The research aims to make more and more available targeted medications for Alzheimer’s disease. But you need to get there early. Early diagnosis can become, in the future, the tool to make the best use of the treatments that will arrive. In the meantime, if the weapons are sharpened for tomorrow, it is necessary to give answers to the many needs that today concern patients and especially those who care for them.
On the occasion of the World Day against the disease of 21 September, here come “7 good suggestions for not forgetting Alzheimer’s”Created by AIMA, the Italian Alzheimer’s disease association and the Italian Society of Neurology (SIN). The current picture, in any case, is summed up by the numbers.
In Italy it is believed that new cases of dementia are about 150 thousand every year: since Alzheimer’s disease constitutes at least 50% of all forms of dementia, new patients in Italy are 70 thousand every year. Currently there are about 600 thousand and in the majority of cases they are treated at home. The average prognosis of Alzheimer’s disease is 12 years and the people involved in care are 3 million.
The present and the future
“We have to think about the sick of today and those of tomorrow, who will have different needs. Today’s patients need more adequate services that also bridge the incredible disparity in treatment between the various regional systems – explains Patrizia Spadin, President of AIMA. Then there are the sick of tomorrow, for them we can finally glimpse a light at the end of the tunnel thanks to early diagnosis. However, the health system must equip itself to accommodate an ever-increasing number of patients to understand which ones may be eligible for the new therapies. It would be absurd to be caught unprepared by a future that we have been waiting for for a long time and that today we feel so close ”.
According to Gioacchino Tedeschi, President of the Italian Society of Neurology and Director of the Neurological and Neurophysiopathology Clinic, AOU University of Campania “Luigi Vanvitelli” in Naples, “for the first time they appear on the horizon of possible medications that could change the scenario.
The problem we face today concerns first of all the identification of who can possibly be entrusted to the new therapies. In fact, these therapies have been shown to be more effective in mild cognitive impairment in people who have amyloid in the brain. If it is true that the disease is widespread, we do not know exactly how many people have mild degenerative decay, therefore an important differential diagnosis work is necessary.
Until we have the markers in the peripheral blood the work will be very complex, the amyloid can in fact be documented by a PET scan or by an examination of the CSF. It is clear that a reorganization of the system will be necessary that provides for a closer interaction with the territory, from general practitioners to centers capable of making the diagnosis, all this to select within a large audience, which we evaluate from 100 to 300 thousand individuals, the people who could make use of the new therapies “.
The 7 good suggestions for not forgetting Alzheimer’s
Together with the appeal for a plan of structural interventions to fill the gaps in the Italian health system, the document “7 good reasons and 7 good proposals for not forgetting Alzheimer’s” highlights other future guidelines.
First, the opportunity of the Community houses foreseen in the PNRR, so that we are adequately organized to also include Centers for cognitive disorders and dementias, enhancing the multidisciplinary contribution of specialists (doctors and health professionals), general practitioners and social workers. With a view to proximity, the document hopes that community hospitals can be fully involved to respond at a local level to the specific needs of Alzheimer’s patients, as well as family and community nurses, indispensable figures in situations of greater social fragility. .
On the front ofHouse assistance integrated (ADI), the document calls for the creation of a dedicated Alzheimer’s ADI, to be developed consistently with the objectives of the PNRR, to bring to families multidisciplinary specialist skills as well as rehabilitation, psycho-educational and support activities, including digitally.
Finally, AIMA and SIN recall that Italy is not yet aligned with the regulatory framework of other European countries that recognize the role of caregiver also through specific protections. In this sense, the training of professional caregivers and support for the family caregiver are indispensable measures, given the complexity of managing the person with Alzheimer’s disease, which requires skills that families learn in the field.
How much does the disease weigh on women
The AIMA and SIN document also draws a synthetic picture of the spread and impact of the disease. In Italy today there are an estimated 1,200,000 cases of dementia, of which about 700,000 of Alzheimer’s disease. The projections, between now and the next decades, will see a notable increase in prevalence mainly due to the aging process of the Italian population.
Alzheimer’s is the third leading cause of death among the over 65 in Western Europe and one of the main causes of disability in the over 60 population worldwide. Italy is the second oldest country in the world (with 63% of over 65s), it is more interested than other countries in a specific strategy that includes an investment plan for the management of the elderly and their state of health. With over 50% of single-member families, it will have to prepare itself for the support of the family-resource, where present, and equip services for that demand that cannot benefit from informal family care.
The burden of the disease on women is considerable: among the three caregivers who, according to estimates in each family unit, take care of the assistance to the sick, the majority are women and bear the greatest burden of care work, with important social consequences. Furthermore, women are also on average more affected by the disease.
The inequality of treatments at a regional level and the absence of stable and constant monitoring of the health outcomes of people with Alzheimer’s disease make the offer and models of care not only different, but also vectors of differentiated opportunities in the face of the same need. In this context, the cost of the disease is currently borne by families. If the costs attributed to the disease are 15.6 billion, those incurred by families are about 80% *.
The new therapies, if confirmed in clinical benefits, will change the course of the disease for a significant number of people with very mild symptoms and / or in very early stages. New treatment models will have to be associated with current models of care, capable of selecting populations at risk, directing them to the appropriate diagnostic process and following them in the therapeutic one. Finally, the document emphasizes the ethical dimension linked to the disease. Forgetting to invest in Alzheimer’s is like losing memory of one’s history and origins, because the treatment system must protect frailty and promote a culture of respect.