Introduction
Methods
Surveyed facilities
Questionnaire
Procedure
Statistical analysis
Results
Main organizational characteristics of CCDDs
Organizational features Referred to 2022 (n = adherent CCDDs) | Italy (n = 511) | North (n = 223) | Center (n = 102) | South/Islands (n = 186) | p |
---|---|---|---|---|---|
Setting, N (%) | |||||
Territorial | 225 (44.0%) | 71 (31.8%) | 42 (41.2%) | 112 (60.2%) | < 0.001 |
Hospital | 239 (46.8%) | 130 (58.3%) | 48 (47.1%) | 61 (32.8%) | |
University | 47 (9.2%) | 22 (9.9%) | 12 (11.8%) | 13 (7.0%) | |
Main CCDD opening days/week, | |||||
median (IQR) | 3 (1–5) | 4 (2–5) | 3 (2–5) | 3 (1–5) | 0.081 |
mean (min–max) | 3.2 (1–6) | 3.3 (1–6) | 3.1 (1–6) | 3.0 (1–6) | |
Main CCDD opening hours/week, | |||||
median (IQR) | 14 (6–27) | 18 (7–31) | 13 (7–22) | 11 (6–24) | 0.006 |
mean (min–max) | 17.6 (1–72) | 19.7 (1.5–47) | 16.5 (1–63) | 15.7 (2–72) | |
CCDDs with branches, N (%) | 98 (19.2%) | 45 (20.2%) | 21 (20.6%) | 32 (17.2%) | 0.690 |
Referred to 2019 (n = adherent CCDDs operating in 2019) | Italy (n = 450) | North (n = 202) | Center (n = 82) | South/Islands (n = 166) | p |
Waiting list existence, N (%) | 357 (79.3%) | 163 (80.7%) | 63 (76.8%) | 131 (78.9%) | 0.756 |
Waiting time to access the services, N (%) | |||||
1–3 months | 215 (60.1%) | 83 (50.9%) | 42 (66.6%) | 90 (68.2%) | 0.002 |
4–6 months | 85 (23.7%) | 52 (31.9%) | 14 (22.2%) | 19 (14.4%) | |
> 6 months | 20 (5.6%) | 12 (7.4%) | 4 (6.4%) | 4 (3.0%) | |
Availability of a ICPs (Region, Hospital, Health Local Service, district level), N (%) | 224 (49.8%) | 139 (68.8%) | 40 (48.8%) | 45 (27.1%) | < 0.001 |
Staff composition: proportion on the overall staff, median % (IQR) mean (min–max) | |||||
Neurologists | 20% (0–43) | 17% (0–33) | 27% (0–50) | 20% (0–50) | 0.015 |
26% (0–100) | 20% (0–100) | 33% (0–100) | 29% (0–100) | ||
Geriatricians | 18% (0–46) | 22% (0–44) | 20% (0–50) | 0% (0–40) | 0.074 |
27% (0–100) | 27% (0–100) | 34% (0–100) | 23% (0–100) | ||
Psychiatrists | 0% (0–0) | 0% (0–0) | 0% (0–0) | 0% (0–0) | < 0.001 |
4% (0–100) | 3% (0–100) | 0.5% (0–14) | 7% (0–100) | ||
Neuropsychologists/psychologists | 17% (0–33) | 22% (14–33) | 9% (0–29) | 0% (0–25) | < 0.001 |
19% (0–100) | 24% (0–83) | 17% (0–100) | 13% (0–67) | ||
Other (nurses, social workers, speech therapists, physiotherapists, occupational therapists, cultural mediators, geneticists, interpreters, administrative) | 25% (0–40) 25% (0–82) | 28% (0–40) 26% (0–75) | 0% (0–33) 16% (0–67) | 33% (0–50) 27% (0–82) | < 0.001 |
Referred to 2020/2021 | Italy (n = 450) | North (n = 202) | Center (n = 82) | South/Islands (n = 166) | p |
Opening in 2020, N(%) | |||||
Always open | 165 (36.7%) | 50 (24.8%) | 26 (31.7%) | 89 (53.6%) | < 0.001 |
Closed for < 3 months | 133 (29.6%) | 73 (36.1%) | 31 (37.8%) | 29 (17.5%) | |
Closed for > = 3 months | 124 (27.5%) | 63 (31.2%) | 20 (24.4%) | 41 (24.7%) | |
Closed for unknown time | 28 (6.2%) | 16 (7.9%) | 5 (6.1%) | 7 (4.2%) | |
Opening in 2021, N (%) | |||||
Always open | 368 (81.8%) | 163 (80.7%) | 69 (84.2%) | 136 (81.9%) | 0.594 |
Closed for < 3 months | 39 (8.7%) | 21 (10.4%) | 5 (6.1%) | 13 (7.8%) | |
