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Amiri S, Keffeler JI, Crain DR, Denney JT, Buchwald D. Racial, ethnic, and rural disparities in distance to physicians among decedents with Alzheimer's disease and related dementias in Washington State. Alzheimers Dement 2024; 20:3671-3678. [PMID: 38506275 PMCID: PMC11095416 DOI: 10.1002/alz.13756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Distance to physicians may explain some of the disparities in Alzheimer's disease and related dementia (AD/ADRD) outcomes. METHODS We generated round trip distance between residences of decedents with AD/ADRD and the nearest neurologist and primary care physician in Washington State. RESULTS The overall mean distance to the nearest neurologist and primary care physician was 17 and 4 miles, respectively. Non-Hispanic American Indian and/or Alaska Native and Hispanic decedents would have had to travel 1.12 and 1.07 times farther, respectively, to reach the nearest neurologist compared to non-Hispanic White people. Decedents in micropolitan, small town, and rural areas would have had to travel 2.12 to 4.01 times farther to reach the nearest neurologist and 1.14 to 3.32 times farther to reach the nearest primary care physician than those in metropolitan areas. DISCUSSION These results underscore the critical need to identify strategies to improve access to specialists and primary care physicians to improve AD/ADRD outcomes. HIGHLIGHTS Distance to neurologists and primary care physicians among decedents with AD/ADRD American Indian and/or Alaska Native decedents lived further away from neurologists Hispanic decedents lived further away from neurologists Non-metropolitan decedents lived further away from neurologists and primary care Decrease distance to physicians to improve dementia outcomes.
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Affiliation(s)
- Solmaz Amiri
- Institute for Research and Education to Advance Community Health (IREACH)Elson S. Floyd College of Medicine, Washington State UniversitySeattleWashingtonUSA
| | | | | | - Justin T. Denney
- Department of SociologyWashington State UniversityPullmanWashingtonUSA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health (IREACH)Elson S. Floyd College of Medicine, Washington State UniversitySeattleWashingtonUSA
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Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers. JMIRX MED 2024; 5:e42211. [PMID: 38488740 PMCID: PMC11004515 DOI: 10.2196/42211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/11/2023] [Accepted: 01/13/2024] [Indexed: 03/19/2024]
Abstract
Background Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. Objective We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. Methods This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Results Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Conclusions Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.
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Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
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Amano T, Halvorsen CJ, Kim S, Reynolds A, Scher C, Jia Y. An outcome-wide analysis of the effects of diagnostic labeling of Alzheimer's disease and related dementias on social relationships. Alzheimers Dement 2024; 20:1614-1626. [PMID: 38053452 PMCID: PMC10984499 DOI: 10.1002/alz.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/01/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION This study examines how receiving a dementia diagnosis influences social relationships by race and ethnicity. METHODS Using data from the Health and Retirement Study (10 waves; 7,159 observations) of adults 70 years and older predicted to have dementia using Gianattasio-Power scores (91% accuracy), this study assessed changes in social support, engagement, and networks after a dementia diagnosis. We utilized quasi-experimental methods to estimate treatment effects and subgroup analyses by race/ethnicity. RESULTS A diagnostic label significantly increased the likelihood of gaining social support but reduced social engagement and one measure of social networks. With some exceptions, the results were similar by race and ethnicity. DISCUSSION Results suggest that among older adults with assumed dementia, being diagnosed by a doctor may influence social relationships in both support-seeking and socially withdrawn ways. This suggests that discussing services and supports at the time of diagnosis is important for healthcare professionals.
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Affiliation(s)
- Takashi Amano
- Department of Social WorkSchool of Arts and SciencesRutgers University NewarkNewarkUSA
| | | | - Seoyoun Kim
- Department of SociologyTexas State UniversitySan MarcosUSA
| | - Addam Reynolds
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesUSA
| | - Clara Scher
- School of Social WorkRutgers UniversityNew BrunswickUSA
| | - Yuane Jia
- Department of Interdisciplinary StudiesSchool of Health ProfessionsRutgers Biomedical and Health SciencesNewarkUSA
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Xu H, Bayless TM, Østbye T, Dupre ME. Care sequences leading to the diagnosis of Alzheimer's disease and related dementias: An analysis of electronic health records. Alzheimers Dement 2024; 20:2155-2164. [PMID: 38270269 PMCID: PMC10984433 DOI: 10.1002/alz.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/24/2023] [Accepted: 12/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND We examined the sequences of clinical care leading to diagnoses of Alzheimer's disease and related dementias (ADRD) using electronic health records from a large academic medical center. METHODS We included patients aged 65+ with their first ADRD diagnoses from January 1, 2014 to December 31, 2019. Using state sequence analysis, care sequences were defined by the ordering of healthcare utilizations occurred in the 2 years before ADRD diagnosis. RESULTS Of 3621 patients (median age 80), nearly half followed a care sequence of having one primary care visit close to their ADRD diagnosis. Additional care sequences included periodic (n = 322, 8.9%) and multiple (n = 416, 11.5%) outpatient visits to primary care and having one (n = 395, 10.9%), multiple (n = 469, 13.0%), or highly frequent (n = 357, 10.7%) outpatient visits to other specialties. Patients' sociodemographic traits contributed to the variability in care sequences. CONCLUSIONS Several distinct patterns of care leading to ADRD diagnoses were identified. Integrated care models are needed to promote early identification of ADRD. HIGHLIGHTS Dementia patients followed distinct care pathways prior to their dementia diagnoses. Key sociodemographic traits contributed to the variation in the sequences of care. Racial differences in the sequencing of care were also found, but only in women.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Teah M. Bayless
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
| | - Truls Østbye
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Matthew E. Dupre
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
- Department of SociologyDuke UniversityDurhamNorth CarolinaUSA
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5
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Tolchin B. Improving Communication Around the Diagnosis of Dementia. Neurol Clin Pract 2024; 14:e200237. [PMID: 38144899 PMCID: PMC10741378 DOI: 10.1212/cpj.0000000000200237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/04/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Benjamin Tolchin
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine; Yale New Haven Health Center for Clinical Ethics
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Armstrong MJ, Bedenfield N, Rosselli M, Curiel Cid RE, Kitaigorodsky M, Galvin JE, Lachner C, Grant Smith A, de Los Ángeles Ortega M, Mohiuddin Y, Shatzer J, Marasco D, Willis D, Bylund CL. Best Practices for Communicating a Diagnosis of Dementia: Results of a Multi-Stakeholder Modified Delphi Consensus Process. Neurol Clin Pract 2024; 14:e200223. [PMID: 38152063 PMCID: PMC10750429 DOI: 10.1212/cpj.0000000000200223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/04/2023] [Indexed: 12/29/2023]
Abstract
