THE ROAD AHEAD TO CURE AND PREVENT ALZHEIMER’S DISEASE: IMPLEMENTING PREVENTION INTO PRIMARY CARE

Most old adults receive their health care from their primary care practitioner; as a consequence, as the population ages, the manifestations and complications of cognitive impairment and dementia impose a growing burden on providers of primary care. Current guidelines do not recommend routine cognitive screening for older persons by primary care physicians, although the vast majority recommend a cognitive status assessment and neurological examination for subjects with a cognitive complaint. Also, no clinical practice guidelines recommend interventions in older adults with cognitive impairment in primary care settings. However, primary care physicians need to conduct a review of risks and protective factors associated with cognitive decline and organize interventions to improve or maintain cognitive function. Recent epidemiological studies have indicated numerous associations between lifestyle-related risk factors and incidental cognitive impairment. The development of biomarkers could also help in diagnosis, prognosis, selection for clinical trials, and objective assessment of therapeutic responses. Interventions aimed at cognitive impairment prevention should be pragmatic and easy to implement on a large scale in different health care systems, without generating high additional costs or burden on participants, medical and social care teams.

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Feasibility and Acceptability of the Informant AD8 for Cognitive Screening in Primary Healthcare: A Pilot Study

The Scientific World JOURNAL ◽

10.1155/2014/302834 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

YanHong Dong ◽

Tuck Seng Cheng ◽

Keith Yu Kei Tsou ◽

Qun Lin Chan ◽

Christopher Li-Hsian Chen

Keyword(s):

Primary Care ◽

Cognitive Impairment ◽

Older Adult ◽

Primary Healthcare ◽

Primary Care Physicians ◽

Case Finding ◽

Adult Patients ◽

Cognitive Screening ◽

Healthcare Settings ◽

Memory Clinics

Objectives.The utility of informant AD8 for case finding of cognitive impairment at primary healthcare settings is unknown and therefore its feasibility and acceptability for targeted screening at a primary healthcare clinic should be investigated.Methods.The informants of older adult patients attending a primary healthcare clinic in Singapore were administered the AD8. Positive screening findings were provided to patients’ primary care physicians for referrals to specialist memory clinics. The acceptability of AD8 was evaluated by collecting feedbacks from the informants and primary care physicians.Results.205 patients and their informants were recruited. However, 6 (2.9%) informants were uncontactable, while the majority of the remaining 199 patients with completed AD8 (96.5%,n=192) found it acceptable where 59 (29.6%) patients were deemed cognitively impaired (AD8 ≥ 2). Clinicians (100%,n=5) found the AD8 helpful in facilitating referrals to memory clinics. However, most referral recommendations (81.4%,n=48) were declined by patients and/or informant due to limited insight of implications of cognitive impairment.Conclusions.The AD8 can be easily administered and is well tolerated. It detected cognitive impairment in one-third of older adult patients and therefore may be useful for case finding of cognitive impairment in the primary healthcare.

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EARLY DETECTION OF MILD COGNITIVE IMPAIRMENT (MCI) IN PRIMARY CARE

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2020.21 ◽

2020 ◽

pp. 1-6

Author(s):

M.N. Sabbagh ◽

M. Boada ◽

S. Borson ◽

M. Chilukuri ◽

B. Dubois ◽

...

Keyword(s):

Primary Care ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Performance ◽

Large Scale ◽

Care Setting ◽

Primary Care Setting ◽

Cognitive Screening ◽

Patient Journey ◽

Cognitive Evaluation

Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to multi-dimensional frictions and barriers associated with evaluating individuals’ cognitive performance. To move toward large-scale cognitive screening, a global panel of clinicians and cognitive neuroscientists convened to elaborate on current challenges that hamper widespread cognitive performance assessment. This report summarizes a conceptual framework and provides guidance to clinical researchers and test developers and suppliers to inform ongoing refinement of cognitive evaluation. This perspective builds upon a previous article in this series, which outlined the rationale for and potentially against efforts to promote widespread detection of MCI. This working group acknowledges that cognitive screening by default is not recommended and proposes large-scale evaluation of individuals with a concern or interest in their cognitive performance. Such a strategy can increase the likelihood to timely and effective identification and management of MCI. The rising global incidence of AD demands innovation that will help alleviate the burden to healthcare systems when coupled with the potentially near-term approval of disease-modifying therapies. Additionally, we argue that adequate infrastructure, equipment, and resources urgently should be integrated in the primary care setting to optimize the patient journey and accommodate widespread cognitive evaluation.

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Screening for dementia in primary care - a viable proposition?