Closed for > = 3 months | 32 (7.1%) | 11 (5.4%) | 7 (8.5%) | 14 (8.4%) | |
Closed for unknown time | 11 (2.4%) | 7 (3.5%) | 1 (1.2%) | 3 (1.8%) |
Services for diagnostic assessment
Diagnostic assessment | Italy (n = 450) | North (n = 202) | Center (n = 82) | South/Islands (n = 166) | p |
---|---|---|---|---|---|
Services provided directly or by agreement, N (%) | |||||
Clinic assessment | 450(100.0%) | 202 (100.0%) | 82 (100.0%) | 166 (100.0%) | 1.000 |
Neuropsychological assessment | 423 (94.0%) | 197 (97.5%) | 75 (91.5%) | 151 (91.0%) | 0.012 |
ECG and cardiological examination | 382 (84.9%) | 176 (87.1%) | 65 (79.3%) | 141 (84.9%) | 0.245 |
Blood tests | 371 (82.4%) | 175 (86.6%) | 62 (75.6%) | 134 (80.7%) | 0.066 |
Brain MRI | 366 (81.3%) | 171 (84.7%) | 65 (79.3%) | 130 (78.3%) | 0.260 |
CT Brain scan | 366 (81.3%) | 169 (83.7%) | 63 (76.8%) | 134 (80.2%) | 0.395 |
EEG | 351 (78.0%) | 168 (83.2%) | 60 (73.2%) | 123 (74.1%) | 0.057 |
PET FDG | 335 (74.4%) | 165 (81.7%) | 57 (69.5%) | 113 (68.1%) | 0.006 |
SPECT | 314 (69.8%) | 148 (73.3%) | 51 (62.2%) | 115 (69.3%) | 0.181 |
PET amyloid | 300 (66.7%) | 142 (70.3%) | 53 (64.6%) | 105 (63.3%) | 0.329 |
Ordinary hospitalization | 297 (66.0%) | 142 (70.3%) | 61 (74.4%) | 94 (56.6%) | 0.005 |
CSF markers | 281 (62.4%) | 153 (75.7%) | 47 (57.3%) | 81 (48.8%) | < 0.001 |
Genetic testing | 254 (56.4%) | 126 (62.4%) | 44 (53.7%) | 84 (50.6%) | 0.065 |
Day hospital | 242 (53.8%) | 115 (56.9%) | 45 (54.9%) | 82 (49.4%) | 0.345 |
Plasma markers | 222 (49.3%) | 120 (59.4%) | 31 (37.8%) | 71 (42.8%) | < 0.001 |
Genetic counseling | 218 (48.4%) | 106 (52.5%) | 34 (41.5%) | 78 (47.0%) | 0.217 |
Functional neuroimaging | 193 (42.9%) | 79 (39.1%) | 32 (39.0%) | 82 (49.4%) | 0.103 |
Volumetric resonance | 182 (40.4%) | 74 (36.6%) | 32 (39.0%) | 76 (45.8%) | 0.197 |
EEG with brain connectivity assessment | 150 (33.3%) | 61 (30.2%) | 23 (28.0%) | 66 (39.8%) | 0.082 |
Total number of neuropsychological tests used | |||||
Median (IQR) | 23 (12–31) | 28 (21–34) | 22 (9–31) | 14 (8–24) | < 0.001 |
Mean (min–max) | 22 (0–50) | 27 (3–50) | 21 (0–50) | 17 (1–49) |
Services for care and treatment
Provision of care services and interventions | Italy (n = 450) | North (n = 202) | Center (n = 82) | South/Islands (n = 166) | p |
---|---|---|---|---|---|
Types of services provided directly or by agreement, N (%) | |||||
Care | |||||
Planning periodic visits | 441 (98.0%) | 200 (99.0%) | 80 (97.6%) | 161 (97.0%) | 0.367 |
Prescribing drug treatment | 444 (98.7%) | 198 (98.0%) | 81 (98.8%) | 165 (99.4%) | 0.496 |
Monitoring of drug treatment | 445 (98.9%) | 199 (98.5%) | 81 (98.8%) | 165 (99.4%) | 0.725 |
Telemedicine | 206 (45.8%) | 108 (53.5%) | 46 (56.1%) | 52 (31.3%) | < 0.001 |
Use of digital tools for remote monitoring | 104 (23.1%) | 37 (18.3%) | 23 (28.0%) | 44 (26.5%) | 0.090 |
Individual patient counseling | 363 (80.7%) | 177 (87.6%) | 64 (78.0%) | 122 (73.5%) | 0.002 |
Patient and family counseling | 383 (85.1%) | 185 (91.6%) | 69 (84.1%) | 129 (77.7%) | 0.001 |
Individual counseling for family members and caregivers | 362 (80.4%) | 179 (88.6%) | 61 (74.4%) | 122 (73.5%) | < 0.001 |
