Showing posts with label Education. Show all posts
Showing posts with label Education. Show all posts

A Community Approach to Managing Brain Health

Contributed by: Dennis Fortier, President, Medical Care Corporation

Science is important, but let’s not overlook pragmatism.

As described in this complimentary post, a pragmatic solution to the looming threat of an Alzheimer’s epidemic is more likely to bear fruit than the most progressed scientific solutions.  It is clear that a better-educated public, timelier diagnosis of medical conditions that impair memory, and robust treatment are all achievable endpoints in a successful campaign against this disease. Importantly, each of these can be achieved through pragmatic, community-based efforts to improve knowledge and raise standards of care among primary care physicians. 

Orange County Vital Aging Program - A Community Example
How such a pragmatic program could be implemented in any given community depends largely on the particular make-up of the organizations and healthcare providers in that community.  As a point of reference, the Orange County Vital Aging Program (OCVA) in southern California is already demonstrating this concept with encouraging early results.  That program provides a template for success worthy of further consideration.

The philosophy behind the OCVA is that timely discourse between an educated public and a well-trained physician community can catalyze better care and improved cognitive health on a mass scale.

The program supports a free website where local residents can gather information, view a community calendar of events and lectures, use free tools for risk identification and management, and find physicians who are trained to manage cognitive health.  Local physicians can use the site to register for ongoing CME courses about managing cognitive health, download guidelines for diagnosing and managing conditions that affect cognition, and to learn about community resources that might benefit their patients with memory disorders.

Having accomplished a foundation level of public education and physician training through public lectures and CME courses in its first year, the OCVA program is seeing three community trends:

1)    Patients who are aging normally, but who are worried about perceived declines in their cognition, are raising concerns to their physicians and then being objectively reassured about their good health without an expensive and unnecessary work-up.
2)    Patients with Alzheimer’s disease are being detected in a timely manner and can now benefit from robust intervention while their brains are still relatively healthy.
3)    Patients with other causes of cognitive impairment (depression, stroke, thyroid, sleep disorder, anxiety, etc.) are being diagnosed and treated effectively.

Conclusive evidence demonstrating that the OCVA program improves health and/or lowers costs of care will not be available until longer-term follow-up is complete.  But the early data suggest that the program has engaged the community and is changing the dynamic between patients and their physicians in the primary care channel.

Overall, the looming threat of an Alzheimer’s epidemic is a real problem that may well have painful consequences. We would all like more certainty that scientific efforts will soon thwart the disease, but we cannot yet count on that with high confidence.  In the meantime, a concerted effort to pragmatically implement the scientific advances from the past decade of research will significantly reduce its likely impact.

For more information about the Orange County Vital Aging Program, please visit the OCVA site or download this summary of Year-1 results.

Alcohol and Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Alcohol kills brains cells.  That's an undisputed fact.

So what should we make of the many studies, including a new one published last week in Age and Ageing, that shows a lower incidence of dementia among those who drink light or moderate amounts of alcohol?

First we should note that many earlier studies have suggested similar findings.  In general, cumulative scientific evidence, supporting the same conclusion, builds a compelling case.  In that regard, the findings that alcohol consumption may somehow protect against dementia, should not be lightly dismissed.  After all, part of the scientific discipline is having an open mind when faced with seemingly contradictory evidence.

On the other hand, most recognize that it has been exceedingly difficult to untangle the many confounding factors in these studies.  For example, in this latest publication, the authors found that the subjects who reported themselves to be drinkers, were also higher educated, less likely to be depressed, and less likely to live alone.  All three of those characteristics are correlated with a lower risk for dementia.

This raises the question: are drinking habits and incidence of dementia both related to the same life style choices?  It is plausible that higher educated people partake in better care throughout their lives, and arrive at the age of dementia risk with a lower probability. They might also be more likely to be in good health, have attained the economic status to support an active social life, and have more social opportunities to drink.

In other words, we cannot yet be certain that drinking alcohol leads to lower incidence of dementia.  Perhaps, other factors  cause low dementia incidence AND more social drinking.

Also keep in mind, there are no studies showing that alcohol helps your liver.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Alzheimer's Awareness Matters

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Today is World Alzheimer's Day. It is a designation aimed at raising awareness about a major threat to the health of the worldwide population and to the economies of our nations.

Last fall, during National Alzheimer's Awareness Month, I wrote an article titled: Alzheimer's Awareness: Why Bother? The article makes the case for how awareness translates into real world gains in our ability to identify, diagnose and treat this complex disease. To my surprise and delight, the article was read about 80,000 times in the 24 hours after I posted it.

