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Rojas-Rozo L, Lee L, Khanassov V, Sivananthan S, Ismail Z, Gauthier S, Vedel I. Latest Canadian Consensus Conference on the Diagnosis and Treatment of Dementia: What's in It for Primary Care? Can J Aging 2024; 43:185-196. [PMID: 37855225 DOI: 10.1017/s0714980823000521] [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: 10/20/2023] Open
Abstract
In 2020, the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) published up-to-date recommendations for the clinical management of persons living with dementia (PLWD) and their caregivers. During the CCCDTD5 meetings, a list of recommendations for dementia care was compiled. With the aid of family physicians and the Canadian Consortium on Neurodegeneration in Aging, we selected the most relevant CCCDTD5 recommendations for primary care and tailored and summarized them in the present manuscript to facilitate their reference and use. These recommendations focus on (a) risk reduction, (b) screening and diagnosis, (c) deprescription of dementia medications, and (d) non-pharmacological interventions. The development of recommendations for the ongoing management of dementia is an iterative process as new evidence on interventions for dementia is published. These recommendations are important in the primary care setting as the entry point for PLWD into the health system.
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Affiliation(s)
- Laura Rojas-Rozo
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Serge Gauthier
- Departments of Neurology and Neurosurgery, and Psychiatry, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
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Browne K, England A, Young R, Moore N, Kjelle E, Owen A, McEntee MF. Radiographers' perceptions of the experiences of patients with dementia attending the radiology department. J Med Imaging Radiat Sci 2024; 55:189-196. [PMID: 38350753 DOI: 10.1016/j.jmir.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Patients with dementia frequently present to the Radiology Department. However, stigmas have been recorded amongst radiographers surrounding imaging persons with dementia (PwD). This study aimed to investigate the impact of PwD attending the Radiology Department for imaging and the resultant effects to all patients, radiographers, and the Department from the perspectives of the examining radiographer. METHODS A paper-based questionnaire of radiographers' perceptions and experiences of individual examinations 'termed an interaction form' was created and made available in a public hospital in Ireland for a period of eight weeks. Radiographers completed the interaction form collecting data regarding individual imaging examinations of PwD. The form comprised sixteen closed and one open-ended question on the radiographers' individual perspectives of PwDs' abilities and distress levels, carers and comforters and their role in the examination, what the radiographer found helpful in the interaction, and any adverse events. Data were analysed using a combination of descriptive analysis and thematic content analysis. RESULTS Thirty-three interaction forms were completed by the participating radiographers. The modality most commonly represented in the survey was general X-ray (58%). Radiographers reported 84% of examinations for PwD required extra time, with 27% of examinations required repeat imaging and 69% of patients appeared distressed. A carer helped facilitate the completion of 77% of examinations. Qualitative data indicated that distractive and communicative techniques were used by radiographers to make the patient feel more comfortable and help with examination success. CONCLUSION PwD often require more time for radiological examinations, they often need repeat imaging and re-scheduling of an examination at a more appropriate time. These factors need to be considered when scheduling and performing radiological examinations. Patient distress was frequently encountered, this area may benefit from further research and dedicated practitioner training which could help drive improvements in patient experience.
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Affiliation(s)
- Katie Browne
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland.
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Elin Kjelle
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
| | - Andrew Owen
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
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Alsalem ZA, Alghathber NM, Alowain FS, Alqahtani MS, Alharbi NG. Dementia Knowledge Among Primary Healthcare Physicians in Riyadh, Saudi Arabia. Cureus 2024; 16:e61112. [PMID: 38800780 PMCID: PMC11128245 DOI: 10.7759/cureus.61112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Dementia poses a significant healthcare challenge globally, and healthcare providers must have adequate knowledge about its diagnosis, management, and support services. By assessing the knowledge level of primary care physicians in Riyadh, we can identify potential gaps and areas for improvement in dementia care, ultimately enhancing patient outcomes and quality of life. This study holds promise in shedding light on the current state of dementia knowledge among primary healthcare physicians in Riyadh and offering insights into strategies to enhance dementia care in this region. METHODS This cross-sectional questionnaire-based study was conducted from the first of June 2023 to the end of December 2023 in Riyadh, Saudi Arabia. A validated questionnaire was used to assess physicians' knowledge, attitude, and practice toward dementia. RESULTS A total of 151 physicians completed the questionnaires. The majority were male (55%), below 30 years of age (88.1%), and family medicine residents (84.8%). Most (74.8%) recognized old age as the most significant risk factor; an overwhelming majority of participants (98.7%) could not identify the minimum course of treatment to judge a medication's effectiveness. The average score of correct responses (7.74 ∓ 4.11) was equivalent to 38.7%. Furthermore, the average correct responses were significantly different among the different job levels of the participants. CONCLUSIONS The findings of this study highlight a lack of knowledge among primary care physicians regarding dementia, emphasizing the crucial importance of physician education in this area. Additionally, the results strongly indicate the need for emphasis on dementia education within the undergraduate medical curriculum, family medicine curriculum, and physician training programs. By addressing these educational gaps, we can better equip physicians to provide optimal care and support for individuals with dementia, ultimately improving patient care and quality of life.