Background and Objectives Many individuals with dementia and their families report not receiving a dementia diagnosis. Previously published standards for delivering a dementia diagnosis are now more than 10 years old and were developed without patient and caregiver input. The objective of this study was to identify best practices for delivering a diagnosis of dementia using existing literature, involvement of diverse stakeholders, and consensus building through a formal modified Delphi approach. Methods We convened a multi-stakeholder working group including a patient, caregivers, Alzheimer's Association staff, and clinicians from diverse backgrounds. The panel used the American Academy of Neurology process for recommendation development, consisting of a half-day workshop and 3 rounds of anonymous modified Delphi voting to achieve consensus. Results The working group convened from May 2022 through January 2023. The group chose to focus statements on a limited number of best practices that can be applied across clinic types. Seven best practice statements achieved consensus after a maximum of 3 rounds of voting. These included the following: (1) Clinicians must show compassion and empathy when delivering a diagnosis of dementia (level A). During dementia diagnosis disclosure, clinicians should (2) ask regarding diagnosis preferences, (3) instill realistic hope, (4) provide practical strategies, (5) provide education and connections to high-quality resources, (6) connect caregivers to support resources, and (7) provide written summaries of the diagnoses, plan, and relevant resources (each level B). Discussion Clinicians need to customize discussion of a dementia diagnosis for individual patients and their caregivers. These 7 best practices provide a diagnosis communication framework that can be implemented across varied clinical settings. Additional strategies, such as using optimal general communication approaches, are also important for dementia diagnosis discussions. Thoughtful application of these best practices is particularly important when caring for individuals from underrepresented communities. Further improving communication regarding dementia diagnoses will require health system changes (e.g., for sufficient time), improved access to specialty dementia care, and clinician training for delivering difficult diagnoses. More research is needed to identify culturally sensitive approaches to discussing dementia diagnoses.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Noheli Bedenfield
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Monica Rosselli
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Rosie E Curiel Cid
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Marcela Kitaigorodsky
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - James E Galvin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Christian Lachner
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Amanda Grant Smith
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - María de Los Ángeles Ortega
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Yasmin Mohiuddin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Julie Shatzer
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Deann Marasco
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Dianna Willis
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Carma L Bylund
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
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7
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Hinojosa-Gonzalez DE, Zafar A, Saffati G, Kronstedt S, Zlatev DV, Khera M. Androgen deprivation therapy for prostate cancer and neurocognitive disorders: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00785-w. [PMID: 38167924 DOI: 10.1038/s41391-023-00785-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Prostate cancer is a prevalent disease that urgently needs to address its treatment-related complications. By examining existing evidence on the association between Androgen Deprivation Therapy (ADT) and dementia, this study contributes to the understanding of potential risks. We sought to analyze the currently available evidence regarding the risk of dementia, Alzheimer's disease (AD), vascular dementia, and Parkinson's disease (PD) in patients undergoing ADT. METHODS A systematic search of PubMed, EMBASE, Scopus, and Google Scholar was performed to identify studies published from the databases' inception to April 2023. Studies were identified through systematic review to facilitate comparisons between studies with and without some degree of controls for biases affecting distinctions between ADT receivers and non-ADT receivers. This review identified 305 studies, with 28 meeting the inclusion criteria. Heterogeneity was assessed using Higgins I2%. Variables with an I2 over 50% were considered heterogeneous and analyzed using a Random-Effects model. Otherwise, a Fixed-Effects model was employed. RESULTS A total of 28 studies were included for analysis. Out of these, only 1 study did not report the number of patients. From the remaining 27 studies, there were a total of 2,543,483 patients, including 900,994 with prostate cancer who received ADT, 1,262,905 with prostate cancer who did not receive ADT, and 334,682 patients without prostate cancer who did not receive ADT. This analysis revealed significantly increased Hazard Ratios (HR) of 1.20 [1.11, 1.29], p < 0.00001 for dementia, HR 1.26 [1.10, 1.43], p = 0.0007 for Alzheimer's Disease, HR 1.66 [1.40, 1.97], p < 0.00001 for depression, and HR 1.57 [1.31, 1.88], p < 0.00001 for Parkinson's Disease. The risk of vascular dementia was HR 1.30 [0.97, 1.73], p < 0.00001. CONCLUSION Based on the analysis of the currently available evidence, it suggests that ADT significantly increases the risk of dementia, AD, PD, and depression.
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Affiliation(s)
- David E Hinojosa-Gonzalez
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA.
| | - Affan Zafar
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA
| | - Gal Saffati
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
| | - Shane Kronstedt
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
| | - Dimitar V Zlatev
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA
| | - Mohit Khera
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
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Fazeli PL, Hopkins C, Vance DE, Wadley V, Li P, Turan B, Wang DH, Bowen PG, Clay OJ. Cognitive prescriptions for reducing dementia risk factors among Black/African Americans: feasibility, acceptability, and preliminary efficacy. ETHNICITY & HEALTH 2024; 29:1-24. [PMID: 37463839 DOI: 10.1080/13557858.2023.2231669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Black/African Americans (B/AAs) have double the risk of Alzheimer's disease and related dementia than Whites, which is largely driven by health behaviors. This study examined the feasibility, acceptability, and preliminary efficacy of a pilot randomized clinical trial of an individualized multidomain health behavior intervention among middle-aged and older B/AAs (dubbed Cognitive Prescriptions [CogRx]). DESIGN Thirty-nine community-dwelling B/AA participants aged 45-65 without significant cognitive impairment were randomized to one of three groups: CogRx, Psychoeducation, or no-contact control. The Psychoeducation and CogRx groups received material on dementia prevalence, prognosis, and risk factors, while the CogRx group additionally received information on their risk factor profile across the five CogRx domains (physical, cognitive, and social activity, diet, sleep). This information was used for developing tailored 3-month goals in their suboptimal areas. RESULTS The CogRx program had high retention (all 13 CogRx participants completed the 3-month program and 97% of the full sample completed at least 1 follow-up) and was well-received as exhibited by qualitative and quantitative feedback. Themes identified in the positive feedback provided by participants on the program included: increased knowledge, goal-setting, personalization, and motivation. The COVID-19 pandemic was a consistent theme that emerged regarding barriers of adherence to the program. All three groups improved on dementia knowledge, with the largest effects observed in CogRx and Psychoeducation groups. Increases in cognitive, physical, and overall leisure activities favored the CogRx group, whereas improvements in sleep outcomes favored Psychoeducation and CogRx groups as compared to the control group. CONCLUSION The CogRx program demonstrated feasibility, acceptability, and preliminary efficacy in increasing dementia knowledge and targeted health behaviors. Further refinement and testing of the implementation and effectiveness of similar person-centered dementia prevention approaches are needed on a larger scale in diverse populations. Such findings may have implications for clinical and public health recommendations. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03864536.