I am linking back to that post today in the hope of spreading the educational message a little more broadly on this important day.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Alzheimer's Awareness: Why Bother?

Contributed by: Dennis Fortier, President, Medical Care Corporation

As you may have read elsewhere, November is National Alzheimer’s Awareness Month. But surely, the public is already well aware of this horrible disease. After all, Alzheimer’s has directly affected approximately 1 in every 2 families and the others must have certainly noted its prominent coverage in the news. We don’t really need more awareness, right?

Wrong.

Some of the information below may surprise you. That is to say, it is information about which you are not presently aware. However, by merely learning the seven facts below you will be helping to reduce the Alzheimer’s problem. That’s right…making you aware of this information and encouraging you to share it with your social networks will facilitate a more informed and more effective approach to combating the threat we face from this disease.

First, here are a few facts and figures that you may already know. Alzheimer’s currently affects more than 5 million Americans and that number is likely to triple by 2050. It is the sixth leading cause of death in the USA and is climbing steadily in the rankings. Also, Alzheimer’s is the leading cause of dementia and accounts for about 65% of all dementia worldwide. These are all sobering facts but perhaps not new to your understanding.

7 Facts You Need To Know
Now, here are some points you may not know but should. It is the following information that I hope will stimulate discussion and promote a better understanding of the disease. With more discourse, we can begin to erode the lingering stigma that currently prevents some people with early symptoms from seeking timely medical attention.

1) We generally detect Alzheimer’s at the end-stage of the disease. On average, Alzheimer’s follows a 14-year course from the onset of the first symptoms until death. There is some variability across patients but 14 years is pretty typical. The more surprising news is that, on average, we diagnose Alzheimer’s in years 8-10 of that disease course. This means that for most patients, symptoms go undiagnosed and untreated for at least seven years, during which time the lesions spread through the brain and cause irreparable damage. Please be aware that we diagnose Alzheimer’s disease far too late to optimize the effects of currently available treatments.

2) Sudden or Severe Memory loss is not a part of normal aging. The point about end-stage detection raises an obvious question about “why” we diagnose this disease so late. There are many contributing factors but most of them can be reduced through awareness and education. Some patients with memory concerns resist medical attention in the early stages because they fear a stigmatizing label or because they are misinformed to believe that Alzheimer’s cannot be treated. Many people, including a startling number of physicians, incorrectly believe that memory loss, even sudden or severe loss, is a normal part of aging. Improving the timeliness of diagnoses for Alzheimer’s is, in many ways, a problem that can be addressed through awareness and education. Please be aware that sudden or severe memory loss is not a part of normal aging and, regardless of the cause of the memory loss, timely medical intervention is best.

3) Current Alzheimer’s drugs are probably more effective than you think. Our widespread practice of late detection has many negative consequences. For example, one of the reasons that current treatments are often deemed ineffective is because they are routinely prescribed for patients with end-stage pathology who already have massive brain damage. With earlier intervention, treatment can be administered to patients with healthier brains, many of whom will respond more vigorously to the recommended therapy. Yes, we need better treatments, but a great start would be to intervene earlier with the treatments we already have. Please be aware that currently approved treatments may be more effective than some headlines indicate.

4) Alzheimer’s disease can be treated. Another treatment related concept about which everyone should be aware is this. Preventing or slowing further brain damage is preferable to letting the damage spread without constraint. Yet, many physicians, patients, and caregivers conclude that any treatment short of a cure is not worthwhile. While today it is true that we have no cure for Alzheimer’s, that does not mean there is no treatment. With a good diet, physical exercise, social engagement, and certain drugs, many patients (especially those detected at an early stage) can meaningfully alter the course of Alzheimer’s and preserve their quality of life. Please be aware that “we have no cure” does not mean “there is no treatment”.

5) The Alzheimer’s drug pipeline is full. Here’s another fact of which you should be aware. Through an intense research effort over the past twenty years, scientists have gained a lot of insight about Alzheimer’s disease mechanisms and about other factors that increase the risk for the disease. Much has been learned and some very promising drugs, based on sound theoretical approaches, are in FDA clinical trials right now. While much of the disease remains shrouded in mystery and we may still be a long way from better treatments, it is possible that an effective agent is already in the pipeline. Please be aware that, although we don’t know when, better treatments for Alzheimer’s are certainly on the way.

