North Macedonia interprofessional dementia care (NOMAD) - personalized care plans for people with dementia and caregiver psychoeducation delivered at home by interprofessional teams.

Introduction: The increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia. Method: We conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates. Results: One hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [-4.75, -0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [-19.74, -2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [-2.61, -1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention's acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia. Discussion: The trial showed that it is effective in reducing caregivers' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.

Self-help support: The Alzheimer's telephone from the user's perspective.

Background: Telephone counseling is an important form of support for informal carers of persons with dementia. The quality and benefit of this kind of service have rarely been evaluated in Germany. Methods: We developed a survey to assess the quality of telephone counseling. We conducted an online survey among 201 users of the telephone hotline "Alzheimer-Telefon" (Alzheimer's telephone service) provided by the German Alzheimer's Association after the consultation. The aim of the study was to determine whether this form of telephone support meets certain quality criteria and the callers' needs. Results: Of the 201 participants, 80% were female. The mean age of the callers was 51 years. 74% of cases were one-off consultations; 26% of the callers sought advice twice or more often. The most common reasons for calling included behavioral changes (45%) and finding a nursing home (41%). Other family members were significantly (p=0.036) more likely to seek local respite options. Based on the 201 online questionnaires evaluated, most callers were highly satisfied with the counseling services provided by the Alzheimer's telephone service. Those seeking advice were particularly satisfied with the appreciative and empathetic communication style of the advisors and their professional competence. This also applies to the accessibility of the telephone. More than three quarters were fully satisfied with the information they received. Almost half of the callers were sure that the advice would help to solve their issue. 14% of people seeking advice were uncertain about how to implement the suggested solutions.A further survey would be worthwhile to determine to what extent the topics of the consultation can be implemented. The feedback from relatives who use the Alzheimer's telephone repeatedly could be used for this purpose - the repetition rate is currently 25% and the trend is rising. Results could be interesting for successful counseling and for the development of further support services. Conclusion: The telephone hotline is a useful component of dementia care in Germany and an important contribution to the National Dementia Strategy.

[Brain check-up: a structured approach diagnosing mild cognitive impairment in the primary care setting]. / Gehirn-Check-up: strukturiertes Vorgehen zur Diagnostik von kognitiven Störungen im hausärztlichen Setting.

BACKGROUND: The reason-related identification of mild cognitive impairment (MCI) in primary care is helpful to treat reversible causes or decelerate progression to dementia by optimal management of existing risk factors. In this process general practitioners are in a key position. The present feasibility study investigated the practicability of a diagnostic algorithm (brain check-up), comprising neuropsychological examinations, differential diagnoses and follow-up measures. METHOD: By means of a standardized questionnaire, the utilization and practicability of the brain check-up was surveyed in n = 37 medical practices of general practitioners and internists in Germany. RESULTS: The brain check-up was performed by n = 37 physicians in 389 patients (66%). The main barriers to implementation included patients' fear of facing the results, the professionals' lack of time, and costs. Overall, 73% of the participants agreed that the brain check-up was practical in everyday treatment. Long waiting times for an appointment with a neurological/psychiatric specialist were perceived as a barrier for optimal care. CONCLUSION: The structured algorithm is convenient in physician's everyday practice and can contribute to identify patients with MCI more easily. Therefore, it appears to be a helpful tool in primary care. To achieve sustainability in everyday use, identified barriers need to be addressed during the implementation phase.