Argentina

Pablo M. Bagnati^a, Janus L. Kremer^b, Fernando E. Taragano^c and Ricardo F. Allegri^d

^aMemory and Aging Center, Instituto de Investigaciones Neurológicas Raúl Carrea (FLENI), Buenos Aires, Argentina

^bInstituto de Neuropsiquiatría Kremer, Córdoba, Argentina

^cDepartment of Neurosciences, Centro de Estudios Médicos e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina

^dMemory and Aging Center, Instituto de Investigaciones Neurológicas Raúl Carrea (FLENI), Buenos Aires, Argentina

In the last decades, the Argentinian population has aged faster than anticipated, resulting in an exponential growth of age-dependent illnesses such as dementia. The increase in dementia in the next 20 years will be much faster in low- to medium-income countries than in richer nations.

In 2010, Argentina recorded just over 40 million inhabitants, with 4.7 million being over 60, proving that our country is not free from the problem [1]. The population pyramid is likely to change into a somewhat inverted pyramid, similar to that of developed countries, due to this increase. In this context the prevalence of dementia is estimated as 12.18% of people over 65 [2]. An epidemiological study in Cañuelas (a city in Buenos Aires province) found that 23% of those over 60 had cognitive impairment [3]. According to these numbers, we can infer that there are approximately 1 million people with cognitive impairment and 480,000 with dementia in the country [4] (see Figure 11.1).

Figure 11.1 Epidemiological data showing ageing and dementia in Argentina

However, there is a lack of epidemiological data needed properly to plan health strategies in dementia care. A recent initiative of the National Health Department to address this is the Registry of Cognitive Pathologies in Argentina (ReDeCAr, Registro de Deterioro Cognitivo en Argentina), which – so it is hoped – will in the short term lead to a national plan to tackle dementia [5]. ReDeCAr is a prospective case register in hospitals and health centres throughout the country, using standardised software, enabling epidemiological observations, centrally recorded by the National Health Department.

This allows us over time to build a centralised database of patients, which will produce a national and regional epidemiological picture, in turn enabling us to generate progressive policies in cognitive impairment and dementia, adapted to real needs [6].

Dementia creates an important economic, social and personal burden. Local studies were therefore conducted to establish the costs of dementia. A study carried out by Allegri et al. showed that the annual costs were US$3420.40 in mild Alzheimer’s dementia and up to US$9657.60 in severe forms, increasing to US$14.447.68 if it included care paid for by the patient’s family [7]. Another recent study showed that different types of dementia (Alzheimer’s, vascular and frontotemporal dementia) have different costs. Vascular dementia is slightly more expensive, probably because of the presence of behavioural symptoms and impairment in functioning [8].

Dementia care in Argentina is shared between the public and private sectors. The public sector provides care to low- and middle-income populations, mainly in hospitals, whereas the private sector tends to provide care to middle- and high-income populations, including home assistance [9]. Unfortunately, this distribution is not equitable: more than 17 million people (43% of the population) have access which is limited to the Public Health System: this segment of healthcare receives only 28% of total health resources [10]. On the other hand, most elderly people (91% of people over 65) receive medical care from Social Security Support in a model which combines health with social care needs, but the economic instability over the years leads to variable efficacy in addressing the demands posed by the illness. Despite this, in the last 5 years, the system has shown a slight improvement [11].

With regard to assessment, diagnosis and treatment of dementia, Argentina has an unequal distribution of specialists (neurologists, psychiatrists and geriatricians): most are located in large cities, while there is a shortage in small towns and rural areas. The facilities needed for accurate diagnosis are scarce, except in Buenos Aires and a few other large provincial cities. There are few specialists trained in geriatric neuropsychiatry, and more education for lay people is needed as well [12].

In the last 10 years, the role of memory or dementia clinics has become more important. Most of these memory clinics are based on private initiatives. Recently, the directors of the 20 most important memory clinics were interviewed [13]. Among its main findings this survey showed that 70% of these memory clinics only cater to private patients. Sixty percent are run by neurologists. However, every clinic had at least one psychiatrist on their staff. Only 35% of the centres perform clinical trials, and only 20% of the groups present original papers or studies at meetings. Sixty percent of the centres have day-care services, 35% of the clinics provide training, and 80% offer counselling for spouses and caregivers [13].

Previous reviews have identified that in most countries, more than two-thirds of people with dementia live at home, and the majority is cared for by family members [14]. Argentina has a similar profile: most senior citizens live at home with their families, but approximately 15% live in nursing homes [15–17]. Family and non-family caregivers need information and counselling about dementia care. In our country, these resources are improving: ALMA (‘Asociación de Lucha contra el Mal de Alzheimer’ – Association against Alzheimer’s Disease, a member organisation of Alzheimer’s Disease International) is the main organisation fighting the disease: it works locally, to promote and offer care and support for people with dementia and their carers. It has more than 20 associations around the country [18]. Our group wrote the first book in the country about dementia family care in 2003, re-edited in 2010 [19]. More books and publications are being published, aimed to help families with early detection and treatment of dementia [20,21].

Early diagnosis of dementia is another challenge. It may be possible to increase the predictive validity of prodromal risk indicators based upon cognitive decline and subjective impairment. One widely advocated approach is the incorporation of disease biomarkers that may indirectly represent the extent of underlying neuropathology: structural neuro-imaging (medial temporal lobe or hippocampal volume), functional neuroimaging (Aβ ligands to visualise amyloid plaques in vivo) and cerebrospinal fluid [22]). In February 2011, FLENI (‘Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia’ – based in Buenos Aires [23]) joined ADNI (‘Alzheimer Disease Neuro Imaging’, a public sector-industry partnership founded in 2004 [24]) to develop biomarkers to predict the progression from normal ageing or mild cognitive impairment to the dementia phase of Alzheimer disease. This research involves volumetric magnetic resonance imaging and positron emission tomography with fluorine-18-labeled deoxyglucose and Aβ ligands (PiB and AV45), cognitive and neurological evaluations, and analyses of cerebrospinal fluid biomarkers (Aβ42, tau and f-tau) [24,25]. In addition, FLENI houses the only brain bank in South America [23]. Another institution in Argentina (‘CEMIC’) studies the diagnosis of early Alzheimer’s with PET and Aβ ligands [26].

In summary, despite having weaknesses, Argentina is currently fighting strongly to improve the quality of life of people with cognitive impairment and dementia and their carers around the country (see Table 11.1). If our governments act urgently to develop research and care strategies, the impact of this disease can be reduced.

Conflict of interest: none.