Global National Policy on Dementia Alzheimer’s...
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28/08/61 1 Global & National Policy on Dementia & Alzheimer’s Disease Associate Professor Vorapun Senanarong, BSc, MD, DTM&H(London), FRCP(London) Professor Vorapun Senanarong, BSc, MD, DTM&H(London), FRCP(London) • Dementia burden • Global dementia observatory • Death in dementia, risk factors in dementia • Global dementia action plan • Research plan • National Drug list
Transcript of Global National Policy on Dementia Alzheimer’s...
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Global & National Policy on Dementia & Alzheimer’s Disease
Associate Professor Vorapun Senanarong, BSc, MD, DTM&H(London), FRCP(London)
Professor Vorapun Senanarong, BSc, MD, DTM&H(London), FRCP(London)
• Dementia burden
• Global dementia observatory
• Death in dementia, risk factors in dementia
• Global dementia action plan
• Research plan
• National Drug list
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Distribution of total societal costs (%) by World Bank Income level
Composition of health expenditure measured in US$
Heavy reliance on out of pocket expenditures leads to financial barriers for poor. WHO/NHA Policy Highlight No.2/May 2011. Geneva, World Health Organization, 2011 (http://www.who.int/nha/use/2008data_highlight2.pdf, accessed 12 February 2012)
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Factors related to caregiver strain
World Alzheimer’s Report 2009. London, Alzheimer’s Disease International, 2009
The integrated caregiving system
WHO2012
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Original EURODEM prevalence estimates of dementia, no major differences between and within countries in prevalence of dementia cf other NCD (Hofman et al)
Dementia and severe cognitive impairment before death by age (dying within one year of interview‐UK)
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Cardiovascular disease mortality trends for males and females (United States: 1979–2007).
Roger V L et al. Circulation 2011;123:e18-e209
Copyright © American Heart Association
Cardiovascular disease (CVD) deaths versus cancer deathsby age (United States: 2007).
Roger V L et al. Circulation 2011;123:e18-e209
Copyright © American Heart Association
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Graph showing growing number of Alzheimer’s disease‐related deaths compared to other diseases
between 2000 and 2010 (percentage change)
Wortmann Alzheimer’s Research & Therapy 2012, 4:40
Alzheimer's Association 2013: Alzheimer' Disease Facts & Figures. www.alz.org/downloads/facts_figures_2013.pdf.
Age and sex adjusted survival in 20244 healthy men and women 40‐79 years EPIC‐Norfolk
1993‐2006 by health behaviour score
1 Non smoker1 Alcohol >0 <14 units/wk1 Not inactive1 Blood vitamin C >50 umol/l
(5 servings fruit and vegetables daily)
YEARS
121086420-2
Cum
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1.0
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Equivalent survival difference14 years chronological age
Khaw et al PLoS Med 2008 Jan 8;5(1):e12.http://www.epic-norfolk.org.uk
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Prevalence of dementia at death by educational level (MRC CFAS)
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Years of full time education
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Brayne et al, PLoS Med 2006
Gill Livingston, Andrew Sommerlad, Vasiliki Orgeta, at al. Dementia prevention, intervention, and care. Lancet 2017. http://dx.doi.org/10.1016/S0140‐6736(17)31363‐6
Life‐course model of contribution of modifiable risk factors to dementiaNumbers are rounded to nearest integer. Figure shows potentially modifiable or non‐modifiable risk factors.
5%
9%
2%1%
5%4%3%2%1%
35%
65%
8%Less education
Early life
ApoE47% Percentage reduction if this risk is eliminated
Midlife
Late life
Potentially modifiable risks
Potentially non‐modifiable risks
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Proportion of CPRD population diagnosed with dementia in the UK by region (A) and age (B)between July, 2005, and June, 2015
Lancet Public Health 2017;2: e149–56
Clinical PracticeResearch Datalink (CPRD)
Time(yr)
Time(yr)
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Lancet Public Health 2017; 2: e149–56
Proportion of patients with dementia prescribed an antidementia drugCPRD=Clinical Practice Research Datalink
Proportion of patients with Alzheimer’s disease prescribed an antidementiadrug
Lancet Public Health 2017; 2: e149–56
Proportion of patients with dementia prescribed an antipsychotics CPRD=Clinical Practice Research Datalink
Proportion of patients with dementia prescribed an anxiolytic, hypnotic, or antidepressant
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European Context (OECD European Union, 2010)
Prevalence of dementia - 7.3 million. Highest prevalence: Sweden, Italy, Switzerland, Germany. Most common causes: Alzheimer’s disease (50-70%),
Vascular dementia (30%). Rates increase with age: one-third of males (32.4%), half
of females (48.8%) at age 95 years. Patterns of care: informal care by families and friends &
formal care at home or in institutions.
Global Dementia Observatory
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Biopsychosocial national dementia plan: Chilli
Front. Aging Neurosci. 2017;9:221.doi: 0.3389/fnagi.2017.0022
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Dementia Strategy
Northern Ireland strategiesDHSSPS (2010) A partnership for Care:
• to improve the health and well being of the people of Northern Ireland.• to ensure safe and effective care services are delivered.
