MD-and-patientNew Guidelines Second Edition Now Available!

Primary care physicians and providers can now screen and evaluate for Alzheimer’s disease and related dementias with more confidence and ease, and access tools to manage behavioral issues. The Alzheimer’s Project Clinical Roundtable, a group of neurologists, psychiatrists, geriatricians, and geriatric psychologists, have been working since 2017  to develop tools to assist the primary care providers who will care for the vast majority of patients experiencing cognitive decline.

The Alzheimer’s Project is a regional initiative established by the San Diego County Board of Supervisors to address the toll of Alzheimer’s disease and related dementias on families, communities and our healthcare systems. Other Roundtables are focused on Care, Cure & Public Education. More information on the entire Alzheimer’s Project can be found here.

The tools on this website have been created to assist providers deal more effectively with patients experiencing memory loss and dementia, and the associated monumental number of family members and caregivers affected by this profound category of disease. Information and resources on this website is updated as new data is identified.

The Guidelines Second Edition (December 2018) booklet includes screening and evaluation instruments recommended, background research and references, best practices algorithms, and resource tools for caregivers.  The Guidelines is comprehensive, and providers are encouraged to download/print/use those pages most relevant to their situation.

CME On-Demand Webinars

 Champions for Health has partnered with The Doctors Company to offer a series of six on-demand courses created by the Alzheimer’s Project Clinical Roundtable. The courses are available free of charge and are approved for AMA PRA Category 1 CreditsTM.  The courses are meant to act as training tools, that can be taken at your own convenience in approximately 15-minute segments. You are encouraged to revisit as needed. Courses are available to all interested; check with your specific professional continuing education guidelines for eligibility to earn credits.  Courses include:

  • Screening for Dementia
  • Evaluation and Diagnosis
  • Addressing & Managing Behavioral and Environmental Signs and Symptoms
  • End of Life Planning, Communications, & Resources
  • Pharmacotherapy for Dementia
  • Pharmacological Management of Behavioral & Psychological Symptoms

Physician Education

Grand Rounds, on-site education, and conferences are offered throughout the year to inform primary care providers on best practices and new resources.  In partnership with Scripps Health in February 2018, content on research, screening and evaluation, and behavioral management was presented.  The presentations can be viewed here, clicking on the particular topic to access slides and video of the presentations.  To schedule an educational presentation for your health system or practice, contact Barbara Mandel, Roundtable facilitator.

NEW! Mobile Apps Provide Guidelines & Instruments in Palm of MD Hand

app-screen

The AlzDxRx mobile application assists physicians to walk through screening and evaluation of patients with cognitive decline while maintaining eye-to-eye contact. Access scoring instruments: MiniCog, AD8, PHQ-9, QDRS, IQCODE, MOCA and SLUMS. Patient identified scores can be emailed for ease in adding to EHR. Download for your phone below.

App Store Google Play

 

 

Brain-Tree

Screening

Screening may be incorporated into the annual health assessment for older individuals, and a screening may require 10 minutes or more.  The Clinical Roundtable recommends the use of the MiniCog as a quick screening tool, and the AD8 to assess caregiver observations of the patient’s behaviors.  Should these assessments identify cognitive impairment, a more thorough evaluation appointment would be appropriate.  Below are links to pdfs of the best practices algorithm and recommended screening instruments.

Screening Algorithm

AD8 Screening

AD8 Screening Spanish

Mini Cog

Mini Cog Spanish

Resources For Caregivers

 

Assisting caregivers through the disease process can take considerable time for the provider and office staff. Below are links to pdfs you may want to have available to give to family members to assure a more effective patient appointment and follow-up.  For more information on working with caregivers click here.

Preparation for Doctor’s Visit

Five Action Steps Family Caregivers Should Take

Information and Resources For Caregivers

Evaluation

An evaluation can be initiated by an RN, PA or other staff to conduct instruments with the patient and/or caregiver. An evaluation appointment may take 45 minutes.

Evaluation and Diagnosis Algorithm

IQCODE

IQCODE Spanish

MOCA 8.1 & 8.2 English

MOCA 8.1 Spanish

PHQ-9

PHQ-9 Spanish

Geriatric Depression Scale Short Form

QDRS

SLUMS

SLUMS Spanish

Making a Disclosure of Alzheimer’s or Other Dementias

Five Action Steps Family Caregivers Should Take

Disease Management

Once a diagnosis is made, both behavioral/environmental and pharmacologic interventions may be needed over the course of the disease. Tools below assist physicians to address the needs of patients and their caregivers.

DICE: Describe, Investigate, Create, Evaluate.

Behavioral and Environmental Management of BPSD

Pharmacologic Management of BPSD

Algorithm for Disease Management

Algorithm for Agitation and Aggression

Algorithm for Depression

Algorithm for Sleep Problems

Algorithm for Wandering

Instrumental Activities of Daily Living

Preparation for Doctor’s Visit

End of Life Planning and Care

The majority of patients living with dementia can be effectively managed by primary care providers. There are a number of cases that may need further evaluation beyond the scope the primary care provider is comfortable, and appropriate referrals are recommended. Further, while these tools and additional training are geared to increase the capacity of primary care providers, should the practitioner not be comfortable with the evaluation, disclosure or disease management of a particular patient, referral to a specialist is recommended.