Irish Journal of Psychological Medicine ◽

10.1017/s079096670000639x ◽

2001 ◽

Vol 18 (2) ◽

pp. 75-77 ◽

Cited By ~ 5

Author(s):

Aideen Freyne

Keyword(s):

Primary Care ◽

Health Policy ◽

Cognitive Impairment ◽

Primary Care Physicians ◽

Screening Programme ◽

Screening Instruments ◽

Cognitive Screening ◽

Care Level ◽

Policy Documents ◽

Primary Care Level

AbstractHealth policy documents recommend screening for cognitive impairment, although in practice this is not implemented. This article looks at the issues which require consideration in implementing a screening programme. These include factors pertinent to the disease under consideration, resources, both personnel and time, lack of experience of cognitive screening at a primary care level, use of screening instruments and uncertainty about management of positive cases. Only by identifying the practical difficulties involved in screening, can steps can be taken to overcome them and to implement screening programmes which are acceptable to the population under consideration and their primary care physicians.

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Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study

Geriatrics ◽

10.3390/geriatrics6030063 ◽

2021 ◽

Vol 6 (3) ◽

pp. 63

Author(s):

Silvia Mejia-Arango ◽

Jaqueline Avila ◽

Brian Downer ◽

Marc A. Garcia ◽

Alejandra Michaels-Obregon ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Cognitive Impairment ◽

Cardiovascular Diseases ◽

Educational Attainment ◽

Access To Health Care ◽

Sociodemographic Factors ◽

Cognitive Status ◽

Access To Health ◽

Mexican Adults

Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

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Screening Neurocognitive Disorders in Primary Care Services: The Quick Mild Cognitive Impairment Approach

Innovation in Aging ◽

10.1093/geroni/igaa057.515 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 158-158

Author(s):

Constanca Paul ◽

Susana Sousa ◽

Pedro Santos ◽

Rónán O’Caoimh ◽

William Molloy

Keyword(s):

Mental Health ◽

Primary Care ◽

Cognitive Impairment ◽

Community Sample ◽

Neurocognitive Disorders ◽

Cognitive Status ◽

Health Concerns ◽

Care Services ◽

Primary Care Services ◽

Mental Health Concerns

Abstract Neurocognitive Disorders (NCD) is an increasingly common condition in the community. The General Practitioner (GP) in Primary Care Services (PCS), have a crucial role in early detection of NCD and is usually the first professional to detect the signs of MCI. The objective of this study was to test the feasibility and utility of the cognitive screening instrument QMCI in Primary Care. A community sample of 436 people 65+ living in the community was randomly selected from a larger group of old people with mental health concerns (N=2734), referred by their GPs. The mean age of the sample was 75.2 years (sd 7.2), with 41.3% men and 58.7% women; 60.4% married followed by 28.7% widows. The education level was low with 21% illiterate and 69,8% people with 4 years education. The QMCI mean was 37.1/100 (sd 16.2). The amount of people screening positive for cognitive impairment QMCI (<62/100) was 94.2%. In the distribution of people with cognitive impairment by Global Deterioration Scale (GDS) three recoded categories, of the 286 people 76,1% where classified as having very mild or mild impairment, 19,4% moderate or moderately serious and 4,5% severe or very severe impairment. These results confirm the perception of GPs about their clients having mental health concerns and the ability of QMCI accurately discriminate MCI. The QMCI is very brief (3-5mins) fitting the short time of GPs to assess cognitive status and timely refer clients to nonpharmacological interventions that could postpone NCD symptoms.

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Primary Care Physicians’ Perceptions of Barriers To Preventive Reproductive Health Care In Rural Communities

Perspectives on Sexual and Reproductive Health ◽

10.1363/4407812 ◽

2012 ◽

Vol 44 (2) ◽

pp. 78-83 ◽

Cited By ~ 30

Author(s):

Cynthia H. Chuang ◽

Sandra W. Hwang ◽

Jennifer S. McCall-Hosenfeld ◽

Lara Rosenwasser ◽

Marianne M. Hillemeier ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Rural Communities ◽

Reproductive Health ◽

Primary Care Physicians ◽

Reproductive Health Care

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Mild cognitive impairment in primary care: a clinical review

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136035 ◽

2018 ◽

Vol 94 (1117) ◽

pp. 647-652 ◽

Cited By ~ 3

Author(s):

Georges Assaf ◽

Maria Tanielian

Keyword(s):

Alzheimer’S Disease ◽

Primary Care ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Clinical Review ◽

Primary Care Physicians ◽

Early Recognition ◽

Neuropsychiatric Symptoms ◽

Evidenced Based

Dementia is projected to become a global health priority but often not diagnosed in its earlier preclinical stage which is mild cognitive impairment (MCI). MCI is generally referred as a transition state between normal cognition and Alzheimer’s disease. Primary care physicians play an important role in its early diagnosis and identification of patients most likely to progress to Alzheimer’s disease while offering evidenced-based interventions that may reverse or halt the progression to further cognitive impairment. The aim of this review is to introduce the concept of MCI in primary care through a case-based clinical review. We discuss the case of a patient with MCI and provide an evidence-based framework for assessment, early recognition and management of MCI while addressing associated risk factors, neuropsychiatric symptoms and prognosis.

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