The Northern Ireland Dementia Strategy ‐ DHSSPS (2011) Improving dementia services in Northern Ireland
• Prevention • Assessment• Treatment of risk factors• Person centred care• Self care • Collaboration between care organisations, local government, independent
and voluntary sectors
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Aims and categories of dementia registries
Alzheimer’s & Dementia 2017; 1‐17
Populations captured in existing dementia registries
Alzheimer’s & Dementia 2017; 1‐17
Registry research: quality of care
People with dementia
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WHO:Globaldementia action plan seven cross‐
cutting principles
Empowerment
Human right
Equity
Multisectoralcollaboration
Universal healthand social care
Evidence‐based practiceAttention to prevention, cure and care
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7 Areas of work
The Global Plan For Dementia : Action and Target
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• WHO meeting in Geneva on implementation of the Global Action Plan on the Public Health Response to Dementia 2017‐2025 (GAP). The meeting included presentation of the newly‐launched Global Dementia Observatory (GDO) and e‐tool
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Lancet Neurol. 2016 Nov;15(12):1285‐1298
Numbers(%) of thematic research avenues by overarching research domain
Lancet Neurol. 2016 Nov;15(12):1285‐1298
Mean of the priority scores for the top 20 thematic research avenues for each of the seven overarching research domains across the 5 scoring criteria
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Technology‐Assisted Care Coordination Model for Chronic Disease
Better Health Outcomes
Decreased Cost
Increased quality
CaregiversPharmacy
Care coordination team
Specialist
sMonitoring
Education
Support Technologies
Peer Leaders
Patients at homeHTN, DM, COPD, CHF,Asthma, depression,
PTSD
Feedback
EducationSupport
Feedback
Primary Care Providers
Non VAProviders
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Int J Geriatr Psychiatry. 2018;1–7.
1. Prevent Future Cases of Dementia Through Increasing Knowledge of Risk and Protective Factors
2. Maximise the Benefits to People Living With Dementia and Their Families of Seeking and Receiving a Diagnosis of Dementia
3. Improve Quality of Life for People Affected by Dementia by Promoting Functional Capabilities and Independence While Preventing and Treating Negative Consequences of Dementia
4. Enable the Dementia Workforce to Deliver Improved Practice by Increasing Knowledge and Informing Changes in Practice and Culture
5. Optimise Quality and Inclusivity of Health and Social Care systems That Support People Affected by Dementia
5 goals30 recommendation
Antidementia Drugs
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Treatment with anti‐dementia Drugs among Medicare Fee‐for‐Service Part D Beneficiaries with a Prevalent or New Diagnosis of Dementia in 2009
Modeled Association of Beneficiary characteristics with Treatment with Anti‐dementia Drug within 1 year of Newly Diagnosed DementiaJ Am Geriatr Soc. 2016; 64(8): 1540–1548
USA
58%
45%
52%
73%
Authorisation and Reimbursement of Alzheimer Drugs in Europe
A = authorised; R = part of the reimbursement system.
EUROPEAN NEUROLOGICAL DISEASE 2007;40‐44
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Prescription and Reimbursement Criteria for Treatments of Alzheimer’s Disease in Europe
EUROPEAN NEUROLOGICAL DISEASE 2007;40‐44
Prescription and Reimbursement Criteria for Treatments of Alzheimer’s Disease in Europe
EUROPEAN NEUROLOGICAL DISEASE 2007;40‐44
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Zahirovic et al. BMC Geriatrics (2018) 18:50
Psychotropic medication: DLB
Zahirovic et al. BMC Geriatrics (2018) 18:50 Anatomical Therapeutic Chemical (ATC) Classification System
N=610
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Antidementia Medication:DLB
Zahirovic et al. BMC Geriatrics 2018; 18:50
JAMA Intern Med. 2014;174(11):1763‐1771. d
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Serge Gauthier, MD, Chair of ADI’s Medical and Scientific Advisory Panel (MSAP), said: “Anti‐dementia drugs are an important component of disease management, in many cases temporarily alleviating symptoms or slowing progression of the condition. Ceasing reimbursement will mean that families will need to shoulder the burden of cost themselves”.ADI is calling for equitable and fair access to anti‐dementia drugs. Alongside our MSAP, a global committee of dementia experts, ADI announces that we will apply to register anti‐dementia drugs onto the WHO Model List of Essential Medicines. Working alongside research institutions, this process will be led by MSAP and completed by 2020.
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การคดัเลอืกยาโดยใช้ระบบคะแนนช่วยลดอคตใินการคดัเลอืกยา
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Antidementia Drugs in the National Drug lists
• Thailand:
• Alzheimer Disease‐ รอผลมตจิากคณะกรรมการประสานผล
• Vascular dementia‐มตคิณะทํางานฯ
ชะลอการคดัเลือกยา donepezil hydrochloride รูปแบบ tab ในข้อบง่ใช้ ภาวะสมองเส่ือมจากโรคหลอดเลือดสมอง (vascular dementia) เข้าบญัชียาหลกัแห่งชาต ิจนกวา่จะมีข้อมลูด้าน efficacy ท่ีมากขึน้ ทัง้นีโ้รคนีย้งัมีวธีิในการป้องกนัอยูคื่อ การป้องกนัไมใ่ห้เป็นโรคหลอดเลือดสมอง (stroke prevention)
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Thank You For Your Attention
