Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

In October 2009, Alzheimer Portugal prepared a document “Plano Nacional de Intervenção Alzheimer” which reflects what some other countries already have. Inspired by the French Alzheimer Plan, Alzheimer Portugal formulated the main ideas which it felt a national plan should include. This document was delivered to the members of the Portuguese parliament. Five of them attended and participated in a round table at a conference hosted by Alzheimer Portugal where this issue was the main topic.

A year later, two proposals were discussed and approved by the Parliament. Unfortunately, these were only recommendations to the government which stepped down a short time after. Consequently, the proposals were never implemented and a National Dementia Strategy has not yet been adopted.

At the moment, because of the economic crisis, dementia is not one of the political priorities.

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

Alzheimer Portugal is not just involved in the development of a National Dementia Strategy. It is the organisation leading the advocacy on this issue. 

Diagnosis, treatment and research

Issues relating to diagnosis

Timely diagnosis at national level

Last year, the government launched an initiative to establish national guidelines (Normas) in different clinical situations. One of these guidelines addresses diagnostic and therapeutical issues in patients with cognitive decline or dementia. The process of public consultation is about to end, and the final guideline will soon be published. The draft document can be accessed at:

http://www.dgs.pt/ms/8/paginaRegisto.aspx?back=1&id=21604

Which healthcare professionals are responsible for diagnosing dementia

GPs may diagnose dementia and prescribe AD drugs but these drugs would not be refundable. Consultations are generally for 20 minutes and cannot be extended. Neurologists and psychiatrists can also diagnose dementia and/or Alzheimer’s disease. According to the Portuguese Alzheimer association, there is a problem concerning the dialogue between GPs and specialists as the specialists do not always provide feedback to the GPs. This may affect GPs’ motivation to make an initial referral. This dialogue needs to be enhanced in order to ensure that the person who goes to the specialist to get medication with reimbursement is motivated to then return to the GP. There are no specific measures to improve timely diagnosis.

Type and degree of training of GPs in dementia

Information was not available on the amount of training in dementia that GPs receive in their professional training to become a GP. Continuing education is an obligation for GPs (i.e.ad hoccourses to update their knowledge).

Required tests to diagnose dementia

Guideline #53 DGS - Abordagem Terapêutica das Alterações Cognitivas is used to diagnose dementia.

Issues relating to medical treatment

The availability of medicines in general

The level of reimbursement depends on the type of illness and whether a person is a pensioner on a low income (i.e. an annual total income not exceeding 14 times the minimum wage). The level ranges from 15% to 95%. Medicines are refunded at 95% if their retail price is equal to or higher than the average retail price of the five cheapest medicines on the market.

Generic medicines can be paid in full by the State for beneficiaries whose income does not exceed a set amount and provided that certain conditions are met[1].

The availability of Alzheimer treatments

All four AD drugs are available to patients in Portugal and are part of the reimbursement system.

Conditions surrounding the prescription and reimbursement of AD drugs

AD drugs are classified as level C drugs and the State covers 40% of their costs if prescribed by a neurologist or psychiatrist. It does not require any specific diagnostic examinations to be carried out, nor does the system provide upper or lower treatment limits.

AD drugs prescribed by a GP are not refundable. However, generic drugs are available in Portugal, which are relatively inexpensive, which means that for many people, this is not a problem.

The Portuguese system reimburses medicines for people living alone or in nursing homes.

Issues relating to research

The national agency which finances research in Portugal is theFundação para a Ciência e Tecnologia(FCT). There is no national specific research programme for Alzheimer’s disease or dementia. Research projects on this topic may be financed but are in competition with other scientific areas. Furthermore, FCT supports national researchers involved in European projects on neurodegenerative disorders, like the Joint Programming on Neurodegenerative Disorders (JPND). Alzheimer Portugal emphasises the need for funding for research to be part of any future national dementia strategy for Portugal.

Additional medical or scientific issues

Progress has been made in modern technologies in Portugal just like the recent possibility to use PET PiB.

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

Acknowledgements

Maria do Rosário Zincke dos Reis, Chair of Alzheimer Portugal and Honorary Treasurer of Alzheimer Europe

Celso Pontes, Coordinator of the Scientific Committee of Alzheimer Portugal

Alexandre de Mendonça, Member of the Scientific Committee of Alzheimer Portugal

António Leuschner, Psychiatrist

[1] European Commission (2011): MISSOC – Mutual information system on social protection : Social protection in the Member States of the European Union, of the European Economic Area and in Switzerland : Comparative tables