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Affiliation(s)
- Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cierra Hopkins
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Danny H Wang
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, State College, PA, USA
| | - Pamela G Bowen
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Aranda MP, Marquez DX, Gallagher-Thompson D, Pérez A, Rojas JC, Hill CV, Reyes Y, Dilworth-Anderson P, Portacolone E. A call to address structural barriers to Hispanic/Latino representation in clinical trials on Alzheimer's disease and related dementias: A micro-meso-macro perspective. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12389. [PMID: 37287471 PMCID: PMC10242183 DOI: 10.1002/trc2.12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 06/09/2023]
Abstract
Introduction This perspective paper addresses the US Hispanic/Latino (herein, Latino) experience with regards to a significant public health concern-the underrepresentation of Latino persons in Alzheimer's disease and related dementias (AD/ADRD) clinical trials. Latino individuals are at increased risk for AD/ADRD, experience higher disease burden, and low receipt of care and services. We present a novel theoretical framework-the Micro-Meso-Macro Framework for Diversifying AD/ADRD Trial Recruitment-which considers multi-level barriers and their impact on Latino trial recruitment. Methods Based on a review of the peer-reviewed literature and our lived experience with the Latino community, we drew from our interdisciplinary expertise in health equity and disparities research, Latino studies, social work, nursing, political economy, medicine, public health, and clinical AD/ADRD trials. We discuss factors likely to impede or accelerate Latino representation, and end with a call for action and recommendations for a bold path forward. Results In the 200+ clinical trials conducted with over 70,000 US Americans, Latino participants comprise a fraction of AD/ADRD trial samples. Efforts to recruit Latino participants typically address individual- and family-level factors (micro-level) such as language, cultural beliefs, knowledge of aging and memory loss, limited awareness of research, and logistical considerations. Scientific efforts to understand recruitment barriers largely remain at this level, resulting in diminished attention to upstream institutional- and policy-level barriers, where decisions around scientific policies and funding allocations are ultimately made. These structural barriers are comprised of inadequacies or misalignments in trial budgets, study protocols, workforce competencies, healthcare-related barriers, criteria for reviewing and approving clinical trial funding, criteria for disseminating findings, etiological focus and social determinants of health, among others. Conclusion Future scientific work should apply and test the Micro-Meso-Macro Framework for Diversifying AD/ADRD Trial Recruitment to examine structural recruitment barriers for historically underrepresented groups in AD/ADRD research and care.
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Affiliation(s)
- María P Aranda
- University of Southern California Alzheimer's Disease Research Center Los Angeles California USA
- USC Suzanne Dworak-Peck School of Social Work Edward R. Roybal Institute on Aging University of Southern California USC Montgomery Ross Fisher Building Los Angeles California USA
| | - David X Marquez
- Department of Kinesiology and Nutrition University of Illinois Chicago Chicago Illinois USA
- Rush Alzheimer's Disease Center Chicago Illinois USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Palo Alto California USA
| | - Adriana Pérez
- Leonard Davis Institute of Health Economics University of Pennsylvania School of Nursing Philadelphia Pennsylvania USA
| | - Julio C Rojas
- Memory and Aging Center UCSF Weill Institute for Neurosciences University of California San Francisco Memory and Aging Center San Francisco California USA
| | - Carl V Hill
- Chief of Diversity Equity and Inclusion Alzheimer's Association Chicago Illinois USA
| | - Yarissa Reyes
- Director of Diversity Equity and Inclusion Alzheimer's Association Chicago Illinois USA
| | - Peggye Dilworth-Anderson
- Health Policy and Management Gillings School of Global Public Health 1104 D McGavran Greenberg, University of North Carolina-Chapel Hill North Carolina USA
| | - Elena Portacolone
- Institute for Health and Aging University of California San Francisco Philip Lee Institute for Health Policy Studies University of California San Francisco San Francisco California USA
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10
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Perales-Puchalt J, Strube K, Townley R, Niedens M, Arreaza H, Zaudke J, Burns JM. Primary Care Provider Preferences on Dementia Training: A Qualitative Study. J Alzheimers Dis 2023; 92:1067-1075. [PMID: 36847003 PMCID: PMC10119892 DOI: 10.3233/jad-221014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Dementia has no cure, but interventions can stabilize the progression of cognitive, functional, and behavioral symptoms. Primary care providers (PCPs) are vital for the early detection, and long-term management of these diseases, given their gatekeeping role in the healthcare system. However, PCPs rarely implement evidence-based dementia care due to time limitations and knowledge about diagnosis and treatment. Training PCPs may help address these barriers. OBJECTIVE We explored the preferences of PCPs for dementia care training programs. METHODS We conducted qualitative interviews with 23 PCPs recruited nationally via snowball sampling. We conducted remote interviews and organized the transcripts for qualitative review to identify codes and themes, using thematic analysis methods. RESULTS PCP preferences varied regarding many aspects of ADRD training. Preferences varied regarding how to best increase PCP participation in training, and what content and materials were needed to help them and the families they serve. We also found differences regarding the duration and timing of training, and the modality of training sessions (remote versus in-person). CONCLUSION The recommendations arising from these interviews have the potential to inform the development and refinement of dementia training programs to optimize their implementation and success.