Information for family and caregivers | 393 (87.3%) | 188 (93.1%) | 69 (84.1%) | 136 (81.9%) | 0.004 |
Home visits | 250 (55.6%) | 98 (48.5%) | 45 (54.9%) | 107 (64.5%) | 0.009 |
Psychosocial, educational and rehabilitation treatments and interventions | |||||
Cognitive rehabilitation | 303 (67.3%) | 153 (75.7%) | 53 (64.6%) | 97 (58.4%) | 0.002 |
Motor rehabilitation | 266 (59.1%) | 114 (56.4%) | 50 (61.0%) | 102 (61.4%) | 0.580 |
Speech and language rehabilitation | 249 (55.3%) | 114 (56.4%) | 41 (50.0%) | 94 (56.6%) | 0.561 |
Occupational rehabilitation | 204 (45.3%) | 80 (39.6%) | 39 (47.6%) | 85 (51.2%) | 0.076 |
Cognitive telerehabilitation | 104 (23.1%) | 38 (18.8%) | 18 (22.0%) | 48 (28.9%) | 0.070 |
Motor telerehabilitation | 78 (17.3%) | 23 (11.4%) | 18 (22.0%) | 37 (22.3%) | 0.011 |
Digital rehabilitation tools | 91 (20.2%) | 31 (15.3%) | 18 (22.0%) | 42 (25.3%) | 0.055 |
Alzheimer’s café | 208 (46.2%) | 121 (59.9%) | 36 (43.9%) | 51 (30.7%) | < 0.001 |
Meeting center | 105 (23.3%) | 51 (25.2%) | 19 (23.2%) | 35 (21.1%) | 0.643 |
Mindfulness | 69 (15.3%) | 20 (9.9%) | 18 (22.0%) | 31 (18.7%) | 0.012 |
Art therapy | 126 (28.0%) | 53 (26.2%) | 32 (39.0%) | 41 (24.7%) | 0.046 |
Sensory stimulation | 83 (18.4%) | 32 (15.8%) | 18 (22.0%) | 33 (19.9%) | 0.405 |
Reminiscence therapy | 130 (28.9%) | 49 (24.3%) | 31 (37.8%) | 50 (30.1%) | 0.067 |
Reality orientation therapy | 153 (34.0%) | 61 (30.2%) | 35 (42.7%) | 57 (34.3%) | 0.131 |
Validation therapy | 124 (27.6%) | 44 (21.8%) | 29 (35.4%) | 51 (30.7%) | 0.035 |
Psychotherapy | 214 (47.6%) | 106 (52.5%) | 34 (41.5%) | 74 (44.3%) | 0.152 |
Behavioural therapy | 183 (40.7%) | 79 (39.1%) | 35 (42.7%) | 69 (41.3%) | 0.820 |
Other assistance services | |||||
Integrated home care | 298 (66.2%) | 142 (70.3%) | 49 (59.8%) | 107 (64.5%) | 0.196 |
Day services | 285 (63.3%) | 141 (69.8%) | 61 (74.4%) | 83 (50.0%) | < 0.001 |
Residential service | 297 (66.0%) | 139 (68.8%) | 54 (65.9%) | 104 (62.7%) | 0.462 |
Respite hospitalization | 265 (58.9%) | 138 (68.3%) | 51 (62.2%) | 76 (45.8%) | < 0.001 |
Transport service | 183 (40.7%) | 88 (43.6%) | 36 (43.9%) | 59 (35.5%) | 0.239 |
Telecare service | 110 (24.4%) | 56 (27.7%) | 20 (24.4%) | 34 (20.5%) | 0.274 |
Telephone listening points | 206 (45.8%) | 107 (53.0%) | 34 (41.5%) | 65 (39.2%) | 0.021 |
Legal aid promotion | 242 (53.8%) | 126 (62.4%) | 47 (57.3%) | 69 (41.6%) | < 0.001 |
Legal support | 250 (55.6%) | 129 (63.9%) | 54 (65.9%) | 67 (40.4%) | < 0.001 |
Clinical-epidemiological research activities | 214 (47.6%) | 104 (51.5%) | 41 (50.0%) | 69 (41.6%) | 0.147 |
Training and professional updating activities | 296 (65.8%) | 147 (72.8%) | 54 (65.9%) | 95 (57.2%) | 0.008 |
Secondary prevention activities on MCI Patients | 272 (60.4%) | 126 (62.4%) | 50 (61.0%) | 96 (57.8%) | 0.671 |
Contacts with family associations | 297 (66.0%) | 151 (74.8%) | 58 (70.7%) | 88 (53.0%) | < 0.001 |
Contacts with third sector organizations | 225 (50.0%) | 114 (56.4%) | 42 (51.2%) | 69 (41.6%) | 0.017 |
Diagnosis of patients followed by CCDDs and Clinical activities of CCDDs
