BACKGROUND: Dementia is a particularly severe societal challenge in several countries of the Danube Region due to higher-than-average increment in population longevity, disproportionate increase of the old-age dependency ratio, and selective outward migration of health care professionals. A survey was conducted among dementia experts to obtain a deeper understanding of the dementia care structures and services in this geographical area, and to identify the educational needs of health care professionals, and the availability of assistive technology. SUBJECTS AND METHODS: A standardized questionnaire was sent out to 15 leading dementia experts/clinicians in 10 Danube Region countries inquiring about professional groups involved in dementia care, availability and reimbursement of services, inclusion of dementia in professional education and training, acceptability of Internet-based education, and availability of assistive technology. The authors are the survey respondents. RESULTS: The majority of individuals with dementia receive care in the community rather than in institutions. The roles of medical specialties are disparate. General practitioners usually identify dementia symptoms while specialists contribute most to clinical diagnosis and treatment. Health care professionals, particularly those who work closely with patients and carers, have limited access to dementia-specific education and training. The greatest need for dementia-specific education is seen for general practitioners and nurses. An Internet-based education and skill-building program is considered to be equivalent to traditional face-to-face but offer advantages in terms of convenience of access. Assistive technology is available in countries of the Danube Region but is significantly underused. CONCLUSION: Dementia care in the Danube Region can be improved by an educational and skill-building program for health care professionals who work in the frontline of dementia care. Such a program should also attempt to enhance interdisciplinary and intersectorial collaboration, to intensify the interaction between primary care and specialists, and to promote the implementation of assistive technology.

Acacdemy of Medical Sciences Kiev Department of clinical physiology and pathology of the central nervous system Kiev the Ukraine

CELLO Faculty of Humanities Charles University Prague the Czech Republic

Department for Clinical Neurosciences and Preventive Medicine Danube University Krems Krems Austria

Department of Neurology Semmelweis University Budapest Hungary

Department of Psychiatry and Psychotherapy Klinikum rechts der Isar Technische Universität München Munich Germany

Helmholtz Centre Munich Deutsches Forschungszentrum für Gesundheit und Umwelt Munich Germany

MEDIWARE corp Prague the Czech Republic

School of Medicine University of Belgrade Neurology Clinic Belgrade Serbia

UH Alexandrovska Department of Neurology Medical University Sofia Sofia Bulgaria

University of Ljubljana Department of Neurology Ljubljana Slovenia

University of Medicine and Pharmacy Carol Davila Department of Clinical Neurosciences Bucharest Romania

University of Zagreb Department of Cognitive Neurology Zagreb Croatia

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European-Commission. European Union Strategy for Danube Region. Brussels: European Commission; 2010.

Rechel B, Grundy E, Robine JM, et al. Ageing in the European Union. Lancet. 2013;381(9874):1312–1322. doi:10.1016/S0140-6736(12)62087-X PubMed DOI

Dimitrov I, Tzourio C, Milanov I, Deleva N, Traykov L. Prevalence of dementia and mild cognitive impairment in a Bulgarian urban population. Am J Alzheimers Dis Other Demen. 2012;27(2):131–135. doi:10.1177/1533317512442371 PubMed DOI PMC

Stefanova E, Pekmezovic T, Nalic D, et al. The diagnosis of dementia is unspecified - report of a pilot survey of dementia in Belgrade. Gerontology. 2004;50(4):260–261. doi:10.1159/000078357 PubMed DOI

OECD. Health at a Glance: Europe 2012. OECD Publishing; 2012. doi:10.1787/9789264183896-en DOI

Bezrukov VV, Polukhov AM, Bachinskaya NY, et al. Dementia prevalence in Kiev aging population based on screening investigation, 2001-2002. Acta Psychiatrica Pschologica Psychotherapeutica Et Etholologica Tavrica. 2004;8:47–52.

Alzheimer-Europe. The Prevalence of Dementia in Europe. Country Comparisons. Luxembourg: Alzheimer Europe; 2014.

Hughes L. Lessons learned: alzheime’s disease clinical trials in Eastern Europe In: Bairu M, Weiner M, editors. Global Clinical Trials for Alzheimer’s Disease. San Diago, London, Waltham: Elsevier; 2014:263–275.

Wimo A, Jönsson L, Gustavsson A. Cost of Illness and Burden of Dementia - the Base Option. Luxembourg: A. Europe; 2009.

European-Commission. The 2015 Ageing Report. Economic and Budgetary Projections for the 28 EU Member States (2013-2060). Brussels: European Commission; 2015.

