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Special article

Vol. 150 No. 4950 (2020)

Conference report: dementia research and care and its impact in Switzerland

Cite this as:
Swiss Med Wkly. 2020;150:w20376


In October 2019, a Swiss panel of experts met for the Dementia Summit in Brunnen, Switzerland, to discuss the latest scientific findings on basic and clinical research, as well as practical and political approaches to the challenges of dementia disorders in Switzerland. Here, we present the conference summary.

To study pathophysiological changes, as well as the underlying mechanism of fluid biomarker changes, excellent experimental approaches, including transgenic mouse models, are available. Current knowledge about presymptomatic disease progression is largely derived from the longitudinal study of individuals with autosomal dominant mutations (Dominantly Inherited Alzheimer Network).

Importantly, more than one third of identified dementia risk factors can be modified. For example, sleep disturbances are not only associated with dementia and neurodegeneration in specific brain regions, but also precede cognitive decline and contribute to the development of brain pathology.

Regarding the neuropsychological examination of dementia disorders, standardised tests of social cognition, one of the six cognitive domains that must be assessed according to the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, are missing, but now under development.

The most important new therapeutic approach in the treatment of Alzheimer’s disease is the current attempt to prevent β-amyloid accumulation. While until now clinical studies have failed because of side effects or insufficient clinical effectiveness, Biogen recently announced positive results of high doses of aducanumab, a monoclonal antibody against β-amyloid. Other approaches also show promise. In China, sodium oligomannate has been approved to treat Alzheimer's disease. The substance suppresses gut bacterial amino acids-shaped neuroinflammation to inhibit Alzheimer’s disease progression.

Assistive technologies for dementia patients can help identify relevant information for care and nursing, as well as measurements for clinical interventions.

Dementia patients have a high risk of developing delirium, even in the home environment. Therefore, it is necessary to use and further develop multi-disciplinary and systematic detection and prevention strategies.

Homecare models for dementia patients with multidisciplinary teams have been established and evaluated and should be expanded.

Dementia is the third-leading cause of death in Switzerland. In palliative care for severe dementia, the improvement of quality of life is of primary importance.

The goals of the National Dementia Strategy, to increase the quality of life in those affected and to reduce taboos surrounding the disease, are still unrealised. The need for further national and regional engagement in order to implement the different findings of the strategy has largely been acknowledged, and these implementations have become the core tasks of a national dementia platform.