Diagnosis and characteristics of clinical activities of CCDDs | Italy (n = 450) | North (n = 202) | Center (n = 82) | South/Islands (n = 166) | p |
---|---|---|---|---|---|
Type of diagnosis Median% (IQR) Mean% (min–max) | |||||
Subjective memory disorder | 10% (5–15) | 5% (4–10) | 10% (5–15) | 10% (5–20) | < 0.001 |
12% (0–62) | 9% (0–41) | 12% (0–50) | 15% (0–62) | ||
Mild cognitive impairment | 20% (15–30) | 20% (15–27) | 20% (15–30) | 20% (15–28) | 0.526 |
21% (0–80) | 21% (1–50) | 22% (5–60) | 21% (0–80) | ||
Dementia | 60% (50–70) | 62% (50–75) | 60% (50–70) | 60% (45–70) | 0.065 |
59% (10–100) | 62% (13–95) | 58% (20–95) | 56% (10–100) | ||
Other | 5% (1–10) | 5% (1–10) | 5% (1–10) | 5% (1–10) | 0.569 |
8% (0–49) | 8% (0–44) | 7% (0–49) | 8% (0–40) | ||
Type of dementia Median% (IQR) Mean % (min–max) | |||||
Alzheimer’s disease | 40% (30–50) | 40% (32–50) | 50% (40–60) | 40% (22–50) | < 0.001 |
41% (5–83) | 43% (9–83) | 48% (5–80) | 36% (5–80) | ||
Frontotemporal dementia | 5% (4–10) | 5% (5–10) | 5% (3–10) | 5% (5–10) | 0.230 |
7% (0–40) | 7% (0–30) | 6% (0–22) | 8% (0–40) | ||
Vascular dementia | 15% (10–20) | 15% (10–20) | 15% (10–20) | 20% (10–28) | < 0.001 |
17% (0–70) | 15% (0–35) | 16% (0–40) | 21% (1–70) | ||
Lewy’s bodies dementia | 5% (3–10) | 5% (4–10) | 5% (4–10) | 5% (2–8) | < 0.001 |
7% (0–34) | 8% (0–34) | 7% (0–20) | 5% (0–30) | ||
Mixed dementia | 20% (15–30) | 20% (12–30) | 20% (10–25) | 25% (15–35) | < 0.001 |
23% (0–70) | 21% (0–60) | 20% (3–70) | 26% (0–70) | ||
Other | 3.5% (1–5) | 4% (1–5) | 2% (0–5) | 3% (0–5) | 0.146 |
5% (0–60) | 6% (0–60) | 3% (0–10) | 4% (0–40) | ||
Number of patients in charge annually visited (assessed at least one time per year) | |||||
Median (IQR) | 505(282–973) | 600(314–1200) | 600(305–875) | 400(245–800) | 0.003 |
Mean (min–max) | 791(24–5000) | 893(80–4830) | 813(100–4500) | 660(24–5000) | |
Average of patients assessed per month, | |||||
Median (IQR) | 64 (35–120) | 78 (40–149) | 80 (35–104) | 50 (30–90) | 0.003 |
Mean (min–max) | 95 (4–600) | 110 (7–600) | 92 (10–380) | 78 (4–450) | |
Average of patients assessed for the first time per month | |||||
Median (IQR) | 20 (10–37) | 22 (10–38) | 20 (12–50) | 19 (12–30) | 0.485 |
Mean (min–max) | 30 (0–200) | 32 (3–200) | 32 (3–110) | 27 (2–170) | |
Percentage of patients that received psychosocial, educational and rehabilitation treatment in the last year | |||||
Median% (IQR) | 25% (0–100) | 22% (0–93) | 29% (0–100) | 28% (0–100) | 0.587 |
Mean% (min–max) | 15% (5–31) | 15% (6–30) | 20% (5–50) | 15% (5–40) | |
Percentage of carers (expressed as average number of patients and carers) that received psychosocial and educational support after dementia diagnosis in the last year | |||||
Median% (IQR) | 24% (0–100) | 24% (0–100) | 26% (0–100) | 25% (0–100) | 0.391 |
Mean% (min–max) | 15% (5–35) | 15% (10–30) | 15% (5–30) | 13% (0–40) | |
Percentage of patients with dementia that received an antipsychotics prescription in the last year | |||||
Median% (IQR) | 36% (0–100) | 31% (1–85) | 38% (3–80) | 41% (0–100) | < 0.001 |
Mean% (min–max) | 30% (20–50) | 30% (15–40) | 35% (25–50) | 40% (22–60) |