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Croatia

2012: National Dementia Strategies (diagnosis, treatment and research)

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

There is not yet a National Dementia Strategy in Croatia and there does not seem to be any interest within the current government in having one.

Involvement of the Alzheimer association (and/or people with dementia)

Alzheimer Croatia is developing a draft document which will eventually be submitted to the government.

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

GPs may diagnose dementia. Sometimes they do and sometimes they prefer to refer patients with suspected dementia to a specialist (a neurologist or psychiatrist) for diagnosis. It is up to the GP to decide. It is not a problem to see a specialist quickly (within a few days). For younger people, it is sometimes considered preferable to hospitalise them for diagnostic purposes.  In such cases, an agreement is made to do all the tests and evaluations at the same time rather than have the person return for different tests over a period of time. The hospitalisation costs are covered as everyone in Croatia has insurance for this.

The duration of GP consultations is about 10 minutes. This is an average rather than obligatory length of time. A GP is free to spend more time with a particular patient but this would reduce the amount of time available for other patients. People sometimes have to return several times before a diagnosis can be made based on the gradual accumulation of the necessary details. There are no incentives for GPs to improve or increase timely diagnosis.

Type and degree of training of GPs in dementia

Over the last ten years, Alzheimer Croatia has tried to educate GPs.  It is now more common to hear about dementia in the medical faculties. The Alzheimer association also tries to educate the population through events held on World Alzheimer’s Day. 

GPs only receive a few hours’ training in dementia during the courses on neurology and psychiatry which are part of the professional training to become a GP. They are obliged to undergo continuing education in order to prolong their licence to practice as a GP. However, they can choose the courses they wish to attend in order to obtain the necessary points to prolong their licences and only a minority of GPs choose courses on Alzheimer’s disease or old age psychiatry.

Required tests to diagnose dementia

The most commonly used tests for the diagnosis of dementia are the MMSE and the clock drawing test. However, a GP will usually not diagnose dementia without first sending the person to a psychologist and for a CT test. The ICD-10 criteria must be fulfilled in order to make a diagnosis of dementia and/or Alzheimer’s disease.

Issues relating to medical treatment

The availability of medicines in general

In Croatia there is a list of medical drugs which are reimbursable.

The availability of Alzheimer treatments

Alzheimer drugs are not on the list of reimbursable drugs. However, one month ago (i.e. in September 2012), it was declared that memantine would soon be partially reimbursed if prescribed by a specialist (a neurologist or psychiatrist). Whilst these drugs may be relatively inexpensive in some countries, for Croatian people they remain too expensive and the average family cannot afford to buy AD drugs.

Conditions surrounding the prescription and reimbursement of AD drugs

Once the GP has received all the test results, s/he makes a diagnosis and prescribes an AD drug if appropriate. However, the drug which is on the reimbursement list (namely, memantine) must be prescribed for the first time by a specialist (neurologist or psychiatrist) in order to be reimbursed. GPs can prescribe AD drugs but patients have to pay for them. If a patient has been referred to a specialist, the specialist makes the diagnosis and can make the first and future prescription of AD drugs. There are no restrictions on the prescription or reimbursement of AD drugs for people living alone or in nursing homes.

Prescription and reimbursement

Donepezil

Rivastigmine

Galantamine

Memantine

Available

Yes

Yes

No

Yes

Reimbursed

No

No

No

Yes, partially (20%)

Initial drug reimbursed if prescribed by

N/A

N/A

N/A

Specialists (neurologist or psychiatrist)

Continuing treatment reimbursed if prescribed by

N/A

N/A

N/A

GP

Required examinations

None

None

None

Must be moderate to severe stage

MMSE limits

None

None

None

None

Issues relating to research

Research is carried out mainly in university hospitals, faculties and institutes. There is a special institute called the Croatian Institute for Brain Research. The main types of research are basic, clinical and translational for which most of the funding comes from the government. Research in the social sciences is not so prominent. Alzheimer Croatia would like to see social science research into dementia being promoted and for carers and people with dementia to be more involved. It also recognises the need to attract more experts in psycho-social research to the field of dementia.

Croatia is not involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) or the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

References

Mimica N, Presečki P. (2010). How do we treat people with dementia in Croatia.Psychiatria Danubina, 22(2), 363-366.

Mimica N, Presečki P. (2010). Current treatment options for people with Alzheimer's disease in Croatia.Chemico-Biological Interactions,187, 409-410.

www.alzheimer.hr

Acknowledgements

Ninoslav Mimica, MD, PhD, Professor of psychiatry, President of Alzheimer Croatia

 

 
 

Last Updated: Tuesday 14 May 2013

 

 
  • Acknowledgements

    The above information was published in the 2012 Dementia in Europe Yearbook as part of Alzheimer Europe's 2012 Work Plan which received funding from the European Union in the framework of the Health Programme. Alzheimer Europe gratefully acknowledges the support it has received from the Alzheimer Europe Foundation for the preparation and publication of its 2012 Yearbook.
  • European Union
 
 

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