  1. National Academies of Sciences, Engineering, and Medicine, Division of Behavioral National Academies of Sciences, Engineering, and Medicine, Division of Behavioral and Social Sciences and Education, Board on Behavioral, Cognitive, and Sensory Sciences, Committee on Developing a Behavioral and Social Science Research Agenda on Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias. In: Winters T, editor. Alzheimer’s Disease and related dementias: Experience and caregiving, epidemiology, and models of care: Proceedings of a workshop - in brief. Washington (DC): National Academies Press (US); 2020.
  2. World Health Organization. Global health estimates: Deaths by case, age, sex, by country and by region. Geneva: World Health Orgaization; 2018.
  3. Prince MJ, Wimo A, Guerchet MM, Ali GC, Wu Y-T, Prina M. World Alzheimer Report: The Global Impact of Dementia. London: Alzheimer’s Disease International; 2017.
  4. Alzheimer Schweiz. Demenz in der Schweiz: 2019, Zahlen und Fakten. (2020).
  5. Eisele YS, Obermüller U, Heilbronner G, Baumann F, Kaeser SA, Wolburg H, et al. Peripherally applied Abeta-containing inoculates induce cerebral beta-amyloidosis. Science. 2010;330(6006):980–2. doi:.
  6. Prusiner SB. Cell biology. A unifying role for prions in neurodegenerative diseases. Science. 2012;336(6088):1511–3. doi:.
  7. Jucker M, Walker LC. Self-propagation of pathogenic protein aggregates in neurodegenerative diseases. Nature. 2013;501(7465):45–51. doi:.
  8. Maia LF, Kaeser SA, Reichwald J, Hruscha M, Martus P, Staufenbiel M, et al. Changes in amyloid-β and Tau in the cerebrospinal fluid of transgenic mice overexpressing amyloid precursor protein. Sci Transl Med. 2013;5(194):194re2. doi:.
  9. Bacioglu M, Maia LF, Preische O, Schelle J, Apel A, Kaeser SA, et al. Neurofilament light chain in blood and CSF as marker of disease progression in mouse models and in neurodegenerative diseases. Neuron. 2016;91(1):56–66. doi:.
  10. Bateman RJ, Xiong C, Benzinger TL, Fagan AM, Goate A, Fox NC, et al.; Dominantly Inherited Alzheimer Network. Clinical and biomarker changes in dominantly inherited Alzheimer’s disease. N Engl J Med. 2012;367(9):795–804. doi:.
  11. Preische O, Schultz SA, Apel A, Kuhle J, Kaeser SA, Barro C, et al.; Dominantly Inherited Alzheimer Network. Serum neurofilament dynamics predicts neurodegeneration and clinical progression in presymptomatic Alzheimer’s disease. Nat Med. 2019;25(2):277–83. doi:.
  12. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734. doi:.
  13. Diekelmann S, Born J. The memory function of sleep. Nat Rev Neurosci. 2010;11(2):114–26. doi:.
  14. Moran M, Lynch CA, Walsh C, Coen R, Coakley D, Lawlor BA. Sleep disturbance in mild to moderate Alzheimer’s disease. Sleep Med. 2005;6(4):347–52. doi:.
  15. Haba-Rubio J, Marti-Soler H, Tobback N, Andries D, Marques-Vidal P, Waeber G, et al. Sleep characteristics and cognitive impairment in the general population: The HypnoLaus study. Neurology. 2017;88(5):463–9. doi:.
  16. Marchi NA, Ramponi C, Hirotsu C, Haba-Rubio J, Lutti A, Preisig M, et al. Mean oxygen saturation during sleep is related to specific brain atrophy pattern. Ann Neurol. 2020;87(6):921–30. doi:.
  17. Cooke JR, Ayalon L, Palmer BW, Loredo JS, Corey-Bloom J, Natarajan L, et al. Sustained use of CPAP slows deterioration of cognition, sleep, and mood in patients with Alzheimer’s disease and obstructive sleep apnea: a preliminary study. J Clin Sleep Med. 2009;5(4):305–9. doi:.
  18. Arioli M, Crespi C, Canessa N. Social Cognition through the lens of cognitive and clinical neuroscience. BioMed Res Int. 2018;2018:4283427. doi:.
  19. Sollberger M, Rankin KP, Miller BL. Social cognition. Continuum (Minneap Minn). 2010;16(4 Behavioral Neurology):69–85. doi:.
  20. Yogarajah M, Mula M. Social cognition, psychiatric comorbidities, and quality of life in adults with epilepsy. Epilepsy Behav. 2019;100(Pt B):106321. doi:.
  21. Maat A, Fett AK, Derks E ; GROUP Investigators. Social cognition and quality of life in schizophrenia. Schizophr Res. 2012;137(1-3):212–8. doi:.
