Developing low-cost cognitive tools for dementia assessment in low-to-middle income countries (LMICs)

2013年，全世界有4440万痴呆症患者。到2030年，这一数字可能会增加到7560万，到2050年将增加到1.355亿。世界上每4秒钟就有一个新的痴呆症病例被诊断出来。毫不奇怪，这一公共卫生挑战的成本是巨大的（2010年为6040亿美元，占全球国内生产总值的1%）。值得注意的是，58%的痴呆症患者被认为生活在中低收入国家，这突显了痴呆症在这些地区的严重影响，与高收入国家相比，这些地区对痴呆症的了解程度较低，卫生和社会护理欠发达，社会排斥程度较高。据估计，到2050年，全世界71%的痴呆症患者将生活在中低收入国家；因此，在卫生基础设施和对受影响个人的支持有限的国家，痴呆症的社会和经济负担越来越大。使这一问题更加复杂的是，中低收入国家中只有不到10%的人得到了痴呆症诊断，或得到了量身定制的医疗指导，以帮助他们及其家人了解他们正在经历的特定形式的痴呆症如何影响他们的日常生活。这些问题还限制了低收入国家参与全球临床试验，在这些试验中，新药治疗可能得到补贴，并提供支持性护理。如果要解决这些问题，就需要迅速采取行动。特别是，迫切需要有效的、低成本的认知评估方法，这些方法可以帮助诊断并在世界上地理和文化多样化的地区使用。在提供不同形式的痴呆症信息的补充下，这可以帮助家庭和卫生保健专业人员为患者实施适当和量身定制的护理，并确定可以纳入全球临床试验的个人。为了解决这个问题，基金会奖的重点是开发新的数字认知测试平台，这些平台可以通过平板电脑和智能手机在低收入国家提供。我们将与全球其他对推进中低收入国家认知评估感兴趣的高收入国家和中低收入国家的合作者合作，确保以中低收入国家的需求为优先的双向伙伴关系。作为该项目的一部分，将开展的开发和试点工作将支持进一步的赠款申请，重点是开发一个共同的认知评估平台，该平台可用于加强评估和干预方法，重点是减轻痴呆症的重大全球负担。

In 2013, there were 44.4 million people with dementia worldwide. By 2030, this number will likely increase to 75.6 million, and by 2050 to 135.5 million. A new case of dementia is diagnosed somewhere in the world every 4 seconds. Not surprisingly, the costs of this public health challenge are substantial (US$604 billion in 2010, 1% of total global GDP). Notably, 58% of individuals experiencing dementia are thought to live in low-to-middle-income countries (LMICs), underlining the high impact of dementia in those regions, where - relative to high income countries (HICs) - understanding of dementia is low, health and social care less well developed, and social exclusion high. By 2050, it is estimated that 71% of individuals with dementia worldwide will be living in LMICs; the social and financial burden of dementia, therefore, is increasingly being felt in countries with limited health infrastructure and support for affected individuals. Compounding this problem, less than 10% of individuals in LMICs receive a dementia diagnosis, or tailored medical guidance to help them and their families understand how the particular form of dementia they are experiencing may impact on their daily living. These issues additionally limit involvement of LMICs in global clinical trials where new drug therapies may be subsidized, and supportive care provided.Rapid action is needed if these problems are to be addressed. In particular, there is an urgent need for effective, low-cost cognitive assessment approaches which can aid diagnosis and be used in geographically- and culturally-diverse areas of the world. When complemented by provision of information about different forms of dementia, this can help families and healthcare professionals implement appropriate and tailored care for patients, and identify individuals who can be included in global clinical trials. To address this problem, the Foundation Award focuses on the development of new digital cognitive testing platforms, able to be provided in LMICs via tablets and smartphones. We will work with collaborators from other HIC and LMICs across the globe also interested in advancing cognitive assessment in LMICs, ensuring a bidirectional partnership with the needs of LMICs foremost. The development and pilot work to be undertaken as part of this project will underpin further grant applications focused on development of a common cognitive assessment platform able to be applied to enhance assessment and interventional approaches focused on reducing the significant worldwide burden of dementia.