Co-author, Second World Alzheimer Report 2010

KI Alzheimer’s Disease Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

QUESTION:

How much of an impact do you consider the World Alzheimer Report 2010 has had since its launch in September 2010? Has its impact taken you by surprise and is interest in this Report noticeably different from responses to the launch of the very first Report in 2009? If so, why do you think that is?

PROF WIMO:

The global response to the 2010 report was much greater than to the 2009 report. The reason is probably money, that is, cost figures seem to be of more interest to the media than just dementia prevalence figures.

QUESTION:

The worldwide dementia database has been developed over the last 10 years and was used to help make estimates of numbers of people suffering with dementia across the world and the costs associated with their treatment and care along with surveys conducted by Alzheimer’s Disease International. How were these estimates made for those people with dementia living in countries where the condition is barely known about and where no official figures or costs exist specifically in a country such as Bangladesh?

PROF WIMO:

In the 2010 report we have some cost figures from low income countries but for most countries there is a lack of data. For this situation we had to rely on imputation, that is, where we use dementia cost figures for nearby/similar countries and then adjust the imputed cost figures according to GDP per person for the country where specific data isn’t available.

QUESTION:

What more needs to be done and could be done to raise awareness of dementia across all societies, particularly to all governments across the world, and about the costs associated with not taking action? How do you see the role of Alzheimer’s Disease International in helping to achieve this?

PROF WIMO:

Alzheimer’s Disease International is very important particularly for the collection of data from low and middle income countries but, of course, also to improve awareness of dementia and the care of those suffering from it in these countries. The prevalence and costs today are already very high but the projected increase in the numbers of people with dementia presents a great challenge, particularly as the social care sectors in low and middle income countries is very limited.

QUESTION:

What kind of action do you consider governments should implement in the low to middle income countries who as yet have no programme or adequate infrastructure for dealing with the consequences of a rise in population age nor a predicted rapid increase in the numbers of people suffering from dementia?

PROF WIMO:

First of all we must put dementia firmly on the political agenda in these countries. The present and projected prevalence of dementia, in combination with figures of resource use and high societal costs, are important to put into focus as well as to question whether informal care eg family carers will be as common in the future as it is today. Migration, urbanisation, women entering the labour market etc could all affect the numbers available to carry out this informal care.

QUESTION:

The Sir William Beveridge Foundation, in partnership with Alzheimer’s Australia (WA) Ltd, is beginning its international work on dementia in Bangladesh by starting to raise awareness about it among the general population and among health and social care professionals. Also by training its Beveridge Carers and Nurses in dementia care who are already working in Bangladesh on care for the elderly projects. Do you see a role for NGOs in helping to spread awareness of dementia and in developing practical work for the diagnosis, treatment and care for people with the condition, particularly in low to middle income countries, but also generally?

PROF WIMO:

Yes indeed. One reason is of course linked to financing as resources are scarce in low-income countries, but also for policy making, as NGOs will have a competence in the field of dementia, for example. NGOs can act as lobbyists to put pressure on the political and care systems in low and high-income countries.

QUESTION:

What role is the World Health Organisation (WHO) playing in spreading awareness of dementia and what difference do you think their approach will make?

PROF WIMO:

WHO needs to focus on dementia more rather than just concentrate on communicable diseases – there is indeed much more for WHO to do. It is also important to stress the impact of dementia not only on the medical care sector but also on the social care sector and the need to establish and improve a social care infrastructure in low and middle income countries.

QUESTION:

How do you see the world situation on dementia in 10 years time if:

a. commitments to action are taken quickly by governments and implemented;

b. no action is taken.

PROF WIMO:

a) As it takes a long time to establish care structures for people with dementia it is important that governments at all levels in any country begins this work now. All countries should develop a dementia care plan. Of course there is also the hope that better drugs will become available that can have an influence on the underlying disease process such as in Alzheimer’s Disease. The problem for high income countries is linked mainly to the financing of long-term care while the focus for low and middle-income countries should be on the development of almost non-existent social care sectors.

b) Due to the rapid increase in prevalence of dementia, the situation is set to become very bad. In high-income countries there may be an economic crisis for patients, caregivers and the care sectors. In low and middle-income countries many people with dementia may be without any care at all.

QUESTION:

There have been recent announcements in the press about breakthroughs in research on the causes of dementia carried out by the Alzheimer’s Disease Research Centre at the Karolinska Institutet in Stockholm. What kind of work and research does the Research Centre at the Karolinska Institutet carry out? Do you think that finding a cure for dementia is the only way forward to effectively combat the disease or could peoples’ attention to their lifestyle ie diet; not smoking; exercise etc provide a more significant barrier by helping to ward off symptoms for longer – or a combination of these?

PROF WIMO:

Dementia research at the Karolinska Institutet (KI) is very broad, from basic molecular and genetic research to clinical trials and epidemiological research. Many years ago, KI reported on the Swedish mutation, an enormous breakthrough in genetic research on Alzheimer´s Disease. Recently there have been reports from KI about the risk factor patterns in dementia, highlighting lifestyle factors. Cardiovascular factors are also risks for developing dementia.

KI is involved in clinical research such as the vaccination studies on Alzheimer’s Disease as well as studies on Nerve Growth Factors. We are also leading research in imaging in Alzheimer’s Disease ie PET and MRI and are one of the leading research groups in the Health Economics of Dementia project. KI has an important role in the Swedish research network, called Swedish Brainpower, as well as in the work of the European Alzheimer´s Disease Consortium (EADC).

Even though there have been many failures in dementia drug trials over the last few years, there are still many drugs in the pipeline (eg vaccination, secretase inhibitors, tau modifying drugs etc).

In a broad context I think that treatment of Alzheimer’s Disease and other dementias must have a multi-faceted approach such as lifestyle factors, treatment of cardiovascular risk factors such as hypertension and new drugs. This means the approach should include primary and secondary and tertiary prevention. Whether genetic intervention for dementia will be possible in the future is still a great challenge.