Dementia beyond 2025: knowledge and uncertainties

International audienceGiven that there may well be no significant advances in drug development before 2025, prevention of dementia/AD through the management of vascular and lifestyle-related risk factors may be a more realistic goal than treatment. Level of education and cognitive reserve assessment in neuropsychological testing deserve attention, as well as cultural, social and economic aspects of caregiving. Assistive technologies for dementia care remain complex. Serious games are emerging as virtual educational and pleasurable tools, designed for individual and cooperative skill-building. Public policies are likely to pursue improving awareness and understanding of dementia; providing good quality early diagnosis and intervention for all; improving quality of care from diagnosis to the end of life, using clinical and economic endpoints; delivering dementia strategies quicker, with an impact on more people. Dementia should remain presented as a stand-alone concept, distinct from frailty or loss of autonomy. The basic science of sensory impairment and social engagement in people with dementia needs to be developed. E-learning and serious games programmes may enhance public and professional education. Faced with funding shortage, new professional dynamics and economic models may emerge through coordinated, flexible research networks. Psychosocial research could be viewed as an investment in quality of care, rather than an academic achievement in a few centres of excellence. This would help provide a competitive advantage to the best operators. Stemming from care needs, a logical, systems approach to dementia care environment through organizational, architectural and psychosocial interventions may be developed, to help reduce symptoms in people with dementia and enhance quality of life. Dementia-friendly environments, culture and domesticity are key factors for such interventions

Recommendations for the use of Serious Games in people with Alzheimer's Disease, related disorders and frailty.

International audienceAlzheimer's disease and other related disorders (ADRD) represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments to assess the disease severity and progression, as well as to improve its treatment, stimulation, and rehabilitation. This is the underlying idea for the development of Serious Games (SG). These are digital applications specially adapted for purposes other than entertaining; such as rehabilitation, training and education. Recently, there has been an increase of interest in the use of SG targeting patients with ADRD. However, this field is completely uncharted, and the clinical, ethical, economic and research impact of the employment of SG in these target populations has never been systematically addressed. The aim of this paper is to systematically analyze the Strengths, Weaknesses, Opportunities, and Threats (SWOT) of employing SG with patients with ADRD in order to provide practical recommendations for the development and use of SG in these populations. These analyses and recommendations were gathered, commented on and validated during a 2-round workshop in the context of the 2013 Clinical Trial of Alzheimer's Disease (CTAD) conference, and endorsed by stakeholders in the field. The results revealed that SG may offer very useful tools for professionals involved in the care of patients suffering from ADRD. However, more interdisciplinary work should be done in order to create SG specifically targeting these populations. Furthermore, in order to acquire more academic and professional credibility and acceptance, it will be necessary to invest more in research targeting efficacy and feasibility. Finally, the emerging ethical challenges should be considered a priority

Assistive technologies to address capabilities of people with dementia: from research to practice

Assistive technologies (AT) became pervasive and virtually present in all our life domains. They can be either an enabler or an obstacle leading to social exclusion. The Fondation Médéric Alzheimer gathered international experts of dementia care, with backgrounds in biomedical, human and social sciences, to analyse how AT can address the capabilities of people with dementia, on the basis of their needs. Discussion covered the unmet needs of people with dementia, the domains of daily life activities where AT can provide help to people with dementia, the enabling and empowering impact of technology to improve their safety and wellbeing, barriers and limits of use, technology assessment, ethical and legal issues. The capability approach (possible freedom) appears particularly relevant in person-centered dementia care and technology development. The focus is not on the solution, rather on what the person can do with it: seeing dementia as disability, with technology as an enabler to promote capabilities of the person, provides a useful framework for both research and practice. This article summarizes how these concepts took momentum in professional practice and public policies in the past fifteen years (2000-2015), discusses current issues in the design, development and economic model of AT for people with dementia, and covers how these technologies are being used and assessed

Le répit : des réponses pour les personnes atteintes de la maladie d'alzheimer ou de maladies apparentées, et leurs aidants ? évolutions de 2000 à 2011

International audienc

Impact socio-économique de la maladie d’Alzheimer et des maladies apparentées en Europe

