Nonprofit•New York, New York, United States•
About: Alzheimer's Foundation of America is a nonprofit organization based out in New York, New York, United States. It is known for research contribution in the topics: Health care & Dementia. The organization has 5 authors who have published 4 publications receiving 292 citations.
University of Washington1, Patient-Centered Outcomes Research Institute2, VA Palo Alto Healthcare System3, Regenstrief Institute4, Texas Tech University Health Sciences Center5, Tufts Medical Center6, University of Minnesota7, Washington University in St. Louis8, University of California, San Diego9, University of Kentucky10, University of the Sciences11, Alliance for Aging Research12, Alzheimer's Foundation of America13, Alzheimer's Drug Discovery Foundation14, Stanford University15
TL;DR: The value of screening for cognitive impairment, including dementia and Alzheimer's disease, has been debated for decades as discussed by the authors, and recent research on causes of and treatments for cognitive impairments has converged to challenge previous thinking about screening.
Abstract: The value of screening for cognitive impairment, including dementia and Alzheimer's disease, has been debated for decades. Recent research on causes of and treatments for cognitive impairment has converged to challenge previous thinking about screening for cognitive impairment. Consequently, changes have occurred in health care policies and priorities, including the establishment of the annual wellness visit, which requires detection of any cognitive impairment for Medicare enrollees. In response to these changes, the Alzheimer's Foundation of America and the Alzheimer's Drug Discovery Foundation convened a workgroup to review evidence for screening implementation and to evaluate the implications of routine dementia detection for health care redesign. The primary domains reviewed were consideration of the benefits, harms, and impact of cognitive screening on health care quality. In conference, the workgroup developed 10 recommendations for realizing the national policy goals of early detection as the first step in improving clinical care and ensuring proactive, patient-centered management of dementia.
TL;DR: D diagnosis and management of AD by PCPs, utilizing specialist consultation as needed, may contribute to earlier diagnosis and treatment, improved doctor-patient and doctor-caregiver communication, increased attention to caregiver needs, and better clinical and quality-of-life outcomes for patients and caregivers.
Abstract: Alzheimer's disease (AD) is a neurodegenerative disorder that causes cognitive and functional disability and affects an estimated 5.1 million Americans.1 Although available treatments do not cure or reverse the course of AD, clinical studies have demonstrated that the cholinesterase inhibitors (ChEIs) and an N-methyl-D-aspartic acid (NMDA) antagonist can delay or slow the progression of cognitive and functional impairment, with greatest benefits achieved when medication is started early and utilized persistently.1,2 Research also shows that psychosocial interventions providing support, education, and counseling to patients and caregivers can improve the quality of life of those afflicted as well as their families.3 Moreover, early diagnosis of AD provides time for patients and families to prepare for the future and obtain necessary services.4,5 Despite the potential benefits of early diagnosis of AD, patients are often diagnosed later in the course of the disease and frequently by a consultant rather than the primary care physician (PCP).6 A recent Internet survey of 539 caregivers of AD patients conducted by Harris Interactive on behalf of the Alzheimer's Foundation of America found that the typical patient experiences symptoms for more than 2 years (26.1 months) and visits an average of 2.3 doctors before being diagnosed with AD.7 At the time of diagnosis, only 43% of patients were in the mild stage of the disease, whereas 23% were in the moderate stage, and the remaining patients (34%) had severe AD.7 The diagnosis and treatment of AD in the primary care setting may already be occurring with increasing frequency. According to GfK Market Measures' 2007 Alzheimer's Disease Caregiver Study, 68% of caregivers identified PCPs as key health care providers for both diagnosing and managing their loved one's AD.8 In fact, PCPs are often in the best position to both make the diagnosis and share it with the patient and the family because of the often long-term, ongoing relationship that the PCP has with the patient and family. Optimal involvement of primary care physicians in making and sharing the diagnosis of AD should result in patients being diagnosed at an earlier stage of the disease, allowing the patients themselves to make decisions about their own health care and express preferences regarding choices that they will be unable to make in the future.3,5 Clinical Points ♦ Making and sharing the diagnosis of Alzheimer's disease may best be accomplished by the patient's primary care physician. ♦ Skillful communication with patients, caregivers, and family members is of paramount importance in the diagnosis and treatment of Alzheimer's disease. ♦ Treatments “work” mostly by slowing progression of the disease. Effectively sharing the diagnosis of AD with patients and their families and communicating with them over the course of the illness concerning the myriad issues that arise presents a formidable challenge for many PCPs. Not surprisingly, significant gaps in communication between PCPs and patients with AD and their caregivers have been identified.9 Although guidelines have been issued by several organizations for sharing the diagnosis of AD and for providing education to patients and caregivers,2,10 there is a need for more practical and detailed guidance concerning how to accomplish this challenging task, particularly in a primary care setting. Accordingly, a national roundtable was convened on March 14, 2008, with the principal goal of arriving at a consensus on a set of recommendations to be offered to PCPs suggesting how best to communicate with patients and families regarding the diagnosis and ongoing management of AD. This roundtable included 4 leading academic physicians with diverse backgrounds (a geriatric psychiatrist, a neuropsychiatrist, a neurologist, and a geriatrician) from geographically diverse regions of the United States, who were invited on the basis of their national reputation in the field and experience working with minority populations with dementia; the executive director of a national AD advocacy organization; the executive director of a national advocacy organization for caregivers; and a medical correspondent with expertise in interviewing and small group leadership. This article, based on those proceedings and intended to be a practical resource for PCPs, will present these recommendations (Table 1), highlighting their potential to improve the quality of medical care for patients with AD, the quality of life for their caregivers, and satisfaction with the medical encounter for the PCP. Expert opinion is supported by the academic literature (search limited to PubMed, English language, 1996–2008, search terms: Alzheimer's disease, primary care, diagnosis, management, caregiver, family, patient-physician relationship). Only statements endorsed by all authors were included in this article. Table 1 Key Recommendations of the Expert Consensus Panel for Sharing the Diagnosis and Management of Alzheimer's Disease (AD)
TL;DR: To report experience with a large, nation‐wide public memory screening program, contact us at [email protected] for more information.
Abstract: Objectives To report experience with a large, nation-wide public memory screening program. Design Descriptive study of community-dwelling elderly adults. Setting Local community sites (48 sites agreed to provide data) throughout the United States participating in National Memory Screening Day in November 2010. Participants Of 4,369 reported participants, 3,064 had complete data records and are included in this report. Measurements Participants completed a questionnaire that included basic demographic information and a question about subjective memory concerns. Each site selected one of seven validated cognitive screening tests: Mini-Cog, General Practitioner assessment of Cognition, Memory Impairment Screen, Kokmen Short Test of Mental Status, Mini-Mental State Examination, Montreal Cognitive Assessment, Saint Louis University Mental Status Examination. Results Overall, 11.7% failed one of the seven screening tests. As expected, failure rates were higher in older and less-educated participants (P's < .05). Subjective memory concerns were associated with a 40% greater failure rate for persons of similar age and education but no memory concerns (odds ratio = 1.4, 95% confidence interval = 1.07–1.78), although only 11.9% of those who reported memory concerns (75% of all participants) had detectible memory problems. Conclusion Screening for cognitive impairment in community settings yielded results consistent with expected effects of age and education. The event attracted a large proportion of individuals with memory concerns; 88.1% were told that they did not have memory problems detectible with the tests used. Further studies are needed to assess how participants respond to and use screening information, whether this information ultimately influences decision-making or outcomes, and whether memory screening programs outside healthcare settings have public health value.
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