6) Taking good care of your heart will help your brain stay healthy. Know this; the health of your brain is very closely tied to the health of your body, particularly your heart. Researchers have shown conclusively that high cholesterol, high blood pressure, and obesity all confer greater risk for cognitive decline. The mechanisms that keep oxygen rich blood flowing through your body play a key role in maintaining a healthy brain. Everyone should be aware about the close association between vascular health and cognitive health. Please be aware that maintaining good vascular health will help you age with cognitive vitality.

7) Managing risk factors may delay or prevent cognitive problems later in life. There are well-identified risk factors for Alzheimer’s disease that are within our power to manage. These include diabetes, head injuries, smoking, poor diet, lethargy, and isolation. With greater awareness of these facts, we can imagine a world where diabetics take more care to control their blood sugar, where helmets are more prevalent in recreational activities that are likely to cause head trauma, where people smoke less and eat more fruits and vegetables, and where everyone makes a better effort to exercise and to stay socially engaged on a regular basis. While these facts may not be well known, they are all well proven. Galvanizing an effort to publicize them is one purpose of National Alzheimer’s Awareness Month. Please be aware that many risk factors for Alzheimer’s can be actively managed to reduce the likelihood of cognitive decline.

So why bother with Alzheimer’s awareness? Because it is a terrible disease poised to ravage our aging society and the lack of education and awareness has lead to a stigma that prevents a more proactive approach to early intervention. The result is that we diagnose it too late, which hampers the efficacy of available treatments. A more educated public could manage risk factors to minimize the likelihood of Alzheimer’s, could monitor personal cognitive health with greater vigilance, and could seek medical attention at the earliest sign of decline. Physicians could then diagnose problems earlier and prescribe appropriate treatment including diet, exercise, and drugs to slow disease progression as much as possible. In the end, we could have fewer cases, more effective treatment, slower progression, higher quality of life, and lower healthcare costs. The social, emotional, and fiscal benefits of awareness and education in this area are too large to quantify.

By reading this article, you have increased your understanding of the problem and raised your awareness about what can be done. That is a great step in the right direction but you can do one thing more. You can help to spread this message.

In the spirit of National Alzheimer’s Awareness Month, please share this article with your friends to promote more widespread awareness. Post it to your Facebook page, Link to it from your Newsletter, Tweet it, or email it. It doesn’t matter how you do your part, it only matters that you get it done.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

The Most Overlooked Opportunity in the Field of Alzheimer’s Care

Contributed by: Dennis Fortier, President, Medical Care Corporation

We all know about the obvious problems associated with Alzheimer's disease (AD). The media carry daily stories about the aging of the population (nearly 10,000 baby boomers turning 65 each day).  We are also inundated with messages about how current medications seem to be minimally effective against this poorly understood disease. Certainly, our limited ability to treat a disease that affects a burgeoning, elderly population makes for dire headlines.

However, there is a third problem that seems to be commonly overlooked in this conversation.

Late Intervention: Both Problem and Opportunity
This third problem is less obvious than the aging population and minimally effective treatment, but solving it will greatly mitigate the impact of these more widely noted themes. The problem is the unacceptably late intervention that we practice against this progressive disease. We routinely diagnose AD near end-stage pathology.

There is a fair degree of variability from case to case but, on average, AD follows a 14-year course from the onset of subtle symptoms until death. This usually includes a 7-year period of mild cognitive impairment (MCI) during which patients remain independent and able to care for themselves. The MCI stage is typically followed by a 7-year period of worsening dementia. In most instances (95% of instances according to one study), AD is first diagnosed during the mild or moderate dementia stages. This correlates roughly to years 8 through 11 on the 14-year time line.

We are dealing with a progressive disease that ravages the brain with each passing year and, on average, we are not intervening with treatment until end-stage pathology and massive brain damage have occurred. Yes, we need better treatments, but we can improve outcomes meaningfully by treating earlier with the currently approved interventions.

Alas, earlier intervention is a sensible but slippery goal. This is because early-stage AD patients, those in the MCI stage, have only mild symptoms. In this way, they look to a physician precisely like the multitudes of "normally aging" patients who have accurately sensed a slowing of their word or name recall, and are needlessly worried about AD. As you might imagine, these two types of patients are difficult to distinguish from one another.

Major Challenge: Discernment of Healthy Patients from Unhealthy Patients
Since the chances are high that a 65-year old patient complaining of subtle memory decline does not have early stage AD, such concerns are usually not closely evaluated until symptoms worsen considerably. This has lead to the current practice of intervening only after the disease has progressed to the dementia stage when, by definition, the symptoms are quite pronounced.

