Dementia in Europe Yearbook 2012 National Dementia Strategies (diagnosis, treatment and research) Including the Alzheimer Europe Annual Report 2011 The Dementia in Europe Yearbook arises from the 2012 Work Plan of Alzhei- mer Europe, which has received funding from the European Union, in the framework of the Health Programme. Neither the European Commission nor any person acting on its behalf is responsible for any use that might be made of the following information. Alzheimer Europe gratefully acknowledges the support it has received from the Alzheimer Europe Foundation for the publication of this Yearbook. 3 Table of contents Foreword ______________________________________________________________ 6 National Reports ________________________________________________________ 8 1 Austria _________________________________________________________ 9 2 Belgium _______________________________________________________ 11 3 Bulgaria _______________________________________________________ 13 4 Croatia ________________________________________________________ 17 5 Cyprus ________________________________________________________ 20 6 Czech Republic __________________________________________________ 22 7 Denmark ______________________________________________________ 26 8 Estonia _______________________________________________________ 31 9 Finland _______________________________________________________ 32 10 France ________________________________________________________ 36 11 Germany ______________________________________________________ 43 12 Greece ________________________________________________________ 46 13 Hungary ______________________________________________________ 49 14 Ireland ________________________________________________________ 51 15 Italy __________________________________________________________ 54 16 Jersey _________________________________________________________ 57 17 Latvia _________________________________________________________ 61 18 Lithuania _____________________________________________________ 62 19 Luxembourg ___________________________________________________ 63 20 Malta ________________________________________________________ 65 21 Netherlands ___________________________________________________ 70 22 Norway _______________________________________________________ 76 23 Poland ________________________________________________________ 81 24 Portugal _______________________________________________________ 85 25 Romania ______________________________________________________ 88 26 Slovakia _______________________________________________________ 91 27 Slovenia _______________________________________________________ 92 28 Spain _________________________________________________________ 95 29 Sweden _______________________________________________________ 97 30 Switzerland ___________________________________________________ 103 31 Turkey _______________________________________________________ 106 32 United Kingdom (England) _______________________________________ 109 33 United Kingdom (Northern Ireland) _________________________________ 119 34 United Kingdom (Scotland) _______________________________________ 125 35 United Kingdom (Wales) _________________________________________ 134 Acknowledgements ___________________________________________________ 136 5 Foreword Foreword It gives me great pleasure to present this report on the development of national dementia strategies in Europe. The report contains information on the situa- tion in 32 countries regarding the development of national dementia strategies focusing on three main topics, namely diagnosis, treatment and research. Of course, not all countries have such strategies as they are at different stages of development in relation to responding to the challenge that dementia poses. National dementia plans all aim to address dementia but do so in different ways. We have decided to focus on the three above-mentioned topics in this report and in our next report to address more care-related issues such as the provision of care, the training of healthcare professionals and social care staff, support at home, in the community and in nursing homes, as well as issues linked to perceptions of dementia and dementia-friendly societies. However, all countries have citizens with dementia who require timely diagnosis, treat- ment and support. This is essential to their quality of life and may help prevent prema- ture entry into long-term residential care. It also represents a moral duty of each society towards people with dementia based on solidarity, beneficence, dignity and equity. Even countries which lack a national dementia strategy may have a system in place to diagnose dementia and organise treatment. Many are also involved in research at European level and/or fund research in their own country. Those countries which do have a strategy often have a timeframe within which to accomplish the goals they have set. Consequently, for each country, provisions relating to a national dementia strategy are described, followed by details of progress with their implementation. Wherever possible, details of how diag- nosis, treatment and research are currently addressed at national level are provided. It is hoped that this information will enable readers to compare how different countries have addressed these common issues and perhaps learn from the different solutions which have been attempted. As some countries are further along the process than oth- ers and have monitored their own progress, it is possible to benefit from their experi- ence of success and of the obstacles they may have encountered along the way. Most, however, are in the early stages and many do not yet have a national dementia strategy. Most of the reports were written by or with the assistance of Alzheimer Europe’s member associations to whom we are immensely grateful. Some external experts also helped compile the reports. The names of all those who made it possible to produce this report are acknowledged at the end of each country report. It is encouraging to see how far some countries have come in developing national strate- gies and how others are well on the way to doing so. Alzheimer Europe is closely moni- toring this development and would be pleased to receive your comments and further information about developments within Europe. Jean Georges Executive Director Alzheimer Europe 7 National Reports National Reports 1 Austria 1 Austria 1.1 Background information about the National Dementia Strategy There is as yet no national dementia strategy in Austria. 1.2 Diagnosis, treatment and research 1.2.1 Issues relating to diagnosis This is not addressed at national level. 1.2.1.1 Which healthcare professionals are responsible for diagnosing dementia GPs are permitted to diagnose dementia and/or Alzheimer’s disease and they do. The diagnosis can also be made by a specialist doctor (i.e. a neurologist, psychiatrist or geri- atrician). GPs do not have set consultations times and there are no incentives to encour- age timely diagnosis. They do not, for example, receive additional payment for special examinations to diagnose Alzheimer’s disease. 1.2.1.2 Type and degree of training of GPs in dementia GPs do not receive special training in dementia during their professional training to become a GP and continuing education is voluntary. 1.2.1.3 Required tests to diagnose dementia There are no official guidelines, recommendations or tests which must be used in order to diagnose dementia and/or Alzheimer’s disease. The MMSE and clock drawing tests are most commonly used. 1.2.2 Issues related to medical treatment 1.2.2.1 The availability of medicines in general Austria keeps a list of pharmaceutical products for which expenses are covered by the healthcare system. Nevertheless, patients and carers need to cover part of the costs of medicines. This charge is currently set at EUR 5.15 per item prescribed. For infectious diseases and in cases of need, medicines may be free of charge. 1 1.2.2.2 The availability of Alzheimer treatments All four AD drugs are available in Austria and are included on the list of pharmaceutical products that are covered by the healthcare system. 1.2.2.3 Conditions surrounding the prescription and reimbursement of AD drugs Prescription is limited to specialist doctors and this applies to treatment initiation, as well as to continuing treatment decisions although continued treatment would be refunded 1 European Commission (2012): MISSOC – Mutual information system on social protection: Social protection in the Member States of the European Union, of the European Economic Area and in Switzerland: Comparative tables 9 for six months if prescribed by a GP. For the prescription of acetylcholinesterase inhibi- tors, an MMSE is required. Treatment with acetylcholinesterase inhibitors is limited to people with an MMSE between 26 and 10, whereas treatment with memantine is reim- bursed for patients scoring between 14 and 3 on this scale. Medicines for people living alone and for people in nursing homes are also covered by the healthcare system. However, in the case of people with dementia living alone, there must be a carer who can ensure that the person with dementia takes the medication. Bi-therapy with an acetylcholinesterase inhibitor and memantine is officially excluded from reimbursement in Austria, which means that patients would have to pay for one of the drugs except in well-founded cases (www.erstattungskodex.at). Prescription and Donepezil Rivastigmine Galantamine Memantine reimbursement Available