Alzheimer’s disease is the most common cause of dementia among people 65 and older. It represents between 60-70% of all cases of dementia and around 50% of them exclusively show Alzheimer’s disease in their brains.
Alzheimer’s is a progressive neurodegenerative disorder that can be described clinically in three different stages: preclinical, Mild Cognitive Impairment (MCI) due to Alzheimer’s disease, and dementia due to Alzheimer’s disease.
CEAFA (Spanish Alzheimer’s Confederation) estimates that around 1,200,000 people could suffer from Alzheimer’s in Spain. The figure is obtained from the prevalence of the disease in all age ranges. As for the Spanish Neurology Society (SEN), it warns of an alarming underdiagnosis in our country, stating that up to 30% of cases could be undiagnosed.
Diagnostic advances in recent years make it possible to detect early clinical symptoms of progressive cognitive impairment in a patient, before it affects their functional abilities, thus making it possible to intervene in the early stages. This possibility will notably improve the quality of life of both the patient and the family caregiver: it will allow the patient to make vital decisions in the best possible cognitive conditions, and it will grant early access to the necessary pharmacological and nonpharmacological therapies; it will give families and family caregivers time to prepare for the process they are starting; it will keep the catalogue of needs of public protection systems updated and adapted to real demands; it will show the extent of the disease, promoting the urgency of investing in biomedical and social research; will promote actions to raise awareness and non-exclusion of people with dementia, to respect their rights and dignity , to build a society friendly to Alzheimer’s. In short, it will put the person at the center, applying the necessary and sufficient resources in an adapted way.
However, the families’ aspirations listed above face several barriers: in Spain, Primary Care, which is the gateway to the Specialized Care System –in charge of dementia diagnosis-, is becoming a bottleneck that the COVID-19 crisis has narrowed further Despite the availability of new diagnostic tools that allow early detection of Alzheimer’s, these are not always used due to a certain “sanitary nihilism” that underestimates the advantages of acting early since there is no cure, which is really frustrating; public social resources for dementia care are not enough and private ones are not available to all families, a situation that discourages action with older patients.
The stigma of dementia and the lack of information in our society regarding the existing pharmacological and non-pharmacological tools to slow its progress result in a delay in the diagnosis and hinder social awareness.
Therefore, several challenges arise if we want to advance in an early and accurate diagnosis:
- Find support from social and health protection systems on social awareness campaigns on dementia
- Overcome social nihilism regarding the advantages of “being on time”
- Improve dementia detection tools in Primary Care
- Expedite referral to Specialized Care
- Improve coordination between the social and health systems
- Adapt the social resources available to the true needs of the patients
- Increase investment in biomedical and social research
In conclusion, CEAFA considers that early and accurate diagnosis is the best tool to put the patients at the center of care, to make them the protagonists of their own decisions and to build dementia friendly societies.