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Affiliation(s)
- Jaime Perales-Puchalt
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelsey Strube
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Ryan Townley
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Health System, Kansas City, KS, USA
| | - Michelle Niedens
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Health System, Kansas City, KS, USA
| | - Hector Arreaza
- Clínica Sierra Vista, Bakersfield, CA, USA
- Rio Bravo Family Medicine Residency Program, Bakersfield, CA, USA
| | | | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Health System, Kansas City, KS, USA
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11
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Zhu CW, Gu Y, Cosentino S, Kociolek AJ, Hernandez M, Stern Y. Racial/Ethnic Disparities in Misidentification of Dementia in Medicare Claims: Results from the Washington Heights-Inwood Columbia Aging Project. J Alzheimers Dis 2023; 96:359-368. [PMID: 37781805 PMCID: PMC10759149 DOI: 10.3233/jad-230584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Misidentification of dementia in Medicare claims is quite common. OBJECTIVE We examined potential race/ethnic disparities in misidentification of dementia in Medicare claims in a diverse cohort of older adults who underwent careful clinical assessment. METHODS Participants were enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, population-based, prospective study of cognitive aging in which dementia status was assessed using a rigorous clinical protocol. ICD-9-CM and ICD-10-CM diagnosis codes in all available Medicare claims (1999-2019) were compared to clinical dementia diagnosis and categorized into three mutually exclusive groups: 1) congruent-, 2) over-, and 3) under- identification during the study period. Multinomial logistic regression model was used to examine the relationship between race (White, African American/Black, other) and ethnicity (Hispanic/Latinx, non-Hispanic/Latinx) and congruency of dementia identification after controlling for clinical (cognition, function, comorbidities) and demographic characteristics (age, sex, education), and inpatient and outpatient utilization. RESULTS Across all person-years, 88.4% had congruent identification of dementia compared to clinical diagnosis, in 4.1% of the times participants were over-identified with dementia, and 7.5% of the times the participants were under-identified. Rates of misidentification was higher in minority participants than in White, non-Hispanic participants. Multivariable estimation results showed that the probability of over-identification with dementia was 2.2% higher for African American/Black than White (p = 0.05) and 2.7% higher for Hispanic participants than non-Hispanics (p = 0.03) participants. Differences in under-identification by race/ethnicity were not statistically significant. CONCLUSIONS African American/Black and Hispanic participants were more likely over-identified with dementia in Medicare claims.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Anton J. Kociolek
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Michelle Hernandez
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
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12
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Zhu CW, Neugroschl J, Barnes LL, Sano M. Racial/ethnic disparities in initiation and persistent use of anti-dementia medications. Alzheimers Dement 2022; 18:2582-2592. [PMID: 35218291 PMCID: PMC9402814 DOI: 10.1002/alz.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Racial/ethnic disparities in anti-dementia medications use in longitudinally followed research participants are unclear. METHODS The study included initially untreated participants followed in National Alzheimer's Coordinating Center Uniform Data Set who were ≥65 at baseline with Alzheimer's disease dementia. OUTCOMES Outcomes for acetylcholinesterase inhibitor (AChEI) treatment included (1) any new AChEI treatment during follow-up, and (2) persistence of treatment during follow-up categorized into: intermittent treatment (< 50% follow-ups reporting treatment), persistent (≥50% follow-ups), and always treated. Outcomes for memantine treatment were similarly constructed. RESULTS Controlling for participant characteristics, Black and Hispanic participants remained less likely than White participants to report any new AChEI or memantine treatment during follow-up. Among those who reported new treatment during follow-up, both Black and Hispanic participants were less likely than White participants to be persistently treated with AChEI and memantine. DISCUSSION Substantial racial/ethnic treatment disparities remain in controlled settings of longitudinal research in which participants have access to dementia experts, suggesting wider disparities in the larger community.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Judith Neugroschl
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center and Department of Neurological Sciences, Chicago, IL.Rush University Medical Center, Chicago, IL
| | - Mary Sano
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Davis MA, Lee KA, Harris M, Ha J, Langa KM, Bynum JPW, Hoffman GJ. Time to dementia diagnosis by race: A retrospective cohort study. J Am Geriatr Soc 2022; 70:3250-3259. [PMID: 36200557 PMCID: PMC9669160 DOI: 10.1111/jgs.18078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Non-Hispanic Black individuals may be less likely to receive a diagnosis of dementia compared to non-Hispanic White individuals. These findings raise important questions regarding which factors may explain this observed association and any differences in the time to which disparities emerge following dementia onset. METHODS We conducted a retrospective cohort study using survey data from the 1995 to 2016 Health and Retirement Study linked with Medicare fee-for-service claims. Using the Hurd algorithm (a regression-based approach), we identified dementia onset among older adult respondents (age ≥65 years) from the Telephone Interview for Cognitive Status and proxy respondents. We determined date from dementia onset to diagnosis using Medicare data up to 3 years following onset using a list of established diagnosis codes. Cox Proportional Hazards modeling was used to examine the association between an individual's reported race and likelihood of diagnosis after accounting for sociodemographic characteristics, income, education, functional status, and healthcare use. RESULTS We identified 3435 older adults who experienced a new onset of dementia. Among them, 30.1% received a diagnosis within 36 months of onset. In unadjusted analyses, the difference in cumulative proportion diagnosed by race continued to increase across time following onset, p-value <0.001. 23.8% of non-Hispanic Black versus 31.4% of non-Hispanic White participants were diagnosed within 36 months of dementia onset, Hazard Ratio = 0.73 (95% CI: 0.61, 0.88). The association persisted after adjustment for functional status and healthcare use; however, these factors had less of an impact on the strength of the association than income and level of education. CONCLUSION Lower diagnosis rates of dementia among non-Hispanic Black individuals persists after adjustment for sociodemographic characteristics, functional status, and healthcare use. Further understanding of barriers to diagnosis that may be related to social determinants of health is needed to improve dementia-related outcomes among non-Hispanic Black Americans.
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Affiliation(s)
- Matthew A. Davis
- Department of Systems, Populations, and LeadershipUniversity of Michigan School of NursingAnn ArborMichiganUSA,Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Kathryn A. Lee
- Department of Systems, Populations, and LeadershipUniversity of Michigan School of NursingAnn ArborMichiganUSA
| | - Melissa Harris
- Department of Systems, Populations, and LeadershipUniversity of Michigan School of NursingAnn ArborMichiganUSA
| | - Jinkyung Ha
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Kenneth M. Langa
- Survey Research CenterInstitute for Social Research, University of MichiganAnn ArborMichiganUSA,Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA,Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMichiganUSA
| | - Julie P. W. Bynum
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Geoffrey J. Hoffman
- Department of Systems, Populations, and LeadershipUniversity of Michigan School of NursingAnn ArborMichiganUSA
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Wilkins CH, Windon CC, Dilworth-Anderson P, Romanoff J, Gatsonis C, Hanna L, Apgar C, Gareen IF, Hill CV, Hillner BE, March A, Siegel BA, Whitmer RA, Carrillo MC, Rabinovici GD. Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia: A Secondary Analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) Cohort Study. JAMA Neurol 2022; 79:2796653. [PMID: 36190710 PMCID: PMC9531087 DOI: 10.1001/jamaneurol.2022.3157] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023]
Abstract
Importance Racial and ethnic groups with higher rates of clinical Alzheimer disease (AD) are underrepresented in studies of AD biomarkers, including amyloid positron emission tomography (PET). Objective To compare amyloid PET positivity among a diverse cohort of individuals with mild cognitive impairment (MCI) or dementia. Design, Setting, and Participants Secondary analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS), a single-arm multisite cohort study of Medicare beneficiaries who met appropriate-use criteria for amyloid PET imaging between February 2016 and September 2017 with follow-up through January 2018. Data were analyzed between April 2020 and January 2022. This study used 2 approaches: the McNemar test to compare amyloid PET positivity proportions between matched racial and ethnic groups and multivariable logistic regression to assess the odds of having a positive amyloid PET scan. IDEAS enrolled participants at 595 US dementia specialist practices. A total of 21 949 were enrolled and 4842 (22%) were excluded from the present analysis due to protocol violations, not receiving an amyloid PET scan, not having a positive or negative scan, or because of small numbers in some subgroups. Exposures In the IDEAS study, participants underwent a single amyloid PET scan. Main Outcomes and Measures The main outcomes were amyloid PET positivity proportions and odds. Results Data from 17 107 individuals (321 Asian, 635 Black, 829 Hispanic, and 15 322 White) with MCI or dementia and amyloid PET were analyzed between April 2020 and January 2022. The median (range) age of participants was 75 (65-105) years; 8769 participants (51.3%) were female and 8338 (48.7%) were male. In the optimal 1:1 matching analysis (n = 3154), White participants had a greater proportion of positive amyloid PET scans compared with Asian participants (181 of 313; 57.8%; 95% CI, 52.3-63.2 vs 142 of 313; 45.4%; 95% CI, 39.9-50.9, respectively; P = .001) and Hispanic participants (482 of 780; 61.8%; 95% CI, 58.3-65.1 vs 425 of 780; 54.5%; 95% CI, 51.0-58.0, respectively; P = .003) but not Black participants (359 of 615; 58.4%; 95% CI, 54.4-62.2 vs 333 of 615; 54.1%; 95% CI, 50.2-58.0, respectively; P = .13). In the adjusted model, the odds of having a positive amyloid PET scan were lower for Asian participants (odds ratio [OR], 0.47; 95% CI, 0.37-0.59; P < .001), Black participants (OR, 0.71; 95% CI, 0.60-0.84; P < .001), and Hispanic participants (OR, 0.68; 95% CI, 0.59-0.79; P < .001) compared with White participants. Conclusions and Relevance Racial and ethnic differences found in amyloid PET positivity among individuals with MCI and dementia in this study may indicate differences in underlying etiology of cognitive impairment and guide future treatment and prevention approaches.