  22. Henry JD, von Hippel W, Molenberghs P, Lee T, Sachdev PS. Clinical assessment of social cognitive function in neurological disorders. Nat Rev Neurol. 2016;12(1):28–39. doi:.
  23. De Roche S, Sollberger M. Soziale Kognition bei neurodegenerativen Krankheiten im DSM-5. Fakultät für Psychologie UB, editor. 2015.
  24. McDonald S, Flanagan S, Rollins J, Kinch J. TASIT: A new clinical tool for assessing social perception after traumatic brain injury. J Head Trauma Rehabil. 2003;18(3):219–38. doi:.
  25. McDonald S, Bornhofen C, Shum D, Long E, Saunders C, Neulinger K. Reliability and validity of The Awareness of Social Inference Test (TASIT): a clinical test of social perception. Disabil Rehabil. 2006;28(24):1529–42. doi:.
  26. McDonald S. New frontiers in neuropsychological assessment: Assessing social perception using a standardised instrument, The Awareness of Social Inference Test. Aust Psychol. 2012;47(1):39–48. doi:.
  27. Jarsch M, Sollberger M. Entwicklung der Basler Version des The Awareness of Social Inference Test (BASIT) - mit Schwerpunkt Perspektivenübernahme. Fakultät für Psychologie UB, editor. 2017.
  28. Ryff I, Sollberger M. Entwicklung der Basler Version des The Awareness of Social Inference Test (BASIT) - mit Schwerpunkt Emotionserkennung. Fakultät für Psychologie UB, editor. 2017.
  29. Deuschl G, Maier W, et al. S3-Leitlinie Demenzen. In: Deutsche Gesellschaft für Neurologie, Hrsg. Leitlinien für Diagnostik und Therapie in der Neurologie. Available at: 2016.
  30. Querfurth HW, LaFerla FM. Alzheimer’s disease. N Engl J Med. 2010;362(4):329–44. doi:.
  31. Rinne JO, Brooks DJ, Rossor MN, Fox NC, Bullock R, Klunk WE, et al. 11C-PiB PET assessment of change in fibrillar amyloid-beta load in patients with Alzheimer’s disease treated with bapineuzumab: a phase 2, double-blind, placebo-controlled, ascending-dose study. Lancet Neurol. 2010;9(4):363–72. doi:.
  32. Salloway S, Sperling R, Fox NC, Blennow K, Klunk W, Raskind M, et al.; Bapineuzumab 301 and 302 Clinical Trial Investigators. Two phase 3 trials of bapineuzumab in mild-to-moderate Alzheimer’s disease. N Engl J Med. 2014;370(4):322–33. doi:.
  33. Doody RS, Thomas RG, Farlow M, Iwatsubo T, Vellas B, Joffe S, et al.; Alzheimer’s Disease Cooperative Study Steering Committee; Solanezumab Study Group. Phase 3 trials of solanezumab for mild-to-moderate Alzheimer’s disease. N Engl J Med. 2014;370(4):311–21. doi:.
  34. Cummings JL, Cohen S, van Dyck CH, Brody M, Curtis C, Cho W, et al. ABBY: A phase 2 randomized trial of crenezumab in mild to moderate Alzheimer disease. Neurology. 2018;90(21):e1889–97. doi:.
  35. Ostrowitzki S, Lasser RA, Dorflinger E, Scheltens P, Barkhof F, Nikolcheva T, et al.; SCarlet RoAD Investigators. A phase III randomized trial of gantenerumab in prodromal Alzheimer’s disease. Alzheimers Res Ther. 2017;9(1):95. doi:.
  36. Sevigny J, Chiao P, Bussière T, Weinreb PH, Williams L, Maier M, et al. The antibody aducanumab reduces Aβ plaques in Alzheimer’s disease. Nature. 2016;537(7618):50–6. doi:.
  37. Beyond amyloid: New approaches to Alzheimer’s disease treatment. EBioMedicine. 2020;51:102648. doi:.
  38. Cure Alzheimer’s Fund. Biogen announces intention to file with FDA for approval for new Alzheimer’s drug aducanumab. 2020. Available at:
  39. Sabbagh MN. Alzheimer’s disease drug development pipeline 2020. J Prev Alzheimers Dis. 2020;7(2):66–7.
  40. DIAN-TU Phase 3 Clinical Trials, Topline Results [news release]. Chicago, Ill: Alzheimer’s Association. Available at: [Accessed 2020 February 10].
  41. AlzForum. Cognitive decline trips up API trials of BACE inhibitor. 2019.
  42. Huang LK, Chao SP, Hu CJ. Clinical trials of new drugs for Alzheimer disease. J Biomed Sci. 2020;27(1):18. doi:.
  43. Cummings J, Lee G, Ritter A, Sabbagh M, Zhong K. Alzheimer’s disease drug development pipeline: 2019. Alzheimers Dement (N Y). 2019;5(1):272–93. doi:.
  44. Wang X, Sun G, Feng T, Zhang J, Huang X, Wang T, et al. Sodium oligomannate therapeutically remodels gut microbiota and suppresses gut bacterial amino acids-shaped neuroinflammation to inhibit Alzheimer’s disease progression. Cell Res. 2019;29(10):787–803. doi:.
