Research to make life easier for dementia patients

Interview with Prof. Johannes Pantel from the ICNF

Prof. Dr. med. Johannes Pantel, the Frankfurt endowed professor for Geriatric Psychiatry, has designed a research project that has not only impressed his collaboration partners at the University of Heidelberg, but also the patients and their carers participating in the project, as well as the Ministry of Health. The project is concerned with encouraging communication and cooperation in out-patient senior health care. The aim is to improve the quality of life for dementia patients. Dementia is the most frequent and serious psychiatric disease in old age.

In an interview with our ICNF Newsletter editor Nicola A. Mögel, Johannes Pantel describes the topic and aims of the project. The interview took place in October 2008.

Editor: Congratulations, Prof. Pantel, in May of this year you received conformation of funding for your latest research project. What exactly is it about?

Pantel: Our project, which has the rather clumsy name ”Qualified measures to increase the quality of life for dementia patients by improving communication and cooperation in out-patient senior health care”, for short Quadem, wants to improve the care of dementia patients in their own home by practical assistance to support communication and cooperation. Ultimately, everyone concerned wants dementia patients, with their reduced ability to cope, to be able to continue to live at home and not have to go into an old people’s home. Indeed, this is also the aim set by the “Act on further structural development of health care insurance”, which was passed by the Federal Cabinet in October 2007.

Editor: Who is your research project aimed at?

Pantel: The project is directed at the health care system in the entire Rhein-Main region. A health care system comprises all the people involved in the care of dementia patients in their own home. Besides those affected, this includes relatives, professional carers working for out-patient services and voluntarily helpers. Through targeted qualified measures we want to make all those involved more efficient in order to improve their strengths, i.e. resources, in a sustainable manner. It is not unusual that caring relatives can no longer cope with helping their infirmed family members due to exhaustion. Then the dementia patient can no longer be properly cared for at home. We want to change this.

With dementia patients we hope that by specifically concentrating on communication problems we can encourage remaining faculties and put them to better use. So the project definitely also includes a curative approach.

Editor: Who is funding the project?

Pantel: Our project was successful in the initiative “Lighthouse Project Dementia” proposed by the Ministry for Health and is funded by 418,000 Euro from them. In the nation-wide process projects were chosen – according to the Ministry – that are future oriented and sustainably advance research, diagnosis and therapy of dementia diseases, or provide an exemplary function in the care of dementia patients. The project is planned to run for two years and started in the summer of 2008.

In addition, we receive funds from Ministry of Research grants as well as form diverse foundations (e.g. the BHF Bank Foundation and Krupp Foundation) for our clinical and laboratory research. Parallel development is followed in dementia research: one approach is seeking possible ways to relieve the symptoms with drug treatments and diagnostics; the other is improving the quality of care. Here, programs are being developed and evaluated to improve patient care, and they are analyzed scientifically for their effectiveness. If they are successful, the programs can be introduced as courses in the training of personnel for senior care.

Also the Government expects the efficacy of the Lighthouse projects to be scientifically proven and that senior care establishments will adopt these programs. Here, we are cooperating with the “Arbeiterwohlfahrt” (AWO) in the south Hessen and north Baden regions, with the “Bürgerinstitut” in Frankfurt and the Social Work Office in the city of Wiesbaden.

Editor: Who else do you cooperate with in this project?

Pantel: Quadem is sponsored by many partners. Running the project is in my hands and is based at the Clinic for Psychiatry and Psychotherapy at the Johann Wolfgang Goethe University Frankfurt/Main. Our scientific collaboration partners at the University of Heidelberg are the Institute for Gerontology (Prof. Andreas Kruse) and the Section Geriatric Psychiatry (Prof. Johannes Schröder). Altogether up to 13 researchers are involved in Quadem. Their tasks also include coordinating a total of some 600 project participants. Besides the patients, this includes their family and relations, the care personnel and voluntary helpers.

Editor: Are the dementia patients taking part able to understand that they are participating in a research project?

Pantel: Our project was examined and approved by the ethics commission. The scientific investigation was explained to each participant. However, there are indeed some patients with medium or sever dementia who can no longer follow our explanation and are incapable of giving consent. In these cases the legal representative is asked to act in the best interest of their protective obligations. In Germany there are strong protective regulations for patients. In our case, the detrimental potential for the participants is extremely small in comparison to a drug trial. In addition, beyond the usefulness to the group as a whole, it is probable that the project will be directly useful for the participating patient as well.

Editor: Why did you become a brain scientist?

Pantel: I was already interested as an undergraduate in the question of how decisions are reached in the human brain. Where is the boundary between body and soul? At the start of my studies I swayed between psychiatry and neurology. Now with my research I find myself at the interface between basic neurobiology research and interaction and communication. Correspondingly, I am also interested in the neurobiological changes that for example cause memory defects or selective perception in dementia patients. To investigate these, one needs to know about neurobiology, psychology, communication theory and philosophy. In addition, developing our communication improvement programs for dementia patients included basic knowledge from pedagogic psychology, as well as keeping an eye on social political discourse.

It is also important for me that knowledge gained through my research is useful in practice. This is why I put great value on Quadem producing project results that will continue to be anchored in the care of dementia patients after the project has ended. In this respect we are in line with the expectations of the Ministry of Health. And we are very pleased that at a meeting organized by the Ministry for next year we can present our work as one of the four model projects out of the total 28 Lighthouse projects.

Editor: Prof. Pantel, thank you very much for your time, and much success for Quadem.

You can find further information about Quadem at:

www.quadem.de
www.gero.uni-heidelberg.de/forschung/quadem.html

Contact:

Prof. Dr. med. Johannes Pantel
Clinic for Psychiatry and Psychotherapy of the Johann Wolfgang Goethe University
Heinrich-Hoffmann-Straße 10
60528 Frankfurt/Main
Tel: 069-6301-4095
info@quadem.de

Joint publication of the project partners:

Schönknecht P., Pantel J., Kruse A., Schröder J. (2005) Prevalence and natural course of aging-associated cognitive decline in a population based sample of “young-old” subjects. American Journal of Psychiatry 172: 2071-77.