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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)
Cas
es /
100
Stroke
Dementia
Parkinson
Disease burden H.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 – 95 000 2010 – 111 000 2015 – 124 000 2020 – 138 000 2025 – 157 000 2030 – 180 000 2035 – 202 000 2040 – 213 000 2045 – 218 000 2050 – 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 Health
and 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.
Cancer
Alzheimer’s
Stroke
Cancer
Alzheimer’s
Stroke
Cancer
Heart disease
Alzheimer’s
Cancer
Alzheimer’s
Stroke
Cancer
Alzheimer’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 doctor Yes, 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
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