Psychosocial interventions in dementia care research: The INTERDEM manifesto

Dementia is a biomedical, psychological and societal disability, which poses complex challenges that are different to those of many other disabilities. As a global health problem, it takes a heavy toll on people, society and the economy. Alzheimer’s Disease International, using detailed population-based studies of the prevalence of dementia in different world regions (http://www.alz.co.uk/adi/pdf/prevalence.pdf), estimates that there are currently 30 million people with dementia worldwide, with 4.6 million new cases annually and projections for over 100 million affected people by 2050. As the population ages, the full costs will also escalate, thus making dementia an international priority. In 2008, during his term of EU presidency, French President Nicolas Sarkozy called for prioritising dementia and the development of a European-wide Alzheimer’s plan and the EU Council of Ministers has also called for collaborative action on Alzheimer’s disease research. As a follow-up to the October 2008 conference ‘The fight against Alzheimer’s disease’ organised by the French EU Presidency, and in line with the 2009 Communication from the European Commission on ‘A European initiative on Alzheimer’s disease and other dementias’, the Belgian Presidency of the EU has, from July 2010, initiated a forum to exchange best practices on societal responses to dementia. However, despite two decades of intensive research in Alzheimer’s disease and an active strategy for the recognition and monitoring of the pre-dementia stages (see Knopman et al., 2001, for the American Association of Neurology practice parameter), we are still some way away from a cure or a treatment which can prevent the disorder from worsening or significantly influence its course. Even if curative drug treatments were available, it is likely that the costs of these would be prohibitive, particularly for many developing countries at a time when the prevalence of dementia itself is set to increase in line with the escalating numbers of older people. There is a growing interest in psychosocial interventions in dementia care, but few have reached the stage of rigorous evaluation and even fewer have been widely implemented. In Europe, the diversity of languages and cultures act as an obstacle for developing, testing and implementing evidence-based psychosocial interventions. However, if psychosocial interventions have positive and costeffective outcomes on cognition and quality of life and on rates of institutionalisation, there is potential for dissemination and wider implementation through written materials or manuals detailing intervention protocols. This is particularly relevant for developing countries, where staff can be trained to deliver interventions in settings where access to the anti-dementia drugs is poor or non-existent. The need for a rapid and substantial increase in the quantity and quality of psychosocial research in dementia care has therefore never been more urgent.