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Bacsu JDR, Spiteri RJ, Nanson K, Rahemi Z, Webster C, Norman M, Stone C. Understanding stigma of dementia during COVID-19: a scoping review. Front Psychiatry 2024; 15:1261113. [PMID: 38600982 PMCID: PMC11004454 DOI: 10.3389/fpsyt.2024.1261113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Stigma of dementia is one of the greatest challenges for people living with dementia. However, there is little research on the different types of stigma of dementia in the COVID-19 pandemic. The purpose of this scoping review is to synthesize the existing literature on dementia-related stigma (self, public, and structural stigma), during the pandemic. Methods Guided by Arksey and O'Malley's scoping review framework and PRISMA guidelines, CINAHL, EMBASE, Google Scholar, Medline, PsycINFO, and Web of Science were searched for English language literature from January 2020 to June 2023. Inclusion criteria consisted of peer-reviewed, original research articles addressing stigma of dementia during the COVID-19 pandemic. Thematic analysis was used to analyze the data and steps were taken to ensure rigor. Results Fifteen articles met our inclusion criteria. Four primary themes were identified including: 1) COVID-19 stereotypes and assumptions of dementia; 2) human rights issues and deprived dignity; 3) disparate access to health services and supports; and 4) cultural inequities and distrust. Discussion The COVID-19 pandemic has contributed to the stigmatization of people living with dementia. Further research is needed to develop, implement, and evaluate interventions targeted towards the different types of dementia-related stigma (including self, public, and structural stigma). Moreover, our findings highlight the need for more collaborative research that prioritizes the lived experience and input of diverse people living with dementia. Research partnerships with diverse people living with dementia are vital to improving future pandemic planning. Only through evidence-informed research and lived experience can we begin to fully address the different types of dementia-related stigma and enhance the quality of life of people living with dementia.
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Affiliation(s)
| | - Raymond J. Spiteri
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kate Nanson
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Zahra Rahemi
- School of Nursing, Clemson University, Clemson, SC, United States
| | | | - Myrna Norman
- Engagement of People with Lived Experience of Dementia (EPLED), Maple Ridge, BC, Canada
| | - Chantelle Stone
- Department of Psychology, Thompson Rivers University, Kamloops, BC, Canada
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Warren A. The relationship between perceived stigma and perceived stress in cognitive decline: a survey of persons with mild cognitive impairment and their caregivers. Front Psychol 2023; 14:1293284. [PMID: 38144994 PMCID: PMC10740212 DOI: 10.3389/fpsyg.2023.1293284] [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: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction While Alzheimer's disease and other causes of dementia have rapidly become a global health crisis with growing incidence that is unabated, the incidence of Mild Cognitive Impairment (MCI) far exceeds that of Alzheimer's disease. Persons with MCI demonstrate some level of cognitive impairment, but daily functions remain intact and there is no certainty that they will develop dementia. Yet, the possibility conjures a considerable amount of fear and anxiety, further fueled by a vast array of misconceptions and stigma. The pervasive nature of this stigma permeates society and culture at many levels. Persons with MCI who are at higher risk for development of dementia may be especially vulnerable to fear and stigma associated with the diagnosis. Based on this premise, the primary aim of this study was to examine the relationship between perceived stigma and perceived stress in persons with MCI and their care partners, including the relationship between income and the study variables. The secondary aim was to examine the effect of a combined cognitive rehabilitation and wellness program on these perceptions. Methods Thirty participants were recruited from Mayo Clinic's Health Action to Benefit Independence and Thinking (HABIT) program. MCI (n = 15) and care partner (n = 15) participants completed the Stigma Impact Scale (SIS) and the Perceived Stress Scale (PSS) before and after the HABIT program. Results Average SIS and PSS scores decreased in the MCI, care partner, and combined groups, both pre- and post-HABIT. Linear regression was used to assess the relationship between perceived stigma and stress, controlling for income. A significant relationship was found between perceived stigma and perceived stress both pre and post-HABIT. Discussion The results suggest a relationship exists between perceived stigma and perceived stress in persons with MCI and their care partners, and an educational program such as HABIT may strengthen this relationship by informing participants of potential challenges that occur in cognitive decline. Understanding these relationships may provide an opportunity to provide tools for this vulnerable population.