World Alzheimer's Day 2021
[PT][EN]
Today we observe World Alzheimer's Day, organized by the Alzheimer's Society , and part of Alzheimer's Disease Month . This year's theme is Dementia and as such we have the testimony of Professor Manuel Gonçalves Pereira, co-principal investigator of the Mental Health Needs and Interventions laboratory , including the work of Conceição Balsinha and Maria J. Marques, and also Luísa Alves, researcher at Neurology laboratory : Stroke and Dementia by Professor Miguel Viana Baptista:
Dementia is a syndrome, typically chronic and progressive, involving a set of cognitive alterations with an impact on daily activities, functional decline, and relevant disability. According to the classification of the American Psychiatric Association (DSM-V) it falls under the 'major' neurocognitive disorder. Alzheimer's disease (pure or in combination) accounts for 40-80% of dementia cases (to find out more: WHO or Alzheimer's Disease International ). We can estimate more than 200,000 people with dementia in Portugal (350,000 in 2050, projections from Alzheimer Europe). Recently, CEMBE/FMUL estimated the costs of Alzheimer's disease, for 2018, at two billion euros (1% of GDP). Several research groups from CEDOC at NOVA Medical School are dedicated to clinical, epidemiological and service research in this area.
At the Comprehensive Health Research Center, the group led by Manuel Gonçalves Pereira has been studying the psychosocial aspects of dementia: caused by organic brain diseases, the psychological and social aspects also determine serious problems. Therefore, service responses must integrate psychosocial components, covering the most frequent care needs. An EU-JPND project – Actifcare – focused on difficulties in accessing and using home care and day care centres, implying unmet needs and lower quality of life for patients and their families.
Maria Marques , MSc in health and aging and doctoral student at FCM-UNL, was interested in the quality of the relationship between people with dementia and their families, as a factor that promotes and protects health. The quality of this relationship helps to face many of the challenges associated with dementia, adopt constructive strategies, and alleviate negative aspects such as the caregiver's burden and suffering. By facilitating the use of services, it could also delay many institutionalizations.
In this line, the group has investigated interventions with families and collaborated with Alzheimer Portugal in work developed by the Association (support for informal caregivers, psychoeducational groups ).
Patients and families need help in health and social systems that are still relatively inhospitable despite improvements. This ranges from primary health care to referral for Neurology or Psychiatry appointments, in emergency services or admissions to general hospitals (due to intercurrent infections, operations, etc.), in continuing or palliative care and terminal situations. The third sector being crucial, the group has focused on the role that primary care should play. Among other reasons, for the proximity and because the family doctor observes the patient as a whole: if someone has, as is often the case, dementia, and diabetes at the same time, and if one of the problems affects the management of the other, integrated answers must be sought.
Conceição Balsinha, a graduate assistant in General and Family Medicine, became interested in dementia in primary care. In her PhD work at FCM-UNL, she explored the perspectives of users of these services and teams. These are not yet prepared to implement the recommendations related to dementia: professionals need to develop specific skills; the role of nurses needs to be defined and community support needs to gain scope. This work motivated another project (Dementia in primary care: The patient , the carer and the doctor in the clinical encounter ; Bayer/NOVA Saúde Ageing 2018 grant ), on the dynamics of communication involving these triads in General and Family Medicine consultations and the its influence on clinical outcomes.
In addition to fundamental research and community services, CEDOC-NMS has been studying the epidemiology of neuropsychiatric disorders in aging, collaborating with the 10/66 Dementia Research Group. In Portuguese population samples aged 65 years and over, the estimates of the prevalence of dementia were around 9.2%, while for depression with clinical significance (deserving a response from the services) they were around 18%. Depression is a risk factor for developing dementia, but it is also a frequent complication of these conditions.
In another CEDOC-NMS team, coordinated by Miguel Viana Baptista (Neurology : Stroke and Dementia ), Luísa Alves (graduated hospital assistant in Neurology, co-responsible for the consultation of cognitive diseases at Centro Hospitalar Lisboa Ocidental) has been dedicated to studying the transition, to Dementia, of the Mild Cognitive Deficit (MCD). In the MCD, independence in activities of daily living is maintained. Neuropsychological assessment plays a role in diagnosis and prognosis, being essential in this area of clinical investigation. The team has recently studied the neuropsychological predictors of MCD stability, as is the case with some memory and non-verbal abstraction tests, emphasizing the long-term stability of the patients. Some neuropsychological measures may also help to estimate the time to conversion to dementia in individuals with MCD due to Alzheimer's disease.
Left to Right: M.M. Gonçalves Pereira, Conceição Balsinha, Maria J. Marques, Luísa Alves