Design of a Comprehensive Alzheimer’s Disease Clinic and Research Center in Spain to Meet Critical Patient and Family Needs

摘要

Alzheimer’ Disease (AD) affects people worldwide, and the prevalence is rising as the population ages. There is an international effort to understand the biology of AD in order to develop primary and secondary prevention strategies, and to develop effective therapeutic interventions for individuals who are already symptomatic. One of the critically important pieces of all national plans to address AD is the call for the development of service models for delivery of quality, effective care based on best evidence. We describe here one type of care model developed by the Fundació ACE, Institut Català de Neurociènces Aplicades (Fundació ACE, Barcelona, Spain) that integrates diagnosis, therapy, follow-up care, day care and a day hospital, and does so in the context of an active clinical research and educational program. There were 13,048 individuals newly evaluated and diagnosed in Fundació ACE between 1996 and 2011. Of these, 6,132 had AD (47.0%), 3,871 mild cognitive impairment (MCI) (29.7%), and 1,958 had no cognitive impairment (15.0%). Follow-up information is available on 4,735 (47.3%) AD and MCI patients, and these indicate that MCI develops into dementia at a rate of 222.6/1,000 person years. APOE genotyping was available in 22.4% of the patients, and the ε4 allele occurred in 45.7% of the AD cases, 37.8% of the MCI, and 31.6% of those without cognitive impairment. Fundació ACE can serve as a model system that can be adapted to other settings within their specific cultural, governmental and legal constraints.