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Farhana N, Peckham A, Marani H, Roerig M, Marchildon G. The Social Construction of Dementia: Implications for Healthcare Experiences of Caregivers and People Living with Dementia. J Patient Exp 2023; 10:23743735231211066. [PMID: 38026064 PMCID: PMC10663651 DOI: 10.1177/23743735231211066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Globally, systems have invested in a variety of dementia care programs in response to the aging population and those who have been diagnosed with dementia. This study is a qualitative secondary analysis of interview data from a larger study investigating stakeholder perceptions of programs that support caregivers and people living with an Alzheimer's Disease or Alzheimer's Disease-related dementia (AD/ADRD) in five North American jurisdictions. This study analyzed interviews with individuals living with an AD/ADRD and caregivers of individuals living with an AD/ADRD (n = 11). Thematic analysis was conducted to understand how the perception of dementia may have shaped their engagement and experience with healthcare systems. Our analysis resulted in three main themes of care users' experience: (i) undesirable experience owing to the overarching negative shared understanding and stereotyping of dementia; (ii) dismissal throughout disease progression when seeking health and social care support; and (iii) dehumanization during care interactions. The findings carry critical social and clinical implications, for example, in informing person-centered approaches to care, and communication tools clinicians can use to enhance provider, patient, and caregiver well-being.
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Affiliation(s)
- Nusrat Farhana
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
| | - Allie Peckham
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA
| | - Husayn Marani
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Monika Roerig
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Greg Marchildon
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Bacsu JDR, Rahemi Z, Nanson K, Webster C, Norman M, Spiteri RJ. Stigma of dementia during the COVID-19 pandemic: a scoping review protocol. BMJ Open 2023; 13:e076300. [PMID: 37643852 PMCID: PMC10465918 DOI: 10.1136/bmjopen-2023-076300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Dementia-related stigma reduces the quality of life of people living with dementia and their care partners. However, there is a dearth of literature synthesising knowledge on stigma of dementia during the COVID-19 pandemic. This scoping review protocol outlines a methodology that will be used to understand the impact of stigma on people living with dementia during the pandemic. Addressing dementia-related stigma is critical to promoting timely dementia diagnoses and enhancing the quality of life for people living with dementia and their care partners. METHODS AND ANALYSIS This review will follow the Arksey and O'Malley methodological framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The review will focus on English-language, peer-reviewed literature published between 13 January 2020 and 30 June 2023. Stigma will be broadly defined according to pre-established components (stereotypes, prejudice and discrimination). We will search six databases including CINAHL, EMBASE, Google Scholar, Medline, PsycINFO and Web of Science. We will also hand-search the reference lists of relevant articles to identify additional manuscripts. Two reviewers will develop the data extraction table, as well as independently conduct the data screening. Any disagreements will be resolved through open discussion between the two researchers, and if necessary, by consulting the full team to achieve consensus. Data synthesis will be conducted using an inductive thematic analysis approach. ETHICS AND DISSEMINATION This review will be the first to explore the impact of dementia-related stigma during the COVID-19 pandemic. An advisory panel including a person living with dementia and a care partner will be consulted to inform our review's findings and support the data dissemination process. The results of this scoping review will be shared and disseminated through publication in a peer-reviewed journal, presentations at academic conferences, a community workshop and webinars with various stakeholders.
