestation (also in neurodegeneration)

• Other neurodegenerative diseases (FTLD, LBD…)

• curable causes of dementia and pseudodementia cca 1% (hypothyroidism, NPH, depression…)

Syndrom of dementia (ABC)• ADLs – impaired self-sufficiency

• Behavioral and psychological symptoms

• Cognitive impairment

14

Making dementia a European priority• Adoption of European Parliament Written Declaration by 59.24%

of MEPs – call for European Action Plan 80/2008• European Commission Initiatives launched in July 2009:

– Council recommendation for Joint Programming of research on neurodegenerative diseases

– Commission Communication on a European initiative on Alzheimer’s disease and other dementias

• European Parliament resolution of 19 January 2011 on a European initiative on Alzheimer´s disease and other dementias

• „Alzheimer Plans“ – Norway, France, UK….• AE – patients and caregivers´organisation – role of caregivers

(70-80% persons with dementia in their care)

Prevention of dementia• „Healthy and active ageing“ – be active,

positive, work and movement…

• Physical and mental activity

• Diet (prevention of cardiovascular factors, antioxidants, flavonoids, vitamins…curcuma, green tea, wine…)

• Medication: gingko biloba (memory complaints, MCI), calcium inhibitors (NILVAD)

•

Five-Country Alzheimer’s Disease Survey

•Designed and analyzed by the Harvard School of Public Healthand Alzheimer Europe

•Fieldwork conducted via telephone (landline and cell phone) by TNS, an independent research company based in London

•Nationally representative random samples of adults age 18 and older in five countries (Slides by Dianne Gove)

• Survey supported by a grant to Alzheimer Europe from Bayer AG. Bayer was not involved in the design of the survey or the analysis of the findings

•.

Interview Dates

Total Interviews Margin of Error

France February 7-14, 2011 529 +/-4.3%Germany February 7-19, 2011 499 +/-4.4%Poland February 7-10, 2011 509 +/-4.3%Spain February 8-13, 2011 502 +/-4.4%U.S. February 7-27, 2011 639 +/-3.9%

Public Attitudes about What Disease They Are Most Afraid of Getting, Top Three Choices

10%

17%

12%

14%

18%

22%

24%

13%

23%

27%

40%

49%

43%

44%

41%

France

Poland

Spain

U.S.

CancerAlzheimer’s

Stroke

CancerAlzheimer’s

Stroke

CancerHeart disease

Alzheimer’s

CancerAlzheimer’s

Stroke

CancerAlzheimer’s

Heart disease

Germany

Public’s Experience with Knowing Someone with Alzheimer’s Disease

42%

73%

33%

77%

19%

54%

34%

73%

30%

72%France

Germany

Poland

Spain

U.S.

France

Germany

Poland

Spain

U.S

Know or have known someone with Alzheimer’s

And that person is/was a family member

Public’s Perception of Whether Alzheimer’s Is a Fatal Disease

35%

61%

53%

42%

55%

34%

62%

33%

50%

44%France

Germany

Poland

Spain

U.S.

France

Germany

Poland

Spain

U.S

Yes, is a fatal disease

No, is not

Public Attitudes about Wanting to See a Doctor If They Were Exhibiting Signs of Confusion and Memory Loss

France

Germany

Poland

Spain

U.S.

France

Germany

Poland

Spain

U.S 10%

89%

4%

95%

9%

85%

7%

90%

11%

88%

Yes, would want to see doctor to determine if Alzheimer’s

No, would not want to see doctor

Public Attitudes about Wanting a Family Member Who Was Exhibiting Signs of Confusion and Memory Loss to See a Doctor

2%

98%

1%

99%

2%

97%

1%

98%

6%

94%France

Germany

Poland

Spain

U.S.

France

Germany

Poland

Spain

U.S

Yes, would want family member to see doctor to determine if Alzheimer’s

No, would not want family member to see doctor

Public Attitudes about Wanting to Be Told If A Doctor Believed They Had Alzheimer’s Disease

5%

94%

2%

96%

2%

98%

3%

97%France

Germany

Poland

Spain

France

Germany

Poland

Spain

Yes, would want to be told

No, would not want to be told

This question not asked in U.S.

Public Attitudes about Wanting a Family Member to Be Told If a Doctor Believed That Family Member Had Alzheimer’s Disease

France

Germany

Poland

Spain

France

Germany

Poland

Spain 13%

81%

11%

80%

9%

87%

10%

84%

Among those who said would want family member to see doctorYes, would want family member to be told

No, would not want family member to be told

This question not asked in U.S.

Public’s Interest in Getting a Test Before Exhibiting Symptoms to Determine If They Were Likely to Get Alzheimer’s in the Future, Should Such a Test Become Available

35%

35%

30%

27%

32%

39%

20%

48%

30%

48%

28%

23%

33%

39%

26%France

Germany

Poland

Spain

U.S.

France

Germany

Poland

Spain

U.S

France

Germany

Poland

Spain

U.S

Very likely to get such a test

Somewhat likely

Not too/not at all likely

There is an effective treatment now

18%

24%

47%

18%

26%

27%

8%

7%

63%

19%

14%

42%

18%

31%

40%France

Germany

Poland

Spain

U.S.

France

Germany

Poland

Spain

U.S

France

Germany

Poland

Spain

U.S

There will be an effective treatment in next five years

Is not an effective treatment now/will not be one in five years

Public’s Perception of Whether There Is Or Will Be an Effective Medical or Pharmaceutical Treatment to Slow the Progression of Alzheimer’s Disease in the Next Five Years

Children book – The Magic Tape Recorder

Supported by Krka