Alzheimer's disease (AD) is a growing healthcare problem. Early diagnosis and effective treatment would benefit patients and caregivers, as well as having economic implications. We conducted a survey of 741 caregivers of patients with AD in Australia, France, Italy, Spain and the UK to assess the current situation regarding the diagnosis and treatment of AD in routine clinical practice. The average time from when symptoms were first noticed by the caregiver to making the first doctor's appointment was 4 months, but 22% of caregivers waited more than 1 year before consulting a doctor. Although the majority of patients (74%) consulted their general practitioner first, the diagnosis was more likely to be made by a specialist; on average, there was a 1-year delay from when symptoms were first noticed by the caregiver to diagnosis. Access to AD care is restricted by many national healthcare systems. The delay in diagnosis imposed by such restrictions impacts on access to early and effective treatment.

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SUMMARY Dementia, a diagnostic syndrome that includes Alzheimer's disease (AD) and vascular dementia, affects more than 4 million Europeans. Its prevalence will increase as the population ages, even though half of cases remain undiagnosed. Dementia has a marked impact on the general health economy. The direct costs of caring for persons with AD alone exceed the cost of heart disease, cancer and stroke combined, primarily because of the need for expensive care in the later stages of the disease. Yet research spending for AD remains disproportionately small. Effective planning for the public health issues posed by AD mandates reduction of either the dependency or the prevalence of the disease. Some drug treatments have alleviated the symptoms of AD and improved the quality of life for patients and their families. However, many countries have introduced inappropriately stringent regulations for the use of medical therapy. These and related issues were addressed during the recent Facing Dementia Forum, in which 175 experts in dementia care discussed results of an extensive international survey. The experts identified three main barriers to effective care: (i) dementia is not considered a health care priority; (ii) there is a mistaken belief that nothing can be done about dementia; and (iii) early dementia is difficult to recognise. These observations provided a basis for the Agenda for Change, a series of strategies to overcome these barriers. The specific findings of the survey, as well as the Agenda for Change, will be reviewed in subsequent articles in this supplement.

Aims To explore the reasons for requesting an emergency ambulance transport to our paediatric emergency department (20,000 attendances p.a.) during office hours from the perspective of the caller. Methods Use of a questionnaire exploring the reasons for calling an emergency ambulance, applied to children aged less than 16 years brought in by ambulance on 5 consecutive weekdays between the hours of 08.00 to 19.00 and comparison to the clinical outcome. The documentation provided by the ambulance crew was examined for the priority given to the call. Results 29 patients presented by ambulance during this time period. Data could be obtained for 27. There were 3 main categories of callers: parents (38%), schools (27%) and General Practitioners (19%) accounting for 84% of callers. 50% of all patients were discharged home from the emergency department, the other half admitted either for surgery or to an in-patient ward (short-stay in 8%). All calls from GPs were given the highest call priority by the ambulance service, 80% patients in this group were admitted. A different picture emerges for calls made by parents and schools respectively: parents’ calls were given high priority in about 50% of cases and 40% of transported children were admitted as inpatients. The reason for parents calling an ambulance was their belief that medical intervention was required. However, only in 40% of cases this was necessary (oxygen, bronchodilators and antipyretics). In contrast, 999 calls made from schools were given second and third priority in all cases. Only 28% of these patients were admitted from ED. Conclusion The appropriateness of 999 calls during daytime hours varies widely amongst groups of callers. Whilst calls from GP surgeries often result in admission, parents seem to be able to make a reliable assessment of their child’s need for urgent medical intervention in only about 50% of cases and in the rest alternative transport may well have been feasible. As far as schools are concerned, the majority of ambulance transport probably is unjustified and poses an area of potential relief for a service stretched to its limits.

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