Dementia among international migrants: An urgent call for better care.

Dementia ranks among the top priorities in global public health, given the processes of population aging and demographic transition that have been in place for several decades, and the high prevalence of neurodegenerative and neurovascular disorders among older adults. In 2020, there were 55 million people living with dementia worldwide and these figures are expected to reach 139 million by 2050 [1]. In addition to the currently high and still growing number of people with dementia in these countries, another issue relates to international migrants, who are often neglected from national healthcare planning.

A recent study investigated the available information relating to international migrants/ethnic minorities in 32 national dementia plans listed on the Alzheimer's Disease International website. Only nine plans explicitly mentioned this topic, and specific actions to tackle this problem were proposed by only eight countries/plans [2]. However, this group is particularly vulnerable and at risk of developing cognitive impairment. The psychological trauma due to the displacement and the initial social isolation once migrants arrived in a new country are both risk factors for further cognitive impairment. Moreover, most of the immigrants came from regions currently experiencing war/conflicts or from low‐ and middle‐incomes countries, where illiteracy or low educational level, brain injuries, limited knowledge about dementia symptoms, and diagnostic stigma remain great challenges [3, 4]. In a previous French retrospective study from 28 memory clinics, the number of immigrants with lower literacy continually increased over a period of 20 years [5]. After the onset of cognitive impairment, the language barriers and cultural differences could delay the help‐seeking behaviors. Healthcare professionals also lack specific tools and training to provide the best tailored assessment and care package.

In the current issue of the European Journal of Neurology, Canevelli and colleagues from the ImmiDem Study (“Dementia in immigrants and ethnic minorities living in Italy”) present the results of a national online survey conducted to investigate the number of international migrants assisted in Italian specialized cognitive disorders and dementia centers and the challenges these centers experience in relation to diagnosis and care provision [6]. The research team gathered responses from 343 of 570 centers (60% response rate) and found that international migrants corresponded to a median of 1.1% of the total referrals. These numbers were reported to have increased in 37.9% of the facilities in the last 5 years. Importantly, only migrants who are registered in the Italian Health System are referred to these specialized centers; hence, refugees and individuals who do not possess documents were not included in the survey. By the end of 2020, the world had 24.5 million refugees or people in refugee‐like situation and around 6.8 million of them were living in Europe [7]. More recently, the war in Ukraine has substantially increased these numbers. Hence, the Italian figures must be much higher, and this also applies to the whole European Union.

In their study, Canevelli et al. report that fewer than 50% of the specialized dementia centers regularly use cognitive screening tests or formal neuropsychological testing for the assessment of migrants. Of note, in very few centers was the cognitive protocol adequately adapted to the cultural and linguistic background of the examined persons. This scenario explains why the quality of the cognitive testing was considered unsatisfactory in about two‐thirds of the cases, with large differences between regions of the country (e.g., North vs. South) [6]. This latter feature may be in part explained by the reduced number of older migrants in the Southern regions of Italy, but also by the lower availability of qualified personnel for cognitive evaluation. Even skilled neuropsychologists may have insufficient experience in the evaluation of people with low education or from diverse cultural/linguistic backgrounds. In this sense, an important initiative is the European Consortium on Cross‐Cultural Neuropsychology, which was launched in 2019 to address these gaps and to propose actions to improve the cognitive assessment of these individuals in the continent [8].

The timely and important study by Canevelli and colleagues clearly indicates that there is an urgent need to develop and coordinate dementia care plans for this neglected and vulnerable population group, at local, national, and European levels.

CONFLICT OF INTEREST

Yaohua Chen and Paulo Caramelli don't have any conflict of interest.

AUTHOR CONTRIBUTIONS

Yaohua Chen: Conceptualization (equal); Investigation (equal); Methodology (equal); Resources (equal); Validation (equal); Writing – original draft (equal); Writing – review & editing (equal). Paulo Caramelli: Conceptualization (equal); Investigation (equal); Methodology (equal); Resources (equal); Writing – original draft (equal); Writing – review & editing (equal).