  45. Schütz N, Saner H, Rudin B, Botros A, Pais B, Santschi V, et al. Validity of pervasive computing based continuous physical activity assessment in community-dwelling old and oldest-old. Sci Rep. 2019;9(1):9662. doi:.
  46. Stucki RA, Urwyler P, Rampa L, Müri R, Mosimann UP, Nef T. A web-based non-intrusive ambient system to measure and classify activities of daily living. J Med Internet Res. 2014;16(7):e175. doi:.
  47. Urwyler P, Stucki R, Rampa L, Müri R, Mosimann UP, Nef T. Cognitive impairment categorized in community-dwelling older adults with and without dementia using in-home sensors that recognise activities of daily living. Sci Rep. 2017;7(1):42084. doi:.
  48. Lenouvel E, Novak L, Nef T, Klöppel S. Advances in Sensor Monitoring Effectiveness and Applicability: A Systematic Review and Update. Gerontologist. 2020;60(4):e299–308. doi:.
  49. Nef T, Chesham A, Schütz N, Botros AA, Vanbellingen T, Burgunder JM, et al. Development and Evaluation of Maze-Like Puzzle Games to Assess Cognitive and Motor Function in Aging and Neurodegenerative Diseases. Front Aging Neurosci. 2020;12:87. doi:.
  50. Vallejo V, Wyss P, Rampa L, Mitache AV, Müri RM, Mosimann UP, et al. Evaluation of a novel Serious Game based assessment tool for patients with Alzheimer’s disease. PLoS One. 2017;12(5):e0175999. doi:.
  51. Chesham A, Wyss P, Müri RM, Mosimann UP, Nef T. What older people like to play: Genre preferences and acceptance of casual games. JMIR Serious Games. 2017;5(2):e8. doi:.
  52. World Health Organization. Integrated care for older people (‎‎‎‎‎ICOPE)‎‎‎‎‎: guidance for person-centred assessment and pathways in primary care. Geneva: World Health Organization; 2019.
  53. World Health Organization. Integrated care for older people (‎‎ICOPE)‎‎ implementation framework: guidance for systems and services. Geneva: World Health Organization; 2019.
  54. Persico I, Cesari M, Morandi A, Haas J, Mazzola P, Zambon A, et al. Frailty and Delirium in Older Adults: A Systematic Review and Meta-Analysis of the Literature. J Am Geriatr Soc. 2018;66(10):2022–30. doi:.
  55. Trzepacz PT, Meagher DJ, Franco JG. Comparison of diagnostic classification systems for delirium with new research criteria that incorporate the three core domains. J Psychosom Res. 2016;84:60–8. doi:.
  56. Tieges Z, Evans JJ, Neufeld KJ, MacLullich AMJ. The neuropsychology of delirium: advancing the science of delirium assessment. Int J Geriatr Psychiatry. 2018;33(11):1501–11. doi:.
  57. Kim SY, Kim JM, Kim SW, Kim ES, Kang HJ, Lee JY, et al. Do the phenotypes of symptom fluctuation differ among motor subtypes in patients with delirium? J Pain Symptom Manage. 2018;56(5):667–77. doi:.
  58. Girard TD, Thompson JL, Pandharipande PP, Brummel NE, Jackson JC, Patel MB, et al. Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study. Lancet Respir Med. 2018;6(3):213–22. doi:.
  59. Morandi A, Zambon A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, et al.; Italian Study Group on Delirium (ISGoD). Understanding factors associated with psychomotor subtypes of delirium in older inpatients with dementia. J Am Med Dir Assoc. 2020;21(4):486–492.e7. doi:.
  60. Johansson YA, Bergh I, Ericsson I, Sarenmalm EK. Delirium in older hospitalized patients-signs and actions: a retrospective patient record review. BMC Geriatr. 2018;18(1):43. doi:.
  61. Bauernfreund Y, Butler M, Ragavan S, Sampson EL. TIME to think about delirium: improving detection and management on the acute medical unit. BMJ Open Qual. 2018;7(3):e000200. doi:.
  62. Carbone MK, Gugliucci MR. Delirium and the family caregiver: The need for evidence-based education interventions. Gerontologist. 2015;55(3):345–52. doi:.
  63. Savaskan E, Baumgartner M, Georgescu D, Hafner M, Hasemann W, Kressig RW, et al. Empfehlungen zur Prävention, Diagnostik und Therapie des Delirs im Alter. Praxis (Bern 1994). 2016;105(16):941–52. doi:.