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Affiliation(s)
- Consuelo H. Wilkins
- Department of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charles C. Windon
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Peggye Dilworth-Anderson
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Reston, Virginia
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | - Bruce E. Hillner
- Department of Medicine, Virginia Commonwealth University, Richmond
| | - Andrew March
- Center for Research and Innovation, American College of Radiology, Philadelphia, Pennsylvania
| | - Barry A. Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Rachel A. Whitmer
- Division of Research, Kaiser Permanente, Oakland, California
- Department of Public Health Sciences, University of California, Davis
| | | | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Associate Editor, JAMA Neurology
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
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15
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White L, Ingraham B, Larson E, Fishman P, Park S, Coe NB. Observational study of patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment without dementia. J Gen Intern Med 2022; 37:2957-2965. [PMID: 34647229 PMCID: PMC9485306 DOI: 10.1007/s11606-021-07169-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Timely diagnosis of cognitive impairment is a key goal of the National Plan to Address Alzheimer's Disease, but studies of factors associated with a timely diagnosis are limited. OBJECTIVE To identify patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment (MCI). DESIGN Retrospective observational study using survey data from the Health and Retirement Study (HRS) from 1995-2016 (interview waves 3-13). PARTICIPANTS 4,760 respondents with incident dementia and 1,864 with incident MCI identified using longitudinal measures of cognitive functioning. MAIN MEASURES Timely or delayed diagnosis based on the timing of a self or proxy report of a healthcare provider diagnosis in relation to respondents first dementia or MCI-qualifying cognitive score, sociodemographic characteristics, health status, health care utilization, insurance provider, and year of first qualifying score. KEY RESULTS Only 26.0% of the 4,760 respondents with incident dementia and 11.4% of the 1,864 respondents with incident MCI received a timely diagnosis. Non-Hispanic Black respondents and respondents with less than a college degree were significantly less likely to receive a timely diagnosis of either dementia or MCI than Non-Hispanic White respondents (dementia odds ratio (OR): 0.61, 95% CI: 0.50, 0.75; MCI OR: 0.40, 95% CI: 0.23, 0.70) and those with a college degree (dementia OR for less than high school degree: 0.30, 95% CI: 0.23, 0.38; MCI OR: 0.36, 95% CI: 0.22, 0.60). Respondents that lived alone were also less likely to receive a timely diagnosis of dementia (OR: 0.69, 95% CI: 0.59, 0.81), though not MCI. Timely diagnosis of both conditions increased over time. CONCLUSIONS Targeting resources for timely diagnosis of cognitive impairment to individuals from racial and ethnic minorities, lower educational attainment, and living alone may improve detection and reduce disparities around timely diagnosis of dementia and MCI.
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Affiliation(s)
- Lindsay White
- Center for Health Care Quality and Outcomes, RTI International, Seattle, WA, USA
| | - Bailey Ingraham
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Eric Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Paul Fishman
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Sungchul Park
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Norma B Coe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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16
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Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez A, Ramirez-Mantilla M, Greiner KA, Burns JM. Impact of the COVID-19 pandemic on Latino families with Alzheimer's disease and related dementias: Perceptions of family caregivers and primary care providers. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.05.25.22275517. [PMID: 35665004 PMCID: PMC9164453 DOI: 10.1101/2022.05.25.22275517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Latinos experience disproportionately poor outcomes in dementia and COVID-19, which may synergistically impact their health. We explored the impact of the COVID-19 pandemic among Latino families with dementia via a qualitative descriptive study of 21 informal caregivers of Latinos with dementia and 24 primary care providers. Two themes arose: The impact of a global pandemic (e.g., accelerated cognitive and physical decline, or caregivers choosing between risking finances and the family's infection given the work situation) and Developing resilience to the effects of the pandemic (e.g., caregivers seeking vaccination sites, moving in with the care recipient and adopting telehealth).
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Affiliation(s)
| | - Jill Peltzer
- University of Kansas Medical Center, Kansas City, KS
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17
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McGrath R, Robinson-Lane SG, Klawitter L, Rhee Y, Hamm JM, McCourt ME, Parker K, Hackney KJ. Undiagnosed Dementia Is Associated with Poor Physical Function in Older Adults. J Alzheimers Dis 2022; 89:473-482. [PMID: 35912741 PMCID: PMC10171085 DOI: 10.3233/jad-220257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Older adults with a cognitive impairment, including those not yet diagnosed, may have deficits in their physical function. OBJECTIVE We sought to determine the associations of cognitive impairment consistent with dementia (CICD) diagnosis status on handgrip strength, gait speed, and functional disability in older adults. METHODS The analytical sample included 8,383 adults aged ≥65-years without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured handgrip strength. Men with handgrip strength <26 kg and women <16 kg were weak. Gait speed was timed across a 2.5-m course and those with slowness had gait speed <0.8 m/s. Participants with difficulty or an inability in completing any basic activities of daily living had a functional disability. The adapted Telephone Interview of Cognitive Status evaluated cognitive function. Persons with scores <7 had a CICD. Healthcare provider dementia-related diagnosis was self-reported. Undiagnosed CICD was defined as no reported dementia-related diagnosis but had CICD, while diagnosed CICD was classified as reporting a dementia-related diagnosis. Covariate-adjusted logistic models were used for the analyses. RESULTS Persons with undiagnosed CICD had 1.37 (95% confidence interval (CI): 1.04-1.80) greater odds for weakness and 2.02 (CI: 1.39-2.94) greater odds for slow gait speed. Older adults with diagnosed CICD had 2.29 (CI: 1.32-3.97) greater odds for slowness and 1.85 (CI: 1.19-2.90) greater odds for functional disability. CONCLUSION Screening for CICD could be recommended when defects in physical function are observed in older adults.
