The Alzheimer’s
Alzheimer’s Disease and Related Dementias Clinical Guidelines
NEW INFORMATION ON ALZHEIMER’S TREATMENT
VA Providing Coverage of Lecanemab for Early Stage AD. Read the press release from March 14, 2023.
NIH report on blood test to detect dementia prior to symptoms released. Read the full article.
FDA grants accelerated approval for lecanemab, the second drug designed to remove plaque from the brain. Read this release from the FDA.
Preventable Risk Factors: Educating your patients. Read this article from the New York Times published July 5, 2022.
MEDICARE RESTRICTED COVERAGE OF ADUCANUMAB, OTHER DISEASE MODIFYING DRUGS
January 12, 2022 article in MedPage Today about the CDC’s decision.
ADUCANUMAB-ARIA STUDY PUBLISHED IN JAMA NEUROLOGY
ADUCANUMAB FOR ALZHEIMER’S: CONTROVERSY & COMMUNICATION ON-DEMAND WEBINAR NOW AVAILABLE
The FDA approval of AduhelmTM (aducanumab) has been a source of controversy and concern. This on-demand webinar, filmed from a live webinar hosted on July 21, 2021, will provide context and practical information for providers needing to answer questions and requests from patients and family members. Click here to access webinar.
THE ALZHEIMER’S PROJECT CLINICAL ROUNDTABLE AND GUIDELINES
Primary care physicians and providers can 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 2015 to develop tools to assist the primary care providers who will care for the vast majority of patients experiencing cognitive decline, as well as assist their family members and caregivers.
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. More information on the entire Alzheimer’s Project can be found on the County website.
While the majority of patients living with dementia can be effectively managed by primary care providers, there are cases that may need further evaluation beyond the scope the primary care provider is comfortable, and appropriate referrals are then recommended. Further, should the practitioner not be comfortable with the evaluation, disclosure or disease management of a particular patient, referral to a specialist is recommended.
Guidelines Third Edition Now Available!
The Physician Guidelines Third Edition (June 2021) booklet includes screening and evaluation instruments recommended, background research and references, best practices algorithms, and resource tools for caregivers. The new edition adds information on caring for caregivers as well as assessing caregiver stress, provides updated community resources, and discusses FDA approved medications. The Guidelines booklet is comprehensive, and providers are encouraged to download/print/use those pages most relevant to their practice.
Physician/Provider Education
Grand Rounds, virtual and on-site education, and conferences are offered throughout the year to inform primary care providers and their staff on best practices and new resources. To schedule a presentation for your health system or practice, contact Barbara.Mandel@ChampionsFH.org.
Presentations are geared toward your specific clinical group. Topics may include:
- Screening and Evaluation of Cognitive Decline
- Updates in Research
- Genetics, Prevalence and Impact of ADRD
- Behavioral Management of ADRD
- Pharmacological Management of Behavioral Issues
- Life Planning through the Stages of Dementia
- Educating, Assessing & Supporting Caregivers
CME On-Demand Webinars
Champions for Health has partnered with The Doctors Company to offer a series of 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 healthcare professionals; 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
- Care Management through the Stages, Communications & Resources
- Pharmacotherapy for Dementia
- Pharmacological Management of Behavioral & Psychological Symptoms
- Q&A: What Physicians Ask About Diagnosing and Treating Dementia
- Aducanumab: Controversy & Patient Communications panel discussion
Mobile Apps REVISED! Provide Guidelines & Instruments in Palm of MD Hand – Download to Your Phone Today!
The AlzDxRx mobile application assists providers 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, plus the ZBI12, a caregiver assessment. Patient identified scores can be emailed to you (HIPAA compliant) for ease in adding to EHR. The app is free and easy to use!
Download the app from your iOS or Android app store today! If you have the app on your phone now, please delete and re-download to make sure you have the most current version.
Make sure that your email accepts mail from no-reply@AlzDxRx.com. In Outlook, you can set this as a Rule, and indicate a level of importance. Patient test result pdfs may otherwise end up in your Spam or Junk mail.
Have problems? Please do the following:
- Delete the app from your phone
- Turn off your phone, wait 30 seconds, and turn it on again
- Go to your app store (iOS or Android) and download the app AlzDxRx again
- Set up your account again, with your NPI and preferred password. Create Account is in the lower left corner of the screen
For any problems, please contact
Barbara.Mandel@ChampionsFH.org.
Health Professionals: RNs, NPs, PAs, & MAs
Learning to assist with screening and evaluation of individuals with cognitive issues will greatly improve patient care and the efficiency of your clinical site. The Clinical Roundtable encourages nurses, nurse practitioners, physician assistants, and medical assistants to become knowledgeable of the 10 Warning signs of dementia, the algorithm for screening, and proficient in conducting a MiniCog screening.
The On-Demand Webinars, detailed to the left, provides CME and CE credits through The Doctors Company that fulfills professional requirements. Webinar #1 on Screening includes a demonstration of conducting the MiniCog, as does the YouTube video linked above. The webinar includes more detailed information to assist you in your practice.
Starting the Conversation on Memory Impairment
An annual Medicare Wellness Visit is often the time that cognitive impairment can be noticed by the provider, or the patient or family member may mention concerns. See the Guidelines for Starting the Conversation, educating patients on brain health and aging, and the use of listening tools.
New Exam Room Poster to Encourage Conversation on Cognitive Decline
Download and print these 8.5 x 11 posters for your exam rooms or waiting rooms to encourage patients and family members to consider symptoms and initiate a conversation with physicians and staff.
Posters available in
Screening for Cognitive Impairment
Screening may be incorporated into the annual health assessment for older individuals, and a screening may require about 10 minutes. 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. Trained healthcare staff can conduct these instruments to facilitate the clinical visit.
Evaluation and Diagnosis
A thorough evaluation of cognitive issues is more detailed and time consuming than a screening, and clinicians performing an evaluation should have a thorough knowledge of cognitive disorders and be comfortable disclosing a diagnosis. An evaluation can be initiated by a trained RN, PA or other staff to conduct instruments with the patient and/or caregiver. An evaluation appointment may take 45 minutes. See the Guidelines for full descriptions and links to the right for the step-by-step algorithm and recommended instruments.
Disease Management Through the Stages
Dementia is disease with a course of four to 20 years, and caregivers will need a variety of supports at different times. Both behavioral/environmental and pharmacologic interventions may be needed over the course of the disease. Tools listed at right assist physicians to assess behavioral issues. Read the Guidelines for information on disease progression, issues to discuss along the journey, and end of life decision making.
Resources for Caregivers
Assisting caregivers through the disease process may be the most important part of a physician’s care of a patient, and can take considerable time for the provider and office staff. See the full range of dementia-specific resources and handouts. The CDC also has a number of resources on supporting caregivers.
CLINICAL TRIALS
Providers are encouraged to discuss clinical trials with patients during early stage disease. In San Diego County, clinical trials are currently being conducted at:
- Excell Research
- The Neurology Center
- Pacific Research Network
- Sharp Neurocognitive Research Center
- UC San Diego Alzheimer’s Disease Research Center
Providers can also find information at clinicaltrials.gov