Gal Z, Lux G, Illes U. Danube Region - Analysis and Long-Term Development Trends of the Macro-Region. Vol. 90 Pécs: Insitute for Regional Studies, Research Centre for Economic and Regional Studies, Hungarian Academy of Sciences; 2013.

Siyam A, Dal-Poz MR. Migration of Health Workers: Tbe WHO Code of Practice and the Global Economic Crisis. Geneva: World Health Organization; 2014.

Alzheimer-Europe. National Dementia Strategies. Luxembourg: Alzheimer Europe; 2016.

Kiejna A, Frydecka D, Adamowski T, et al. Epidemiological studies of cognitive impairment and dementia across Eastern and Middle European countries (Epidemiology of Dementia in Eastern and Middle European Countries). Int J Geriatr Psychiatry. 2010;26(2):111–117. doi:10.1002/gps.2511 PubMed DOI

Alzheimer-Europe. Who Cares? the State of Dementia Care in Europe. Luxembourg: Alzheimer Europe; 2006.

Parmar J, Dobbs B, McKay R, et al. Diagnosis and management of dementia in primary care. Explorative study. Can Fam Physician. 2014;60:457–465. PubMed PMC

Bryans M, Keady J, Turner S, Wilcock J, Downs M, Iliffe S. An exploratory survey into primary care nurses and dementia care. Br J Nurs. 2003;12(17):1029–1037. doi:10.12968/bjon.2003.12.17.11723 PubMed DOI

Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013;13:e010. doi:10.5334/ijic.886 PubMed DOI PMC

Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer’s disease in primary care. A randomized controlled trial. Jama. 2006;295(18):2148–2157. doi:10.1001/jama.295.18.2148 PubMed DOI

Cobb SC. Internet continuing education for health care professionals: an integrative review. J Contin Educ Health Prof. 2004;24(3):171–180. doi:10.1002/chp.1340240308 PubMed DOI

Wutoh R, Boren SA, Balas EA. eLearning: a review of Internet-based continuing medical education. J Contin Edc Health Prof. 2004;24(1):20–30. doi:10.1002/chp.1340240105 PubMed DOI

Ruiz JG, Mintzer KJ, Leipzig RM. The impact of E-learning in medical education. Acad Med. 2006;81(3):207–212. PubMed

Hobday JV, Savik S, Smith S, Gaugler JE. Feasibility of internet training for care staff of residents with dementia: the CARES program. J Gerontol Nurs. 2010;36(4):13–21. doi:10.3928/00989134-20100302-01 PubMed DOI PMC

Bharucha AJ, Anand V, Forlizzi J, et al. Intelligent assistive techology applications to dementia care: current capabilities, limitations and future challenges. Am J Geriatr Psychiatry. 2009;17(2):88–104. doi:10.1097/JGP.0b013e318187dde5 PubMed DOI PMC

Bonner A, Idris T. Assistive technology as a means of supporting people with dementia: a review In: Porteus J, editor. London: Housing Learning & Improvement Network; 2012;1–17. doi:10.1094/PDIS-11-11-0999-PDN DOI

Meiland F, Innes A, Mountain G, et al. Technologies to support community-dwelling persons with dementia: a position paper on issues regarding development, usability, effectiveness and cost-effectiveness, deployment, and ethics. JMIR Rehabil Assist Technol. 2017;4(1):e1. doi:10.2196/rehab.6376 PubMed DOI PMC

Mehrabian S, Extra J, Wu YH, Pino M, Traykov L, Rigaud A-S. The perceptions of cognitively impaired patients and their caregivers of a home telecare system. Med Devices (Auckl). 2014;8:21–29. doi:10.2147/MDER.S70520 PubMed DOI PMC

Hort J, O’Brien JT, Gainotti G, et al. EFNS guidelines for the diagnosis and management of Alzheimer’s disease. Eur J Neurol. 2010;17(10):1236–1248. doi:10.1111/j.1468-1331.2010.03040.x PubMed DOI

Korczak D, Habermann C, Braz S. The effectiveness of occupational therapy for persons with moderate and severe dementia. GMS Health Technol Assess. 2013;9:1–7. PubMed PMC

Donnellan WJ, Bennett KM, Soulsby LK. What are the factors that facilitate of hinder resilience in older spousal dementia carers? A qualitative study. Aging Ment Health. 2015;19(10):932–939. doi:10.1080/13607863.2014.977771 PubMed DOI