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Affiliation(s)
- Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA.,Fargo VA Healthcare System, Fargo, ND, USA
| | | | - Lukus Klawitter
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Yeong Rhee
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Jeremy M Hamm
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - Mark E McCourt
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - Kelly Parker
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Kyle J Hackney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
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18
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de Levante Raphael D. The Knowledge and Attitudes of Primary Care and the Barriers to Early Detection and Diagnosis of Alzheimer’s Disease. Medicina (B Aires) 2022; 58:medicina58070906. [PMID: 35888625 PMCID: PMC9320284 DOI: 10.3390/medicina58070906] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022] Open
Abstract
Primary care physicians play a vital role in the clinical care of their patients, early identification of dementia, and disease advocacy. It is essential to assess the knowledge and attitudes of physicians in the diagnosis of Alzheimer’s disease and other dementias. In primary care, the diagnosis of Alzheimer’s disease is often missed or delayed. With the increased prevalence of Alzheimer’s disease and the growing impact of dementia on health care resources, early detection by primary care physicians (PCP) is essential. Thus, their knowledge and attitudes about early detection and diagnosis are crucial. To examine the knowledge and attitudes of primary care physicians regarding early detection and diagnosis of Alzheimer’s disease and how barriers may contribute to missed and delayed detection and diagnosis. An interpretive scope review was used to synthesize and analyze a body of literature published over the past decade. The study population are physicians in the United States. The current health systems experience challenges in providing early, safe, accurate, and comprehensive Alzheimer’s diagnosis and care by a primary care physician trained or knowledgeable in diagnosing the various forms of dementia. This article identifies several interrelated obstacles to early detection and diagnosis in primary dementia care, including gaps in knowledge, attitudes, skills, and resources for person with dementia (PWD)/caregivers and their primary care providers and systematic and structural barriers that negatively impact dementia care. Research shows that Alzheimer’s disease has gone underdiagnosed and undertreated. Delays in detection, diagnosis, and resource utilization may have social and clinical implications for individuals affected by Alzheimer’s disease and their families, including challenges in obtaining an accurate diagnosis. Until the issues of missed and delayed Alzheimer’s screening become more compelling, efforts to promote early detection and diagnosis should focus on the education of physicians and removing the barriers to diagnosis.
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Affiliation(s)
- Donna de Levante Raphael
- National Memory Screening Department, The Alzheimer's Foundation of America, New York, NY 10001, USA
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19
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Shen J, Chen H, Zhou T, Zhang S, Huang L, Lv X, Ma Y, Zheng Y, Yuan C. Long-term Weight Change and its Temporal Relation to Later-life Dementia in the Health and Retirement Study. J Clin Endocrinol Metab 2022; 107:e2710-e2716. [PMID: 35420682 PMCID: PMC9202702 DOI: 10.1210/clinem/dgac229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Weight loss among middle-aged and older adults has been associated with a higher risk of subsequent dementia. However, most studies have limited follow-up durations or suboptimal control for the potential influence of physical frailty (PF). OBJECTIVE Our study aimed to investigate the long-term and temporal relations of weight change to risk of dementia among middle-aged and older adults in the United States. METHODS A total of 5985 participants aged 65 years and older were included from the Health and Retirement Study. History of long-term weight change was calculated using 9 repeated body mass index measurements during 1992-2008. We then followed participants' dementia status from 2008 to 2018. Multivariable Cox proportional hazard models were used. RESULTS During the study follow-up period (mean = 7.54 years), a total of 682 (11.40%) dementia cases were documented. After adjustment for basic demographic and lifestyle factors, participants with weight loss (median: -0.23 kg/m2 per year) were at a significantly higher risk of dementia (HR = 1.60; 95% CI, 1.33, 1.92), compared with the stable weight group (median: 0.11 kg/m2 per year). This association was attenuated but remained strong and significant after further adjustment for PF (HR = 1.57; 95% CI, 1.30, 1.89). Significant association was observed for weight loss assessed approximately 14 to 18 years preceding dementia diagnosis (HR = 1.30; 95% CI, 1.07, 1.58), and was consistent closer to diagnosis. CONCLUSION Both recent and remote weight loss were associated with a higher risk of later-life dementia among middle-aged and older adults independent of PF status.
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Affiliation(s)
| | | | - Tianjing Zhou
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Simei Zhang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Liyan Huang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaozhen Lv
- Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Yuan Ma
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Yan Zheng
- Yan Zheng, MD, PhD, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai, 200043, China.
| | - Changzheng Yuan
- Correspondence: Changzheng Yuan, ScD, School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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20
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Clinician approaches to communicating a dementia diagnosis: An interview study. PLoS One 2022; 17:e0267161. [PMID: 35421205 PMCID: PMC9009687 DOI: 10.1371/journal.pone.0267161] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background Individuals with cognitive impairment and their families place a high value on receiving a dementia diagnosis, but clinician approaches vary. There is a need for research investigating experiences of giving and receiving dementia diagnoses. The current study aimed to investigate clinician approaches to giving dementia diagnoses as part of a larger study investigating patient, caregiver, and clinician experiences during the diagnosis encounter. Method Investigators conducted telephone interviews with Florida-based clinicians who give dementia diagnoses either rarely or commonly. Interviews employed a semi-structured interview guide querying communication practices used by clinicians when giving dementia diagnoses and how clinicians learned to give dementia diagnoses. Investigators used a descriptive qualitative design to conduct a thematic analysis of data. Results Fifteen Florida-based clinicians participated, representing diverse backgrounds related to gender, race/ethnicity, specialty, and practice setting. Participants reported using patient- and family-centered communication practices including checking patient understanding, communicating empathically, and involving family members. Some clinicians explicitly asked patients and/or family members about their preferences regarding diagnosis disclosure; many clinicians tailored their disclosure based on patient and family characteristics or reactions. Some clinicians reported using specific diagnoses, while others used general terms such as “memory disorder.” Clinicians reported positively framing information, including instilling hope, focusing on healthy behaviors, and discussing symptom management. Finally, clinicians provided patient/family education and arranged follow up. Clinicians reported learning approaches to dementia diagnosis disclosure through formal training and self-education. Conclusions Diverse Florida-based clinicians described dementia disclosure practices largely consistent with published guidance, but clinicians varied on approaches relating to soliciting patient disclosure preferences and terminology used. Clinicians caring for diverse populations described that cultural background affects the disclosure process, but more research is needed regarding this finding and best practices for individuals from different backgrounds.