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Affiliation(s)
| | - Zahra Rahemi
- School of Nursing, Clemson University, Clemson, South Carolina, USA
| | - Kate Nanson
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | | | - Myrna Norman
- Engagement of People with Lived Experience of Dementia (EPLED), Maple Ridge, British Columbia, Canada
| | - Raymond J Spiteri
- Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kokorelias KM, Leung G, Jamshed N, Grosse A, Sinha SK. Identifying the areas of low self-reported confidence of internal medicine residents in geriatrics: a descriptive study of findings from a structured geriatrics skills assessment survey. BMC MEDICAL EDUCATION 2022; 22:870. [PMID: 36522619 PMCID: PMC9756669 DOI: 10.1186/s12909-022-03934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Currently, no standardized methods exist to assess the geriatric skills and training needs of internal medicine trainees to enable them to become confident in caring for older patients. This study aimed to describe the self-reported confidence and training requirements in core geriatric skills amongst internal medicine residents in Toronto, Ontario using a standardized assessment tool. METHODS This study used a novel self-rating instrument, known as the Geriatric Skills Assessment Tool (GSAT), among incoming and current internal medicine residents at the University of Toronto, to describe self-reported confidence in performing, teaching and interest in further training with regard to 15 core geriatric skills previously identified by the American Board of Internal Medicine. RESULTS 190 (75.1%) out of 253 eligible incoming (Year 0) and current internal medicine residents (Years 1-3) completed the GSAT. Year 1-3 internal medicine residents who had completed a geriatric rotation reported being significantly more confident in performing 13/15 (P < 0.001 to P = 0.04) and in teaching 9/15 GSAT skills (P < 0.001 to P = 0.04). Overall, the residents surveyed identified their highest confidence in administering the Mini-Mental Status Examination and lowest confidence in assessing fall risk using a gait and balance tool, and in evaluating and managing chronic pain. CONCLUSION A structured needs assessment like the GSAT can be valuable in identifying the geriatric training needs of internal medicine trainees based on their reported levels of self-confidence. Residents in internal medicine could further benefit from completing a mandatory geriatric rotation early in their training, since this may improve their overall confidence in providing care for the mostly older patients they will work with during their residency and beyond.
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Affiliation(s)
- Kristina Marie Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada
| | - Grace Leung
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada
| | - Namirah Jamshed
- Division of Geriatric Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anna Grosse
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada.
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA.
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Gale SA, Heidebrink J, Grill J, Graff-Radford J, Jicha GA, Menard W, Nowrangi M, Sami S, Sirivong S, Walter S, Karlawish J. Preclinical Alzheimer Disease and the Electronic Health Record: Balancing Confidentiality and Care. Neurology 2022; 99:987-994. [PMID: 36180237 PMCID: PMC9728033 DOI: 10.1212/wnl.0000000000201347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/19/2022] [Indexed: 01/07/2023] Open
Abstract
Because information technologies are increasingly used to improve clinical research and care, personal health information (PHI) has wider dissemination than ever before. The 21st Century Cures Act in the United States now requires patient access to many components of the electronic health record (EHR). Although these changes promise to enhance communication and information sharing, they also bring higher risks of unwanted disclosure, both within and outside of health systems. Having preclinical Alzheimer disease (AD), where biological markers of AD are identified before the onset of any symptoms, is sensitive PHI. Because of the melding of ideas between preclinical and "clinical" (symptomatic) AD, unwanted disclosure of preclinical AD status can lead to personal harms of stigma, discrimination, and changes to insurability. At present, preclinical AD is identified mainly in research settings, although the consensus criteria for a clinical diagnosis may soon be established. There is not yet adequate legal protection for the growing number of individuals with preclinical AD. Some PHI generated in preclinical AD trials has clinical significance, necessitating urgent evaluations and longitudinal monitoring in care settings. AD researchers are obligated to both respect the confidentiality of participants' sensitive PHI and facilitate providers' access to necessary information, often requiring disclosure of preclinical AD status. The AD research community must continue to develop ethical, participant-centered practices related to confidentiality and disclosure, with attention to sensitive information in the EHR. These practices will be essential for translation into the clinic and across health systems and society at large.
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Affiliation(s)
- Seth A Gale
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center.
