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onsdag 23 juli 2014

Lansetti: Dementia globaalisti ottaen

Maailmassa on demntikkoja nyt 44 miljoonaa ja 20 vuodessa johtuen väestönkasvusta  määrä lie kaksinkertaistunut.  Joka neljäs sekuntti diagnosoidaan uusi tapaus. -- Asian hahmottamista on koetettu globaalitasoisesti tehdä G8 Dementia konferenssissa Lontoossa joulukuussa. 2013 ja tautia modifioivaa  parantavaa hoitoa on kaavailtu  saatavan  vuoteen 2025 mennessä.  Päämäärän toteuttamiseksi on sitten ollut  alustava tapahtuma Global Dementia Legacy Event. Todettiin, että tarvitaan uusia lääkeratkaisuja.

The Lancet, Volume 383, Issue 9936, Page 2185, 28 June 2014
doi:10.1016/S0140-6736(14)61066-7Cite or Link Using DOI

Addressing global dementia

Driven by rapid population ageing, 44 million people worldwide are living with dementia, and this number is predicted to nearly double every 20 years. With one case diagnosed every 4 seconds, and a global economic cost of US$604 billion—1% of global GDP—the challenge posed by the social and economic burden of dementia is unequivocal. But only recently has dementia received world leaders' attention. Under the leadership of UK Prime Minister David Cameron, the G8 Dementia Summit held in London in December, 2013, was a historic moment for dementia—a first attempt to shape a global response and to identify a cure or a disease-modifying therapy by 2025. To discuss how such an ambitious goal can be achieved, on June 19, health and finance experts including academics, Alzheimer's charities, WHO, pharmaceutical organisations, and investors gathered in London for the first Global Dementia Legacy Event.
With only three drugs of more than 100 tested since 1998 coming to the market, and no cure in sight, the meeting focused on the need to address this “market failure”, and reinvigorate drug discovery and the early stage of the translation pathway. World Dementia Envoy, Dennis Gillings, outlined three areas that need urgent improvement: the ratio of risk to reward faced by companies investing in dementia, the need to stimulate investment in research and development, and the need to harness the power of social media and big data.
Rewarding research and development for investors and industry was clearly identified as one of the main issues. Using approaches for HIV/AIDS and orphan drugs as possible models, experts suggested extension of patent exclusivity, and freeing up of regulation to allow more rapid testing of new drugs. Screening of existing compounds, discovery challenge prizes, new public—private partnerships, and a platform to innovate, collaborate, and improve openness were also possible ways to accelerate research. Innovative financing to support research was also widely discussed, including new funding mechanisms (eg, premium bond, capital market vehicle, and a venture capital fund), social innovation, and philanthropy. As a further boost, the UK Government announced that it will increase the funding for dementia to £66 million by 2015.
More funding and finding a cure by 2025 are certainly important aspects of dementia, but as Martin Prince (King's College London) and WHO's Shekhar Saxena clearly outlined in their presentations, the challenge ahead is much broader. A larger vision and set of actions are needed to improve the lives of people with dementia and their carers worldwide. A new treatment can only be scaled up when diagnosis, care, and delivery systems are functioning. Little research is carried out on scaling up of cost-effective care strategies and integrated models of care. Little is known about, for example, alternatives to antipsychotic treatment, non-drug approaches, or the place of cognitive stimulation. The dementia research agenda should include studies of disease mechanisms, epidemiology, early diagnosis, prevention, risks and social determinants, non-drug based approaches, and quality of life.
The quest for new drugs must not overshadow improving today's care and patients' lives. Dementia, perhaps more than any other disease, deeply affects not only patients' lives, but also their families—and particularly that of the person providing care (most commonly a woman, worldwide). Caring for patients with dementia is exhausting physically and emotionally; much needs to be done to support patients' carers. Patients and their caregivers were notably under-represented at the first Global Dementia Legacy Event. They have a unique insight into the condition and must be involved early in the development of an action plan.
The majority of countries are ill-prepared to face the burden of dementia with currently only 13 countries worldwide having a national plan. With 60% of patients with dementia living in low-income and middle-income countries, and numbers predicted to triple in Africa by 2050, dementia is also an issue for developing countries.
In its recent report Dementia: A Public Health Priority, WHO provides an extremely valuable approach to tackle dementia globally, with a range of actions to improve care and services for people with dementia and their caregivers, and for countries to develop and implement dementia plans, anchored to health and social system strengthening. The UK's leading role and commitment to dementia are welcome, and this level of political engagement will certainly help. However, to truly be a global response to the threat posed by dementia worldwide, future discussions and action plans must look beyond drugs, and include patients, carers, and developing countries.

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