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21
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Shafir A, Ritchie CS, Garrett SB, Bernstein Sideman A, Naasan G, Merrilees J, Widera E, Flint L, Harrison KL. "Captive by the Uncertainty"-Experiences with Anticipatory Guidance for People Living with Dementia and Their Caregivers at a Specialty Dementia Clinic. J Alzheimers Dis 2022; 86:787-800. [PMID: 35124641 DOI: 10.3233/jad-215203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND After a diagnosis of Alzheimer's disease and related disorders, people living with dementia (PWD) and caregivers wonder what disease trajectory to expect and how to plan for functional and cognitive decline. This qualitative study aimed to identify patient and caregiver experiences receiving anticipatory guidance about dementia from a specialty dementia clinic. OBJECTIVE To examine PWD and caregiver perspectives on receiving anticipatory guidance from a specialty dementia clinic. METHODS We conducted semi-structured interviews with PWD, and active and bereaved family caregivers, recruited from a specialty dementia clinic. Interviews were recorded, transcribed, and systematically summarized. Thematic analysis identified anticipatory guidance received from clinical or non-clinical sources and areas where respondents wanted additional guidance. RESULTS Of 40 participants, 9 were PWD, 16 were active caregivers, and 15 were bereaved caregivers. PWD had a mean age of 75 and were primarily male (n = 6/9); caregivers had a mean age of 67 and were primarily female (n = 21/31). Participants felt they received incomplete or "hesitant" guidance on prognosis and expected disease course via their clinicians and filled the gap with information they found via the internet, books, and support groups. They appreciated guidance on behavioral, safety, and communication issues from clinicians, but found more timely and advance guidance from other non-clinical sources. Guidance on legal and financial planning was primarily identified through non-clinical sources. CONCLUSION PWD and caregivers want more information about expected disease course, prognosis, and help planning after diagnosis. Clinicians have an opportunity to improve anticipatory guidance communication and subsequent care provision.
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Affiliation(s)
- Adi Shafir
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA.,Division of General Internal Medicine and Geriatrics, Oregon Health and Sciences University, Portland, OR, USA
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Palliative Care and Geriatric Medicine and the Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah B Garrett
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,UCSF Department of Humanities & Social Sciences, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Georges Naasan
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai, Icahn School of Medicine, New York, NY, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Merrilees
- UCSF Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Lynn Flint
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
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22
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Parker K, Vincent B, Rhee Y, Choi BJ, Robinson-Lane SG, Hamm JM, Klawitter L, Jurivich DA, McGrath R. The estimated prevalence of no reported dementia-related diagnosis in older Americans living with possible dementia by healthcare utilization. Aging Clin Exp Res 2022; 34:359-365. [PMID: 34524654 PMCID: PMC8925882 DOI: 10.1007/s40520-021-01980-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis. AIMS This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization. METHODS The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years. RESULTS The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%-93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1-90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1-91.4%). DISCUSSION Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless. CONCLUSIONS We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.
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Affiliation(s)
- Kelly Parker
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA
| | - Brenda Vincent
- Department of Statistics, North Dakota State University, Fargo, ND, USA
| | - Yeong Rhee
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA,Department of Statistics, North Dakota State University, Fargo, ND, USA,Department of Public Health, North Dakota State University, Fargo, ND, USA
| | - Bong-Jin Choi
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA,Department of Statistics, North Dakota State University, Fargo, ND, USA,Department of Public Health, North Dakota State University, Fargo, ND, USA
| | | | - Jeremy M. Hamm
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - Lukus Klawitter
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA
| | - Donald A. Jurivich
- Department of Geriatrics, University of North Dakota, Grand Forks, ND, USA
| | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND, 58108, USA. .,Fargo VA Healthcare System, Fargo, ND, USA.
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23
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Perales-Puchalt J, Townley R, Niedens M, Vidoni ED, Greiner KA, Zufer T, Schwasinger-Schmidt T, McGee JL, Arreaza H, Burns JM. Acceptability and Preliminary Effectiveness of a Remote Dementia Educational Training Among Primary Care Providers and Health Navigators. J Alzheimers Dis 2022; 89:1375-1384. [PMID: 36031891 PMCID: PMC9703617 DOI: 10.3233/jad-220235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimal care can improve lives of families with dementia but remains under-implemented. Most healthcare professional training is in person, time-intensive, and does not focus on key aspects such as early detection, and cultural competency. OBJECTIVE We explored the acceptability and preliminary effectiveness of a training, The Dementia Update Course, which addressed these issues. We hypothesized that the training would lead to increased levels of perceived dementia care competency among key healthcare workers, namely primary care providers (PCPs) and health navigators (HNs). METHODS We conducted pre-post training assessments among 22 PCPs and 32 HNs. The 6.5-h training was remote, and included didactic lectures, case discussion techniques, and materials on dementia detection and care. Outcomes included two 5-point Likert scales on acceptability, eleven on perceived dementia care competency, and the three subscales of the General Practitioners Confidence and Attitude Scale for Dementia. We used paired samples t-tests to assess the mean differences in all preliminary effectiveness outcomes. RESULTS The training included 28.6% of PCPs and 15.6% of HNs that self-identified as non-White or Latino and 45.5% of PCPs and 21.9% of HNs who served in rural areas. PCPs (84.2%) and HNs (91.7%) reported a high likelihood to recommend the training and high satisfaction. Most preliminary effectiveness outcomes analyzed among PCPs (11/14) and all among HNs (8/8) experienced an improvement from pre- to post-training (p < 0.05). CONCLUSION A relatively brief, remote, and inclusive dementia training was associated with high levels of acceptability and improvements in perceived dementia care competency among PCPs and HNs.
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Affiliation(s)
- Jaime Perales-Puchalt
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Ryan Townley
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
| | - Michelle Niedens
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
| | - Eric D Vidoni
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - K Allen Greiner
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
| | - Tahira Zufer
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
| | | | | | - Hector Arreaza
- Clínica Sierra Vista, Bakersfield, CA, USA
- Rio Bravo Family Medicine Residency Program, Bakersfield, CA, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
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24
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Huggins LKL, Min SH, Dennis CA, Østbye T, Johnson KS, Xu H. Interventions to promote dementia knowledge among racial/ethnic minority groups: A systematic review. J Am Geriatr Soc 2021; 70:609-621. [PMID: 34628641 DOI: 10.1111/jgs.17495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Certain racial/ethnic minority groups have a higher risk of developing dementia, yet studies have demonstrated that they often have limited knowledge and understanding of this disease. An increasing number of educational and advocacy programs have been developed to promote dementia knowledge. We aimed at assessing current evidence and quality regarding educational interventions for promoting dementia knowledge. METHODS We searched for intervention studies published in English that focused on educational interventions for promoting dementia knowledge among racial/ethnic minority groups. We identified 25 relevant studies through PubMed, PsycINFO, CINAHL, and Scopus, using tailored search terms. We screened titles and abstracts, reviewed full texts, synthesized relevant evidence, and evaluated the studies' quality based on the Mixed Methods Appraisal Tool. Relevant intervention studies took place in communities, hospitals or clinics, and schools, and online. RESULTS Most studies were conducted in the United States (n = 21), followed by the UK (n = 3). Over half of the studies included Asian/Pacific Islander groups (n = 14), followed by Black groups (n = 12) and Hispanic groups (n = 11). The intervention delivery mode varied across studies-from workshops hosted in a faith community to talk shows on YouTube. Target populations included middle-aged and older adults, caregivers and family members, health students and professionals, and elementary school students. Common content included symptoms and signs of dementia, protective and risk factors, and local resources. The assessment of study outcomes varied across studies. Improvement in dementia knowledge and attitudes towards dementia was reported in many studies. Among the included studies, intervention satisfaction was high. The overall quality of the interventions was low. CONCLUSION Formally evaluated educational interventions promoting dementia knowledge are at an early stage. Existing published interventions showed adequate acceptability and promise in promoting better understanding and awareness of dementia in minority groups. More well-designed randomized controlled trials are needed.