| | - Judith Heidebrink
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - Joshua Grill
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - Jonathan Graff-Radford
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - Gregory A Jicha
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - William Menard
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - Milap Nowrangi
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - Susie Sami
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - Shirley Sirivong
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - Sarah Walter
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
| | - Jason Karlawish
- From the Department of Neurology (S.A.G.), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (J.H.), the University of Michigan, Ann Arbor, MI; Institute for Memory Impairments and Neurological Disorders (J.G., Shirley Sirivong), University of California Irvine; Department of Neurology (J.G.-R.), Mayo Clinic, Rochester, MN; Department of Neurology (G.A.J.), Sanders-Brown Center on Aging, University of Kentucky, Lexington; Memory and Aging Program (W.M.), Butler Hospital; Division of Geriatric Psychiatry and Neuropsychiatry (M.N.), Department of Psychiatry, Johns Hopkins University School of Medicine; Brain Health and Memory Center (Susie Sami), University Hospitals, Cleveland Medical Center; Alzheimer's Therapeutic Research Institute (S.W.), University of Southern California; and University of Pennsylvania (J.K.), Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center
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10
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Saposnik G, Ismail Z, Rivard AM, Knifton D, Bromfield G, Terzaghi M, Montoya A, Menard MC. Decision making under uncertainty in the diagnosis and management of Alzheimer's Disease in primary care: A study protocol applying concepts from neuroeconomics. Front Med (Lausanne) 2022; 9:997277. [DOI: 10.3389/fmed.2022.997277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe current management of patients with Dementia, primarily with Alzheimer's Disease (AD) is rapidly evolving. However, limited information is available about the current gaps and decision-making in primary care.ObjectivesTo evaluate factors associated with gaps, risk preferences regarding diagnostic and therapeutic choices in the management of patients with AD by primary care physicians (PCP) from across Canada.MethodsWe propose a non-interventional, cross-sectional pilot study involving 120 primary care physicians referred from the College of Family Physicians of Canada to assess diagnostic and therapeutic decisions in the management of ten simulated AD-related case-scenarios commonly encountered in clinical practice. We initially describe the current landscape and gaps regarding diagnostic and therapeutic challenges in the management of patients with AD in primary care. Then, we provide concepts from behavioral economics and neuroeconomics applied to medical decision-making. Specifically, we include standardized tests to measure risk aversion, physicians' reactions to uncertainty, and questions related to risk preferences in different domains. Finally, we summarize the protocol to be implemented to address our goals. The primary study outcome is the proportion of participants that elect to defer initial investigations to the specialist and the associated factors. Secondary outcomes include the proportion of PCP willing to order cerebral spinal fluid studies, PET scans, or initiate treatment according to the simulated case-scenarios. The study will be conducted in English and French.ConclusionsThe study findings will contribute a better understanding of relevant factors associated with diagnostic and therapeutic decisions of PCP in the management of AD, identifying participant's preferences and evaluating the role of behavioral aspects such tolerance to uncertainty, aversion to ambiguity, and therapeutic inertia.
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11
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Bacsu JD, Cammer A, Ahmadi S, Azizi M, Grewal KS, Green S, Gowda-Sookochoff R, Berger C, Knight S, Spiteri RJ, O'Connell ME. Examining Twitter Discourse on Dementia during Alzheimer’s Awareness Month in Canada: Infodemiology Study (Preprint). JMIR Form Res 2022; 6:e40049. [DOI: 10.2196/40049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
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12
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Bacsu JD, Fraser S, Chasteen AL, Cammer A, Grewal KS, Bechard LE, Bethell J, Green S, McGilton KS, Morgan D, O'Rourke HM, Poole L, Spiteri RJ, O'Connell ME. Using Twitter to Examine Stigma Against People with Dementia During COVID-19: Infodemiology Study (Preprint). JMIR Aging 2021; 5:e35677. [PMID: 35290197 PMCID: PMC9015751 DOI: 10.2196/35677] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Juanita-Dawne Bacsu
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Alison L Chasteen
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Karl S Grewal
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lauren E Bechard
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Bethell
- Knowledge, Innovation, Talent and Everywhere (KITE) - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Shoshana Green
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Katherine S McGilton
- Knowledge, Innovation, Talent and Everywhere (KITE) - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Lisa Poole
- Dementia Advocacy Canada, Calgary, AB, Canada
| | - Raymond J Spiteri
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Megan E O'Connell
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
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13
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Jaeger BDB, Oliveira ML, Castilhos RM, Chaves MLF. Tertiary center referral delay of patients with dementia in Southern Brazil: associated factors and potential solutions. Dement Neuropsychol 2021; 15:210-215. [PMID: 34345362 PMCID: PMC8283886 DOI: 10.1590/1980-57642021dn15-020008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022] Open
Abstract
Early dementia diagnosis has many benefits and is a priority. In Brazil, most cases are diagnosed by a specialist.
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Affiliation(s)
- Brunna de Bem Jaeger
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre ‒ Porto Alegre, RS, Brazil.,Post-graduate Program in Medical Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul ‒ Porto Alegre, RS, Brazil
| | - Milena Lemos Oliveira
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul ‒ Porto Alegre, RS, Brazil
| | | | - Márcia Lorena Fagundes Chaves
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre ‒ Porto Alegre, RS, Brazil.,Post-graduate Program in Medical Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul ‒ Porto Alegre, RS, Brazil.,Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul ‒ Porto Alegre, RS, Brazil
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