Report calls for early diagnosis and treatment of dementia

Credit: Cathy Greenblat

A new report released today by Alzheimer’s Disease International (ADI), reveals that the majority of dementia sufferers worldwide go undiagnosed. It calls on governments to increase early diagnosis and treatment of dementia and demonstrates a number of beneficial treatments and interventions effective in the early stages of the disease.

Additionally the report finds potential financial advantages to early diagnosis and treatment/intervention for countries and healthcare systems.

ADI commissioned a team of researchers led by Professor Martin Prince from the Institute of Psychiatry at King’s College London, to undertake the first-ever comprehensive, systematic review of all evidence on early diagnosis and early intervention for dementia. The review found:

- A grave worldwide ‘treatment gap’ - three-quarters of the estimated 36 million people worldwide living with dementia have not been diagnosed so cannot benefit from treatment, information and care. In high-income countries, only 20-50 per cent of dementia cases are recognised and documented in primary care. In low- and middle-income countries, this proportion could be as low as 10 per cent.

- Failure to diagnose often results from the false belief that dementia is a normal part of ageing and that nothing can be done to help. The new report finds that interventions can make a difference, even in the early stages of the illness. Drugs and psychological interventions for people with early-stage dementia can improve cognition, independence, and quality of life. Support and counselling for carers can improve mood, reduce strain and delay institutionalisation of people with dementia.

- Governments, concerned about the rising costs of long-term care linked to dementia, should spend now to save later. Based on a review of economic analyses, the report estimates that earlier diagnosis could yield net savings of over US$10,000 per patient in high-income countries.

Professor Prince said: ‘There is no single way to close the ‘treatment gap’ worldwide. What is clear is that every country needs a national dementia strategy that promotes early diagnosis and a continuum of care thereafter. Primary care services, specialist diagnostic and treatment centres and community-based services all have a part to play, but to differing degrees depending upon resources.’

Daisy Acosta, Chairman of ADI continues: ‘Failure to diagnose Alzheimer’s in a timely manner represents a tragic missed opportunity to improve the quality of life for millions of people. It only adds to an already massive global health, social, and fiscal challenge - one we hope to see in the spotlight at next week’s United Nations Summit on Non-Communicable Diseases.’

The report recommends that every country develop a national dementia strategy promoting early diagnosis and intervention. The strategy should:

• Promote basic competency among physicians and other health care professionals in early detection of dementia in primary care services.
• Where feasible, create networks of specialist diagnostic centres to confirm early-stage dementia diagnosis and formulate care management plans.
• In resource-poor settings, apply the World Health Organization’s recently developed guidelines for diagnosis and initial management by non-specialist health workers.
• Publicise the availability of evidence-based interventions that are effective in improving cognitive function, treating depression, improving caregiver mood and delaying institutionalisation.
• Increase investment in research - especially randomised control trials to test drugs earlier and over longer periods of time, and to test the efficacy of interventions with particular relevance to early-stage dementia.

Marc Wortmann, Executive Director of ADI concludes: ‘The research team has reviewed thousands of scientific studies detailing the impact of early diagnosis and treatment and found evidence to suggest real benefits for patients and carers. Earlier diagnosis can also transform the design and execution of clinical trials to test new treatments.

’But first we need to ensure that people have access to the effective interventions that are already proven and available, which means that health systems need to be prepared, trained and skilled to provide timely and accurate diagnoses, communicated sensitively, with appropriate support.’