Cognitive Impairment and Alzheimer's Disease

Improve care for patients with dementia and their caregivers.

• Change clinical practice through interactive discussions with an academic detailer
• Deliver evidence-based education and tools to clinicians and healthcare staff
• Give resources to families to prepare for the changes with advancing disease

Published Materials

• Summary Brochure
• Evidence Document
• Patient Brochure – Advance care planning
• Patient Brochure – Amyloid
• Patient Brochure – BPSD
• Caregiver Resources
• Lecanemab (Leqembi) referral sheet
• Lecanemab (Leqembi) information for patients and families
• Lecanemab (Leqembi) information for clinicians

Dementia is a common condition in older adults, with over 6 million people being diagnosed with Alzheimer’s disease in the U.S.¹  As many as 1 in 9 people over the age of 65 have Alzheimer’s disease. After the age of 85, that prevalence rises to 1 in every 3 people having the disease.

Reduce the onset and severity of dementia

While many factors have been associated with the development of dementia, few interventions have conclusively proven to reduce dementia incidence. Two interventions that may reduce patient risk are controlling blood pressure and recommending a Mediterranean diet.^2,3

Assess cognitive symptoms, looking for treatable causes

Patients with signs or symptoms of cognitive impairment should be evaluated for dementia with a validated tool. A comprehensive physical exam, relevant history, and attempts to evaluate for reversible causes should be completed before making the diagnosis.⁴

Discuss treatment options with the patient and family

Older medications, cholinesterase inhibitors (e.g., donepezil) and memantine have a limited role in management. A response to treatment, if it occurs, is time limited and carries a risk of side effects such as nausea, vomiting, bradycardia, hypertension, and dizziness.⁵ Continuously reassess the benefit and risks of medications, if used.

Newer medications, such as monoclonal antibodies to reduce amyloid deposits in the brain, have shown potential benefit. Lecanemab (Leqembi) slowed cognitive decline by 0.45 points on an 18 point scale compared to placebo over 18 months in patients with mild cognitive impairment or mild Alzheimer’s disease.⁶ It is not clear whether such a small change would be noticed by many patients, families, or clinicians.⁷  Testing requirements, logistics relating to infusions, cost of infusions and required testing throughout treatment can be burdensome, in addition to side effects from lecanemab such as cerebral edema, effusion, and hemorrhage. The decision to use lecanemab should be based on a clear discussion of the risks and expected benefit from treatment. It will not stop or reverse cognitive decline.

Plan for future care needs

Advance care planning (ACP) is a continuous, dynamic process of reflection and dialog between a person with dementia, those close to her or him, and their health care providers concerning the patient’s preferences and values in future treatment and care, including end-of-life care.⁸ Documenting the patient’s wishes allows patients to have more control in care and can avoid unnecessary or unwanted treatments. Numerous resources (noted further down this page) can assist patients and families in having discussions and documenting key decisions.

Alosa Health can help your team succeed.

• Evaluate and synthesize the evidence.
• Facilitate web-based and in-person training.
• Provide consulting services to meet your needs.

Click here to contact us for more information about Alosa’s full academic detailing package.

Additional Resources for Providers

• Alzheimer’s Association
• POLST form
• Billing tips for ACP

Additional Resources for Advance Care Planning

• The Conversation Project
• Alzheimer’s Association
• National Institute on Aging
• HealthInAging.org

Additional Resources for Driving

• AAA Senior Driving
• Alzheimer’s Association
• Eldercare transportation locator
• Pennsylvania resources
  • Pennsylvania Transportation Services
  • Pennsylvania Department of Aging – Transportation
• Texas transportation for seniors

Additional Resources for Caregivers

• Alzheimer’s Association caregiver support
• Alzheimer’s Association safety
• Best Programs for Caregiving
• Respite care options
• Pennsylvania resources
  • Pennsylvania Adult Day Centers
  • Local Area Agency on Aging
  • DementiaFriendsPA.org
• Texas resources
  • Local Area Agency on Aging
  • Texas Caregiver Center or 855-YES-ADRC (855-937-2372)
  • Respite Care

Information current at time of publication, May 2023.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating clinician based on the individual patient’s clinical condition.

References

1. Alzheimer’s Association. 2022 Alzheimer’s disease facts and figures. Alzheimers Dement. 2022 Apr;18(4):700-789.
2. Sprint Mind Investigators for the SPRINT Research Group. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019;321(6):553-561.
3. Valls-Pedret C, Sala-Vila A, Serra-Mir M, et al. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(7):1094-1103.
4. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673-2734.
5. Courtney C, Farrell D, Gray R, et al. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomised double-blind trial. Lancet. 2004;363(9427):2105-2115.
6. van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in early Alzheimer’s Disease. N Engl J Med. 2022;388(1):9-21.
7. Andrews JS, Desai U, Kirson NY, et al. Disease severity and minimal clinically important differences in clinical outcome assessments for Alzheimer’s disease clinical trials. Alzheimers Dement (N Y). 2019;5:354-363.
8. Piers R, Albers G, Gilissen J, et al. Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliat Care. 2018;17(1):88-88.