Towards a new Value-based scenario for the management of dementia in Italy: a SINdem delphi consensus study

This national expert-based Delphi-consensus aims at formulating recommendations on the management of dementia care in Italy. This effort seems important and timely given in light of a new scenario arising from a new biological definition of Alzheimer's disease (AD) and the availability of disease-modifying treatments (DMTs). Methods: the Steering Committee of the Italian Neurological Society for dementia (SINdem) created appropriate statements. Invited SINdem experts were requested to vote on the statements according to a modified three-round Delphi method. Only those statements reaching Grade A (full agreement ≥ 75%) or B (overall agreement ≥ 80% and full disagreement < 5%) were included in the final document. Round answers' consistency was graded using the Cohen's k and within-class correlation coefficient. Results: Forty-six experts voted on 20 statements, which focused on the following aspects: i) organization of care services from early diagnosis to the management of advanced clinical stages; ii) access to biomarkers for a biological diagnosis of AD; iii) requirements necessary for the administration of DMTs; iv) main actors and pathways for the management of patients suffering from cognitive disorders. At the end of the process, 4 statements (20%) received a Grade A consensus, while 16 (80%) reached a Grade B consensus. Although the responses reflect heterogeneity among Italian regions, there was a fair degree of consistency for all statements. Conclusion: The high strength of this expert-based Delphi-consensus may offer guidance for improving the patient's journey of individuals with cognitive decline from a biological diagnosis to DMTs administration and may possibly offer hints to the Health Systems on dementia.