Cost assessment of Alzheimer’s disease is a difficult task, all the more so when making a European comparison. How can costs be defined and measured when systems for taking charge of patients or reimbursements differ and when data in some countries are non-existent? The European Commission within the public health community action programme of 2003-2008 finances the European Collaboration on Dementia Socio-Economic Group. The programme was set up and coordinated by Alzheimer Europe and supported by the Alzheimer Médéric Foundation. The Group has created an economic model of the costs of the disease, making various assumptions, approximations and options based on identified economic data available in international literature. The total cost of Alzheimer’s disease or diseases of the same type within Europe (UE 27) is estimated at 160.3 billion euros in 2008 (1.3% of the 2008 gross domestic product of UE 27), of which 71.7 billion in direct costs (45%) and 88.6 billion (55%) in indirect costs. The annual costs per person suffering from Alzheimer’s disease are estimated at 22,194 euros of which 9,925 euros in direct costs and 12,270 euros in indirect costs. For the UE 27 zone, the disease’s load is estimated at 2.12 million years of DALY-disability adjusted life years (441 of DALY-disability adjusted life years for 100.000 people). This load is heavier than that of diabetes

Dementia beyond 2025: knowledge and uncertainties

International audienceGiven that there may well be no significant advances in drug development before 2025, prevention of dementia/AD through the management of vascular and lifestyle-related risk factors may be a more realistic goal than treatment. Level of education and cognitive reserve assessment in neuropsychological testing deserve attention, as well as cultural, social and economic aspects of caregiving. Assistive technologies for dementia care remain complex. Serious games are emerging as virtual educational and pleasurable tools, designed for individual and cooperative skill-building. Public policies are likely to pursue improving awareness and understanding of dementia; providing good quality early diagnosis and intervention for all; improving quality of care from diagnosis to the end of life, using clinical and economic endpoints; delivering dementia strategies quicker, with an impact on more people. Dementia should remain presented as a stand-alone concept, distinct from frailty or loss of autonomy. The basic science of sensory impairment and social engagement in people with dementia needs to be developed. E-learning and serious games programmes may enhance public and professional education. Faced with funding shortage, new professional dynamics and economic models may emerge through coordinated, flexible research networks. Psychosocial research could be viewed as an investment in quality of care, rather than an academic achievement in a few centres of excellence. This would help provide a competitive advantage to the best operators. Stemming from care needs, a logical, systems approach to dementia care environment through organizational, architectural and psychosocial interventions may be developed, to help reduce symptoms in people with dementia and enhance quality of life. Dementia-friendly environments, culture and domesticity are key factors for such interventions

Les fonctions sensorielles et la maladie d'Alzheimer : une approche multidisciplinaire

Relations between sensory functions and Alzheimer's disease are still under explored.To understand them better, theFondation MédfJricAlzheimer has brought together a multi-disciplinary expert group. Aristote's five senses must be enhanced by today's know ledge of proprioception, motor cognition and pain perception. When cognition breaks dawn, the persan with dementia perceives the world around her with her sensory experience, yet is unable to intagratB all this information to understand the contaxt.The trBBtment of mul tiple sensory inputs by the brain is closely linked to cognitive processes. Sensory deficits reduce considerably the autonomy of people with dementia in their daily fife and their rela tions with others, increase their social isolation and the risk of accidents. Professionals involved with neurodegenerative diseases remain poorly aware of sensory deficits, which can bias the results of cognitive tests. However. there are simple tools to detect these deficits, notably for vision, hearing and balance disorders, which can be corrected. Many interventions for cognitive rehabilitation or quality of fife improvement are based on sen sory functions. The environment of people with dementia must be adapted to become understandable, comfortable, safe and eventually therapeutic.Afin de mieux comprendre les relations, encore insuffisamment étudiées, entre les fonctions sensorielles et la maladie d'Alzheimer, la Fondation Médéric Alzheimer a réuni un groupe d'experts multi-disciplinaire. Aux cinq sens d'Aristote, il faut aujourd'hui ajouter la proprioception, la cognition motrice et la perception de la douleur. Lorsque la cognition se détériore, la personne atteinte de la maladie d'Alzheimer voit le monde qui l'entoure avec son expérience sensorielle, sans qu'elle puisse toutefois intégrer toutes ces informations pour comprendre le contexte. Le traitement des multiples informations sensorielles par le cerveau est étroitement lié à des processus cognitifs. Les déficits sensoriels réduisent considérablement l'autonomie des personnes malades dans la vie quotidienne, leurs relations avec autrui, augmentent leur isolement social et le risque d'accidents. Les professionnels impliqués dans les maladies neurodégénératives restent insuffisamment sensibilisés aux déficits sensoriels, qui peuvent fausser l'évaluation de la cognition. Il existe pourtant des outils de repérage simples de ces déficits, notamment pour les troubles de la vision, de l'audition et de l'équilibre qui peuvent être corrigés. De nombreuses interventions pour la réhabilitation cognitive ou l'amélioration de la qualité de vie s'appuient sur les fonctions sensorielles. L'environnement des personnes malades doit être adapté pour le rendre compréhensible, confortable, sûr et si possible thérapeutique