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

Dementia is a common condition in older adults, with 7.2 million people being diagnosed with Alzheimer’s disease in the U.S.¹ The prevalence of Alzheimer’s disease increases with age, with 1 in every 3 people having the disease after age 85.

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. Interventions with the best evidence are controlling blood pressure, receiving recommended vaccinations (particularly the shingles vaccine), treating hearing loss with a hearing aid and audiologist support, and lifestyle interventions such as eating a Mediterranean diet or DASH diet, getting physical activity, and prioritizing social engagement.^2-10

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.¹¹

Discuss treatment options with the patient and family

None of the currently available medications provide clinically meaningful benefit over placebo.

Each medication option comes with risks

• cholinesterase inhibitors (e.g., donepezil) may cause nausea, diarrhea, headaches, dizziness, and bradycardia
• memantine may cause dizziness, confusion, headache, and hypertension
• anti-amyloid medications (e.g., donanemab, lecanemab) may cause an increase in brain swelling and bleeding^{12, 13}

Anti-amyloid medications have logistical hurdles.

• They are administered in a clinicians office, typically by infusion.
• They require increased MRI scans to monitor for adverse effects, and PET scans with donanemab treatment.

It may be reasonable to choose not to initiate medications immediately or at all.

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.¹⁴ 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.