To date, there is no effective treatment for dementia syndromes, but there are various measures to counteract the progression. It is generally assumed that treatment should begin as early as possible. The Swiss Memory Clinics Association has drawn up updated recommendations for the diagnosis of dementia. A new brochure with therapy recommendations was also published this year.
The umbrella term “dementia” refers to a syndrome of cognitive impairment relevant to everyday life, which can be caused by various factors. The most common cause is Alzheimer’s disease, followed by neurovascular diseases (e.g. ischemic stroke, cerebral hemorrhage), which can lead to vascular dementia, as well as other diseases that are associated with dementia symptoms [1]. The diagnostic possibilities for dementia have improved considerably in recent years. The recommendations for the diagnosis of dementia developed by the Swiss Memory Clinics Association focus on the methods approved in Switzerland with the aim of improving early and differential diagnosis [2]. The recommendations can be downloaded free of charge from the FOPH website.
Mild cognitive impairment ( MCI) is an important early or risk syndrome of dementia and is increasingly being diagnosed in clinical practice. In the future ICD-11 and DSM-5, MCI is defined as a mild neurocognitive disorder and in the context of specific neurodegenerative diseases, such as Alzheimer’s disease [3,4]. A significant proportion of older people report a decline in cognitive performance, although they do not show a decline in performance on diagnostic cognitive tests [5,6]. This condition is referred to assubjective cognitive decline ( SCD).
The recommendations on the treatment of dementia, also drawn up by the Swiss Memory Clinics association, are also available free of charge on the FOPH website [11]. The German S3 guideline published in 2023 was also included [7]. The care of people with dementia depends on the stage of the disease. Today, various drug and non-drug interventions are available for patients with Alzheimer’s disease and other forms of dementia. In addition to treating the primary symptoms of dementia, there are also therapeutic measures for accompanying psychological and behavioral symptoms. However, the choice of the appropriate therapy is complex and depends on various factors, such as the individual symptoms, the stage of the disease or the age [8]. An important treatment goal is often to delay admission to a nursing home. As can be seen in Figure 1 , there are now pharmacotherapeutic treatment options that can be used even for mild cognitive impairment that does not meet the criteria for manifest dementia [9]. One Ginkgo biloba special extract that has been extensively investigated in preclinical and clinical studies is EGb® 761, which is approved by health insurance companies in Switzerland under the trade name Tebokan® [10].
Literature:
- Peters N, et al: Dementia from a neurological perspective – Part 1. Swiss Medical Forum 2023; 23(13): 986-990.
- “Diagnostic recommendations for dementia”, www.bag.admin.ch/bag/de/home/strategie-und-politik/nationale-gesundheitsstrategien/demenz/schwerpunktthemen/ambulantes-betreuungssetting.html#644434738,(last accessed 07.11.2024).
- ICD-11: International Statistical Classification of Diseases and Related Health Problems, 11th Revision 2023b.
- Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.): American Psychiatric Publishing, Inc. 2013. https://doi.org/10.1176/appi.books.9780890425596.
- van der Flier WM, Scheltens P: Amsterdam dementia cohort: Performing research to optimize care. J Alzheimers Dis 2018; 62: 1091-1111.
- Garcia-Ptacek S, et al: Subjective cognitive impairment subjects in our clinical practice. Dement Geriatr Cogn Dis Extra 2014; 4: 419-430.
- S3 guideline dementia, long version, version: 4.0, status: 28.11.2023, AWMF register no. 038-013.
- “Therapy recommendations for dementia”, webinar, www.alzheimer-schweiz.ch/de/beitrag/webinar-2024-therapieempfehlungen-bei-demenz,(last accessed 08.11.2024)
- “Early diagnosis of dementia and the primary options for action”, Dr. med. Ansgar Felbecker, Schwabe Pharma Special-Focus Symposium, ZAIM MediDays Zurich, 30.08.2024.
- Swissmedic: Medicinal product information, www.swissmedicinfo.ch,(last accessed 08.11.2024)
- “Therapy recommendations for dementia”, brochure, Swiss Memory Clinics/National Dementia Platform: Federal Office of Public Health (ed.), June 2024.
FAMILY PHYSICIAN PRACTICE 2024; 19(11): 24