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Affiliation(s)
- Lenique K L Huggins
- Department of Biology, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Se Hee Min
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Truls Østbye
- Duke Global Health Institute, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kimberly S Johnson
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina, USA.,Durham Veterans Administration, Durham, North Carolina, USA.,Geriatrics Research Education and Clinical Center, Durham, North Carolina, USA
| | - Hanzhang Xu
- Duke Global Health Institute, Durham, North Carolina, USA.,Duke University School of Nursing, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
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25
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Lin PJ, Daly AT, Olchanski N, Cohen JT, Neumann PJ, Faul JD, Fillit HM, Freund KM. Dementia Diagnosis Disparities by Race and Ethnicity. Med Care 2021; 59:679-686. [PMID: 34091580 PMCID: PMC8263486 DOI: 10.1097/mlr.0000000000001577] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dementia is often underdiagnosed and this problem is more common among some ethnoracial groups. OBJECTIVE The objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia. RESEARCH DESIGN This was a prospective cohort study. SUBJECTS A total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims. MEASURES We performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity. RESULTS A higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91-1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20-2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites. CONCLUSIONS Non-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Allan T. Daly
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Jessica D. Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | | | - Karen M. Freund
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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McGrath R, Robinson-Lane SG, Clark BC, Suhr JA, Giordani BJ, Vincent BM. Self-Reported Dementia-Related Diagnosis Underestimates the Prevalence of Older Americans Living with Possible Dementia. J Alzheimers Dis 2021; 82:373-380. [PMID: 34024819 PMCID: PMC8943904 DOI: 10.3233/jad-201212] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dementia screening is an important step for appropriate dementia-related referrals to diagnosis and treat possible dementia. OBJECTIVE We sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally representative sample of older Americans with a cognitive impairment consistent with dementia (CICD). METHODS The weighted analytical sample included 6,036,224 Americans aged at least 65 years old that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 Health and Retirement Study. The adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores≤6 were considered as having a CICD. Healthcare provider dementia-related diagnosis was self-reported. Age, sex, educational achievement, and race and ethnicity were also self-reported. RESULTS The overall estimated prevalence of no reported dementia-related diagnosis for older Americans with a CICD was 91.4%(95%confidence interval (CI): 87.7%-94.1%). Persons with a CICD who identified as non-Hispanic black had a high prevalence of no reported dementia-related diagnosis (93.3%; CI: 89.8%-95.6%). The estimated prevalence of no reported dementia-related diagnosis was greater in males with a CICD (99.7%; CI: 99.6%-99.8%) than females (90.2%; CI: 85.6%-93.4%). Moreover, the estimated prevalence of no reported dementia-related diagnosis for non-high school graduates with a CICD was 93.5%(CI: 89.3%-96.1%), but 90.9%(CI: 84.7%-94.7%) for those with at least a high school education. CONCLUSION Dementia screening should be encouraged during routine geriatric health assessments. Continued research that evaluates the utility of self-reported dementia-related measures is also warranted.
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Affiliation(s)
- Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA,Fargo VA Healthcare System, Fargo, ND, USA
| | | | - Brian C. Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA,Department of Biomedical Sciences, Ohio University, Athens, OH, USA,Department of Geriatric Medicine, Ohio University, Athens, OH, USA
| | - Julie A. Suhr
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA,Department of Psychology, Ohio University, Athens, OH, USA
| | - Bruno J. Giordani
- Department of Psychiatry, Neurology, and Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Brenda M. Vincent
- Department of Statistics, North Dakota State University, Fargo, ND, USA
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Green AR, Boyd CM, Gleason KS, Wright L, Kraus CR, Bedoy R, Sanchez B, Norton J, Sheehan OC, Wolff JL, Reeve E, Maciejewski ML, Weffald LA, Bayliss EA. Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study. J Gen Intern Med 2020; 35:3556-3563. [PMID: 32728959 PMCID: PMC7728901 DOI: 10.1007/s11606-020-06063-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events. OBJECTIVES To elucidate patient, family, and physician perspectives on medication discontinuation and recommended language for deprescribing discussions in order to inform an intervention to increase awareness of deprescribing among individuals with dementia and MCC, family caregivers and primary care physicians. We also explored participant views on culturally competent approaches to deprescribing. DESIGN Qualitative approach based on semi-structured interviews with patients, caregivers, and physicians. PARTICIPANTS Patients aged ≥ 65 years with claims-based diagnosis of dementia, ≥ 1 additional chronic condition, and ≥ 5 chronic medications were recruited from an integrated delivery system in Colorado and an academic medical center in Maryland. We included caregivers when present or if patients were unable to participate due to severe cognitive impairment. Physicians were recruited within the same systems and through snowball sampling, targeting areas with large African American and Hispanic populations. APPROACH We used constant comparison to identify and compare themes between patients, caregivers, and physicians. KEY RESULTS We conducted interviews with 17 patients, 16 caregivers, and 16 physicians. All groups said it was important to earn trust before deprescribing, frame deprescribing as routine and positive, align deprescribing with goals of dementia care, and respect caregivers' expertise. As in other areas of medicine, racial, ethnic, and language concordance was important to patients and caregivers from minority cultural backgrounds. Participants favored direct-to-patient educational materials, support from pharmacists and other team members, and close follow-up during deprescribing. Patients and caregivers favored language that explained deprescribing in terms of altered physiology with aging. Physicians desired communication tips addressing specific clinical situations. CONCLUSIONS Culturally sensitive communication within a trusted patient-physician relationship supplemented by pharmacists, and language tailored to specific clinical situations may support deprescribing in primary care for patients with dementia and MCC.
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Affiliation(s)
- Ariel R Green
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Kathy S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Leslie Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Courtney R Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Ruth Bedoy
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Bianca Sanchez
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Norton
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Linda A Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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