Today, however, there are short neuropsychological assessments, scored with sophisticated computer algorithms, that accurately distinguish MCI from normal aging. These assessment tools perform an efficient traffic control function to escort the worried well out of the health care system, while retaining those with objectively measured deficits for a comprehensive diagnostic work-up. With such brief and inexpensive assessment tools, physicians can now intervene earlier and treat memory disorders like AD before unnecessary brain damage has occurred. Doing so will foster a major improvement in standards of care for Alzheimer's patients.

Education and Awareness: Next Opportunities for Better Care
In this regard, the major challenge to an immediate improvement in care becomes one of awareness and education for the public and for primary care physicians. This is difficult but perhaps more certain in its achievability than the more scientifically challenging process of fully understanding AD and developing treatment agents that will halt its progression.

We need to tackle this disease from all angles and getting an earlier start with intervention seems to be an immediately graspable approach that does not, in my opinion, get enough attention in the field.

Lack of Education About Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The Alzheimer's Society in the UK recently published the results of their survey exploring the degree to which the average person understands this disease.

While there was no surprise that the average citizen is not aware of recent scientific advances, certain findings were somewhat alarming. In that regard, the fact that a third of respondents thought Alzheimer's disease was an inevitable part of normal aging was particularly illuminating.

Additionally, about a quarter of all respondents were not aware that risk factors can be managed to reduce the likelihood of dementia. Given this low level of understanding, one can easily see why there is not a greater proactive approach by aging patients to engage their physicians in discussions about memory loss.

In the near term, the greatest health care advance we can facilitate in the Alzheimer's field will be driven by education. If we had a well-informed public visiting enlightened physicians where cognitive health was regularly and objectively monitored, we would identify memory disorders much earlier and intervene with greater clinical success.

Alzheimer's Detected Too Late

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The Atlanta Constitution Journal has a nice piece today about the poor state of Alzheimer's detection. While we refer to this reality quite frequently in this blog, it is worth reading the article because they do a good job describing the magnitude of the problem and they frame a possible solution.

The focus of the article is on the lack of screening in physician offices. While I agree that a general screening approach to the aging population could be a factor in solving this problem, I don't think it is necessarily the only approach and probably not the most efficient approach. I would suggest a "case-finding" mentality where physicians are well-educated about what questions to ask and which signs to watch and where they have viable assessment tools to help them further evaluate patients likely to have an emerging problem.

The article describes several reasons that such screening is not more common including lack of physician education, lack of screening standards, and lack of time for screening in an office visit. On slow news days going forward (if there are any), I will revisit this post and give my thoughts on each of those barriers.

The Alzheimer's Project: Viewable Online

Contributed by: Dennis Fortier, President, Medical Care Corporation
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One of the major barriers to better care in the Alzheimer's field is lack of education. This blog is dedicated to helping solve that problem.

In general, patients and physicians are not adequately informed about the benefits of vigilantly monitoring cognitive health and managing risk factors as successful strategies to promote vital aging. The recent HBO documentary (The Alzheimer's Project) made an excellent contribution to the level of public knowledge and I am happy to report that it is now freely accessible, in its entirety, online.

You can view it here and, if you have not already done so, I encourage you to watch it.

More Encouraging News about Dementia Education

Contributed by: Dennis Fortier, President, Medical Care Corporation
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As I noted here last week, an educational campaign sponsored by the Alzheimer's Society seemed to be sensitizing the public to the importance of seeking medical attention to discuss memory concerns. This comment was based on a survey of people in the UK who reported that their likelihood of seeing a physician about a memory concern was increased after seeing the advertising campaign.

In news today, physicians have reported an actual increase in the number of patients coming to them with suspicion of a memory disorder. This provides encouraging further evidence that the campaign will have a meaningful impact on the health of the UK's aging population.

As earlier facts presented in this blog make clear, educating the public and catalyzing earlier intervention against memory impairing medical conditions looks to be one of the most effective strategies in combating the growing prevalence of dementia. I hope we can all support and implement a similar approach in the USA.

Encouraging news about Dementia Education

Contributed by: Dennis Fortier, President, Medical Care Corporation
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One of the major challenges in the fight against memory disorders is the general lack of understanding about the importance of early intervention. While we have all come to accept the importance of a timely diagnosis in the case of cancer and other progressive diseases, we have not, as a society, made that connection to Alzheimer's disease.

I am very encouraged to read today about a campaign funded by the Alzheimer's Society in the UK that has reportedly been quite successful in this regard. Apparently, the educational campaign (Titled: Worried About Your Memory?) has increased the likelihood that a person with a memory concern will discuss their situation with a physician. This is an important step that we need to encourage in the USA as well.