14.07.2015 Effective early intervention to counter forgetfulness in old age
International dementia symposium. Poor concentration and increasing forgetfulness are early signs of dementia, a disease that can rob a person of the ability to live independently. In early June, some 120 people working in public administration, research and the practical setting met at the first international dementia symposium, hosted by Switzerland, to discuss possible ways in which the health service and society can meet this challenge.
The Federal Office of Public Health was asked to organise the first international symposium on the challenges of dementia at the Paul Klee Centre in Berne. The idea was put forward in August 2014 by the German-speaking health ministers of Germany, Austria, Liechtenstein, Luxembourg and Switzerland, who were keen to cultivate a cross-border dialogue. The meeting was opened by Federal Councillor Alain Berset on 4 June 2015. He emphasised the ministers' expectation that the countries would be able to learn from each other and receive new impetus for their own plans of action. Some 120 people from all five countries took up the invitation to attend, including experts from public administration, research, the practical setting, professional associations and organisations representing patients and carers.
The first symptoms
The members of the ensemble "Hirntheater" [theatre in the brain] acted a short scene showing how the first symptoms of dementia make themselves felt.
Leni is sitting at a table set for afternoon coffee. She and her 10-year-old daughter Anna live in the same house as her father. Berni is in his mid-70s and was a head chef before he retired. They get on well and he helps her a lot. Of late, though, he has been getting less reliable, and sometimes forgets where he has to go to pick up Anna from her piano lessons. He went to a memory clinic to be examined and was diagnosed with the initial stage of Alzheimer's disease. Berni recently became friends with Angela, a neighbour, and now Leni wants to meet Angela, so she has invited both of them to celebrate her father's birthday. And now they've arrived. Berni introduces Angela, saying "You know, Leni, Angela lives just down the road in Armbrust Street." Angela laughs. "No," she says, "in Tell Street." "He has such a sense of humour," she says, looking happily at Lena. Angela had no idea that she was being invited to Berni's birthday party. A bit embarrassed, she says, "I didn't get you a present, I'm afraid." Leni has got one; she gives her father a bicycle lock that is too big to miss. He's a keen cyclist, but sometimes he forgets where he's left his bike. "That wouldn't happen so easily with a car," Angela says. "I'm afraid I can't drive. If you can, I'd love to go to Alsace and eat snails some time." The daughter changes the topic and sends her father out to his bike. She explains to Angela that her father can no longer drive because he is ill. Angela can't believe it and says he'll soon get better. "We all get a bit forgetful as we get older." At that moment Berni returns, stands by the table and expresses his heartfelt thanks to the two women. Angela is delighted. "Such a sense of humour," she enthuses.
Delaying the progression of the disease
If you function normally in everyday life and are able to complete cognitive tasks, you are considered healthy. Yet imaging techniques show that degenerative changes occur in the brain at a very early stage. The brain is evidently capable of compensating for declining cognitive abilities for a long time. However, this ability to compensate can suddenly be lost, resulting in an abrupt change in the life of the person with dementia. There is currently no cure for these vascular changes in the brain. "But there are alternatives," said Prof. Tobias Hartmann, coordinator of the national dementia prevention programme in Luxembourg. In his view, these involve reducing the risk factors associated with dementia, and he cited known risk factors such as high blood pressure, diabetes, smoking, high cholesterol levels and loneliness. Nowadays, he continued, we know that the presence of three of these risk factors at the same time is associated with a six-fold increase in the risk of developing dementia. A research team in Finland carried out a major interventional study on the basis of this knowledge. In the study, people with an increased risk of dementia were given a customised programme to follow that modified their lifestyle in terms of nutrition, physical activity and social activity. As a result of these modifications, many of the people in the study did not develop dementia at any time in their lives, or were able to enjoy a good quality of life with only minor restrictions for many years. However, preventive measures have to be realistic, long-term and designed in such a way that they are acceptable to the individual concerned. In July 2015, Luxembourg launched a progamme to train healthcare professionals to help interested individuals achieve a health-promoting lifestyle. The participants at the symposium concluded that it is important to raise awareness in the population of the importance of maintaining a health-promoting lifestyle into old age. Prof. Stefanie Auer from Krems also emphasised that people close to the patient must be made aware that an early diagnosis can dispel uncertainties and can pave the way to measures designed specifically to promote quality of life and provide help as needed.
Dr. Barbara Bleisch from the Swiss TV programme Sternstunde Philosophie talked to Prof. Susanne Boshammer from Osnabrück about the ethical aspects of dealing with dementia. "Dementia is not an individual problem," said the professor, who did not offer any patent remedies during the interview. She felt that in old age the emphasis should be less on autonomy than on successful cohabitation. There is also a need to deal with fears and to learn to live with the uncertainty of not knowing as a healthy person what it feels like to have dementia. She felt that this collective uncertainty opens up new perspectives. "Never before have we had so many ways of organising daily life with people suffering from dementia with so much dignity." We need to take leave of the past and try not to focus solely on shared memories, and instead discover the possibility of moving forward. In addition, Boshammer emphasised that people with dementia also have a right to express their needs in society.
Symposium proceedings available in early September
The proceedings of the symposium will be published on the FOPH website in early September 2015. They will feature some of the current activities in the five countries and a summary of the results of the group discussions held at the symposium on four topics: raising awareness in society, prevention and secondary prevention, living at home with dementia, and collaboration in care.