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)61066-7
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Copyright © 2014 Elsevier Ltd All rights reserved.
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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