  64. Pérez-Ros P, Martínez-Arnau FM. Delirium assessment in older people in emergency departments. A literature review. Diseases. 2019;7(1):14. doi:.
  65. Singler K, Thomas C. HELP – Hospital Elder Life Program – ein multimodales Interventionsprogramm zur Delirprävention bei älteren Patienten [HELP - Hospital Elder Life Program - multimodal delirium prevention in elderly patients]. Internist (Berl). 2017;58(2):125–31. Article in German. doi:.
  66. Davoudi A, Manini TM, Bihorac A, Rashidi P. Role of wearable accelerometer devices in delirium studies: A systematic review. Crit Care Explor. 2019;1(9):e0027. doi:.
  67. Schweizerische Gesundheitsdirektorenkonferenz (GDK). Leitfaden zur Psychiatrieplanung. 2008.
  68. Deutsche Gesellschaft für Psychiatrie und Psychotherapie. Psychosomatik und Nervenheilkunde: S3 Leitlinie Psychosoziale Therapien bei schweren psychischen Erkrankungen. 2. Auflage. 2018.
  69. van der Steen JT, Radbruch L, Hertogh CMPM, de Boer ME, Hughes JC, Larkin P, et al.; European Association for Palliative Care (EAPC). White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliat Med. 2014;28(3):197–209. doi:.
  70. Koopmans RTCM, van der Sterren KJMA, van der Steen JT. The ‘natural’ endpoint of dementia: death from cachexia or dehydration following palliative care? Int J Geriatr Psychiatry. 2007;22(4):350–5. doi:.
  71. Houttekier D, Cohen J, Bilsen J, Addington-Hall J, Onwuteaka-Philipsen BD, Deliens L. Place of death of older persons with dementia. A study in five European countries. J Am Geriatr Soc. 2010;58(4):751–6. doi:.
  72. Pautex S, Herrmann FR, Le Lous P, Ghedira M, Zulian GB, Michon A, et al. Symptom relief in the last week of life: is dementia always a limiting factor? J Am Geriatr Soc. 2007;55(8):1316–7. doi:.
  73. Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529–38. doi:.
  74. Eicher S, Theill N, Geschwindner H, Moor C, Wettstein A, Bieri-Brüning G, et al. The last phase of life with dementia in Swiss nursing homes: the study protocol of the longitudinal and prospective ZULIDAD study. BMC Palliat Care. 2016;15(1):80. doi:.
  75. Savaskan E, Bopp-Kistler I, Buerge M, Fischlin R, Georgescu D, Giardini U, et al. Empfehlungen zur Diagnostik und Therapie der behavioralen und psychologischen Symptome der Demenz (BPSD) [Recommendations for diagnosis and therapy of behavioral and psychological symptoms in dementia (BPSD)]. Praxis (Bern 1994). 2014;103(3):135–48. Article in German. doi:.
  76. Loizeau AJ, Theill N, Cohen SM, Eicher S, Mitchell SL, Meier S, et al. Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail. Age Ageing. 2019;48(1):67–74. doi:.
  77. Loizeau AJ, Cohen SM, Mitchell SL, Theill N, Eicher S, Martin M, et al. Physician and surrogate agreement with assisted dying and continuous deep sedation in advanced dementia in Switzerland. Neurodegener Dis. 2019;19(1):4–11. doi:.
  78. Anquinet L, Rietjens JA, Vandervoort A, van der Steen JT, Vander Stichele R, Deliens L, et al. Continuous deep sedation until death in nursing home residents with dementia: a case series. J Am Geriatr Soc. 2013;61(10):1768–76. doi:.
  79. Swiss Academy Of Medical Sciences. Medical-ethical guidelines: Management of dying and death. Swiss Med Wkly. 2018;148:w14664. doi:.
  80. Loizeau AJ, Shaffer ML, Habtemariam DA, Hanson LC, Volandes AE, Mitchell SL. Association of prognostic estimates with burdensome interventions in nursing home residents with advanced dementia. JAMA Intern Med. 2018;178(7):922–9. doi:.
  81. Davies N, Schiowitz B, Rait G, Vickerstaff V, Sampson EL. Decision aids to support decision-making in dementia care: a systematic review. Int Psychogeriatr. 2019;31(10):1403–19. doi:.
  82. Various. Lebensende mit Demenz. Eicher S, Geschwinder H, Wolf H, Riese F, editors. University of Zurich; 2018.
  83. Bundesamt für Gesundheit (BAG) und Schwz. Konferenz der kantonalen Gesundheitsrektorinnen und -direktoren (GDK) Nationale Demenzstrategie 2014–2019. 2016
  84. Frey K, Frey M, Schläpfer B, Suri M. Schlussbericht: Evaluation Nationale Demenzstrategie 2014-2019. B,S,S, und Kek-CDC consultants. Basel/Zürich. 2019.