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Published 10 March 2009, =
doi:10.1136/bmj.b931
Cite=20
this as: BMJ 2009;338:b931
Editorials
The National Dementia strategy in England
A "smorgasbord" of evidence, economics, and = obligation=20
Public awareness of dementia is currently high, thanks to =
touching=20
personal accounts of the illness through individual =
experience,=20
such as that of the writer Sir Terry Pratchett. The recommendations include a mix of long awaited priority =
setting=20
and reaffirmation of existing legislation. Some are =
obvious=97for=20
example, good quality information for people with dementia =
and=20
their carers and improved community support and =
implementation=20
of the Carers=92 strategy=97aspirations that simply =
provide a=20
stimulus for local initiatives. The benefits of early =
diagnosis and=20
intervention are highlighted=97for economic reasons and for =
individual=20
wellbeing. The need to improve the quality of care for people =
with=20
dementia in general hospitals and in institutional care is =
stressed.=20
The research base needs to be expanded, with coordination =
between the=20
Dementia and Neurodegenerative Diseases Network, charities, =
and the=20
research councils. The cited justification for the =
recommendations=20
includes economic necessity, empirical research, and =
patients=92=20
preferences (and sometimes all three). The strategy does not =
suggest=20
the introduction of screening but that awareness needs to be=20
raised. Memory clinics are not buildings but pathways to=20
coordinated multidisciplinary care.
The management of dementia is supported by a substantial body =
of=20
evidence in several key areas. The clinical efficacy of drugs =
for=20
dementia is accepted, although their cost effectiveness in =
the early=20
stages of the illness has not been proved to the satisfaction =
of the=20
National Institute for Health and Clinical Excellence.5<=
/SUP>=20
Effective interventions to relieve stress on carers are =
available,=20
with effect sizes comparable to drug treatments. Similar plans are being developed for UK devolved nations, and=20
countries across Europe are beginning to prepare for the =
emerging=20
health and social care challenges presented by dementia. Many =
have specific dementia plans (Norway, Ireland, and Germany in =
particular), and the French dementia plan has received high=20
level political backing from President Sarkosy, together with =
The intermingling of research evidence with current best =
practice=20
is a logical way forward, and the strategy should be in the=20
context of other initiatives such as the Carer=92s strategy, =
the=20
Care Quality Commission, and Putting People First. Cite this as: BMJ 2009;338:b931
Alistair Burns, professor of old age=20
psychiatry1, Philippe Robert,=20
professor of psychiatry2 1 University of Manchester Psychiatry Research Group, =
Manchester=20
M13 9PL, 2 Centre M=E9moire de Ressources et de Recherche, =
CHU de Nice,=20
H=F4pital de Cimiez, 06000, Nice, France Alistair.Burns{at}manchester.ac.uk
Provenance and peer review: =
Commissioned; not=20
externally peer reviewed.
![3D{euro}=20](3D"http://www.bmj.com/math/euro.gif")
19bn; $24bn) a =
year.1.6bn over=20
five years. This plan is characterised by transparency and =
unitary=20
governance, although it spans the education, health, =
research, and=20
social ministries. Its main objectives are to improve =
knowledge about=20
dementia, reduce stigma, provide better education and =
training for=20
professionals, ensure that people with dementia are properly=20
diagnosed, and develop a range of services for people with =
dementia=20
and their carers.
Competing interests: AB is editor in chief =
of the=20
International Journal of Geriatric Psychiatry, =
co-chairs the=20
research advisory panel of the UK Alzheimer=92s Society, and =
was a=20
member of the raising awareness workgroup of the National=20
Dementia strategy consultation. He receives research funding =
and=20
consultancy fees from drug companies that manufacture and =
market=20
drugs for Alzheimer=92s disease including Eisai, Pfizer, =
Shire,=20
Novartis, Janssen Cilag, Wyeth, and Lundbeck. PR co-chairs =
the=20
behavioural and psychological subgroup of the European=20
Alzheimer=92s Disease Consortium (EADC) and was a member of =
the French=20
report committee devoted to the report of the French National =
Alzheimer=92s Disease National Plan. He receives research =
funding and=20
consultancy fees from drug companies that manufacture and =
market=20
drugs for Alzheimer=92s disease including Eisai, Pfizer, =
Novartis,=20
Janssen Cilag, Wyeth, and Lundbeck.
References
Relevant Article
BMJ 2008 337: a602.
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