Using a public health framework to address Alzheimer's disease and related dementias (ADRD), the Idaho ADRD Program encourages providers to consider and promote efforts that address primary, secondary, and tertiary risk reduction of ADRD.
As recipients of the Centers for Disease Control and Prevention's (CDC) BOLD funding, Idaho and you, as a provider, have access to three national centers of excellence. The centers provide research, resources, collaborative opportunities, and support to Idaho. Those centers are BOLD Center of Excellence for Dementia Caregiving, BOLD Center of Excellence for Early Detection of Dementia, and BOLD Center of Excellence for Dementia Risk Reduction. If you are interested in any of these opportunities or would like to get connected, please contact the Idaho ADRD Program (ADRD@dhw.idaho.gov).
The secondary level of risk reduction refers to detecting ADRD early, when symptoms are affecting a person's life but before a crisis occurs, and working to delay the progression of the disease. Many healthcare professionals wonder what the benefit of an early diagnosis is, especially when resources are not always available. Here are a few reasons:
- Providing an early diagnosis empowers the person (and family) with information they need to take control of their condition, plan for the future, and live well with dementia. Early diagnosis helps identify treatable conditions, and it helps the person with dementia live independently for longer (Alzheimer’s Association, 2023; Rasmussen and Langerman, 2019).
- Receiving a diagnosis early and adequate symptom management may help reduce unnecessary hospitalizations or premature institutional placement. Most people with ADRD have a co-occurring chronic condition, and symptoms of ADRD can complicate the management of chronic conditions. Hospitalizations for people with ADRD are often due to complications resulting from cognitive impairment and not for the cognitive impairment itself. (Anderson, et. al., 2020).
In Idaho, 9.2% of Idahoans 45 years and older reported having subjective cognitive decline. However, less than half have discussed this concern with their healthcare provider, and 81.6% had at least one chronic health condition (BRFSS, 2020).
According to the Alzheimer's Association (2020), a national survey of 1,000 primary care physicians (PCP) revealed:
- 50% stated they were not prepared to care for this growing population,
- 27% reported being only "sometimes" or "never" comfortable answering patient questions about Alzheimer’s, and
- 39% reported "never" or "only sometimes" being comfortable with making a diagnosis of Alzheimer’s or other dementias.
If you have a patient who is experiencing significant changes from their previous level of thinking or functioning, consider having the patient fill out this comprehensive tool and bring it in to help facilitate a conversation around what they are experiencing. This tool was developed by a group of interdisciplinary retired physicians who also live with neurocognitive disorders and serve on the National Council of Dementia Minds.
Early Diagnosis Provider Resources
Review the articles below to learn more about the research behind early detection.
- Borson S & Chodosh J. Early Detection of Dementia and the Goal of Population-based Care. Generations. 2023. https://generations.asaging.org/early-dementia-detection-and-population-based-care
- Petersen, RC, Lopez, O, Armstrong, ML, et al. Practice guideline update summary: Mild cognitive impairment. J. Neurol. 2018;90(3). https://doi.org/10.1212/WNL.0000000000004826
- Rasmussen, J, Langerman, H. Alzheimer's Disease - Why We Need Early Diagnosis. Degener Neurol Neuromuscul Dis. 2019;9: 123-130. https://doi.org/10.2147%2FDNND.S228939
- Sabbagh, MN, Perez A, Holland, TM, et al. Primary prevention recommendations to reduce the risk of cognitive decline. Alzheimer's Dement. 2022;18: 1569–1579. https://doi.org/10.1002/alz.12535
Disclaimer: The Idaho Department of Health and Welfare does not endorse any particular product. The contents of each toolkit listed below are solely the responsibility of the authors and do not necessarily represent the official views of the Department.
UsAgainstAlzheimer’s developed the BrainGuide: Toolkit for Healthcare Providers to help address the need for better resources. Here you will find information you can share with patients about ways to reduce their risk for dementia, resources to help address the unique needs of communities of color, and tools to help you share BrainGuide with your patients. BrainGuide is free, available in English and Spanish, and allows people to take a memory questionnaire for themselves or a loved one.
The American Academy of Family Physician's free Cognitive Care Kit offers resources to help physicians, families, and caregivers support individuals with, or at risk for, cognitive impairment.
Cognitive Impairment Care Planning Toolkit
This free toolkit can help you deliver person-centered care planning.
Early Detection of Dementia Toolkit - Health Systems
This toolkit is designed to assist healthcare professionals in thinking about the value of early detection of dementia and how to develop an initial plan.
Gerontological Society of America (GSA) KAER Toolkit
The GSA KAER Toolkit is intended to support primary care teams in implementing a comprehensive approach to initiating conversations about brain health, detecting and diagnosing dementia, and providing individuals with community-based supports.
Explore additional toolkits/guides for Alzheimer's and Dementia outreach, recruitment, and engagement resources from the National Institute of Health's National Institute on Aging. Visit webpage here.
Alzheimer's Association: Health Systems and Medical Professionals
The Alzheimer's Association has partnered with government and professional organizations to develop several physician guidelines and recommendations that can help you care for your patients with dementia and help both patients and caregivers cope and live with a dementia diagnosis.
Cognition in Primary Care: Clinical Tools
Cognition in Primary Care is a program to facilitate detection of cognitive impairment and improve care for people with dementia. This site has tools providers can use to:
- Be Aware: Dementia is Under-diagnoses (Staff Workflow)
- Decide: Is an Evaluation Needed?
- Evaluate: Tools for Evaluation
- Counsel: Set a Plan and Refer to Community Resources
The Alzheimer's Association has several cognitive assessment tools (patient assessment tools and informant tools) used to identify individuals who may need additional evaluation. No one tool is recognized as the best brief assessment to determine if a full dementia evaluation is needed. However, the expert workgroup identified several instruments suited for use in primary care based on the following: administration time ≤5 minutes, validation in a primary care or community setting, psychometric equivalence or superiority to the Mini-Mental State Exam (MMSE), easy administration by non-physician staff and relatively free of educational, language and/or cultural bias. For a definitive diagnosis of mild cognitive impairment or dementia, individuals who fail any of these tests should be evaluated further or referred to a specialist.
Comprehensive Tool for Patients to Document Symptoms
If you have a patient who is experiencing significant changes from their previous level of thinking or functioning, consider having the patient complete this comprehensive tool to document their symptoms over time. Have the patient bring this tool in to share with you, as their provider, to help facilitate conversations around what they are experiencing and the potential for an easier, quicker, and accurate diagnosis and treatment. This tool was developed by a group of interdisciplinary retired physicians who also live with neurocognitive disorders and serve on the National Council of Dementia Minds.
Consider Referrals to other Healthcare Providers
Consider referring patients to an Occupational Therapist and/or Speech Language Pathologist if there is difficulty chewing, swallowing, and/or handling utensils and tools needed to eats. These resources may be helpful for you: Feeding and Nutrition (for dementia) by the Family Caregiver Alliance and Food and Eating by the Alzheimer's Association.
Clinic located in Coeur d'Alene, Idaho that provides a team approach to the assessment, diagnosis, and treatment of memory loss.
Clinics are located in Nampa, Eagle, and Boise. Their team of healthcare professionals, including a physician, pharmacist, and social worker, work closely with the patient and their family to provide the tools and education to help the patient age gracefully and prolong their independence as long as possible.
People with Alzheimer’s often have problems with sleeping or may experience changes in their sleep schedule. When managing sleep changes, non-drug coping strategies should always be tried first.