www.nuclmed.gr Hellenic Journal of Nuclear Medicine January-April 2015 (Suppl) 2 The travails of dementia policy development in a small island state: perspectives from Malta Charles Scerri PhD Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Malta Keywords: Dementia –– Malta –– Policy Correspondence address: Room 135, Pharmacy Building, University of Malta, Msida MSD 2080, Malta, E-mail: charles.scerri@um.edu.mt Abstract Malta, the smallest country in the European Union, is experiencing a demographic transition where the share of individuals aged 65-plus currently makes up 16.3% of the total population. This figure is projected to reach 31.2% by 2060. While the opportunity to grow older indicates social success, it creates important challenges at both the personal and political economy levels. As a result of this increase in the number of older persons, age-related neurodegenerative disorders, including the most common forms of dementia, are expected to rise proportionately. This will pose significant societal demands as most dementia care is provided informally by family members living in the community. Furthermore, recent studies have shown that there is considerable lack of awareness and professional training that is seriously undermining timely diagnosis and management. As a result, Malta opted to take a holistic approach towards dementia care by recently launching a long-term strategy focusing on increasing awareness, providing the best services leading to high quality dementia care, and fostering dementia training to healthcare professionals in order to be better equipped to support individuals with dementia. It is a vision that promotes excellence, and effectively reflects the current and future needs of these individuals, their relatives and caregivers. Introduction Dementia is a group of brain disorders characterized by progressive deterioration of cognitive function. It is the most common neurological disorder in old age and a major predictor of morbidity and mortality in the elderly. The most common form of dementia is Alzheimer’s disease (AD). Other types include vascular dementia, dementia with Lewy bodies, fronto-temporal dementia and dementia secondary to disease [1]. Dementia affects individuals in different ways depending on the type and stage of disease progression [2]. Early- stage dementia is often missed or misdiagnosed due to lack of awareness that often leads to the belief that the observed symptoms are a direct consequence of the normal ageing process. Common signs at this stage include impairment of short-term memory, difficulty in verbal communication and decision making, difficulty in carrying out complex activities of daily living (ADL) and changes in mood and behaviour including depression and anxiety. As the disease progresses to subsequent stages, individuals become more forgetful, have increased difficulty in communication, are unable to perform basic ADL and live independently and may display inappropriate behaviour such as wandering, hallucinations and disinhibition [2]. The amount of informal caring for an individual with dementia is also related to the severity of the condition with half of the caregivers spending more than ten hours a day in caring for an individual with late-stage dementia compared to 20% for early-stage dementia [3]. For most progressive dementias, no cure exists that stops or reverses the observed brain cell death. Treatments available to date are mostly approved for AD and are intended to delay the decline in cognitive symptoms for a limited amount of time [4]. Treatment for the common changes in behaviour depends on the presenting symptoms which vary from one individual to another. These are usually the most challenging and distressing characteristic of the disease process and include agitation, anxiety, verbal and nonverbal aggression, hallucinations, delusions and sleep disturbances [5]. According to Alzheimer’s Disease International, the total number of people with dementia worldwide is projected to almost double every twenty years reaching 75.6 million in 2030 and 135.5 million in 2050 [6]. Much of this increase is attributed to low- and middle-income countries, and driven by population growth and demographic ageing [7]. The global societal costs of dementia are enormous as the total estimated worldwide expenditure for the year 2010 was calculated to reach US$604 billion, equivalent to 1% of the world’s gross domestic product [8]. The cost of care provided by families (informal care) together with societal care (care provided by professional personnel in home