An A- Z Guide for Working with Patients
with Memory Loss and Dementia
Objectives
1.
Gain proficiency in brief cognitive screening to help
improve detection of memory loss among older patients
2.
Describe evidence-based medication and nonmedication interventions known to improve outcomes
among patients with dementia and their care partners
3.
Learn how to best support patients and care partners in
accessing services throughout the continuum of the
disease
4.
Identify common health risks associated with caregiving
and address the unique needs of dementia caregivers
5. Recognize how to incorporate health equity
principles into dementia assessment, diagnosis and
care
2
Introduction to
ACT on Alzheimer’s
What is ACT on Alzheimer’s?
statewide
500+
60+
O R G A N I Z AT I O N S
INDIVIDUALS
volunteer
driven
collaborative
I M PA C T S O F A L Z H E I M E R ’ S
BUDGETARY
SOCIAL
PERSONAL
Collaborative Goals/Common
Agenda
5 shared
goals with a
Health Equity
perspective
5
ACT Tool Kit
• Evidence- and consensusbased best practice standards
for Alzheimer’s care
• Tools and resources for:
– Primary care providers
– Care coordinators
– Community agencies
– Patients and care partners
www.actonalz.org/provider-practice-tools
6
Health Care Settings: Care
Coordination
www.actonalz.org/provider-practice-tools
Dementia and Alzheimer’s
8
FAQ
What is the difference between
dementia and Alzheimer’s
disease?
Dementia Diagnoses
FTD
Alzheimer’s disease: 60-80 %
• Includes mixed AD + VD
Lewy Body
Dementia
Lewy Body Dementia: 10-25 %
Vascular
Dementia
– Parkinson spectrum
Alzheimer’s
Disease
Vascular Dementia: 6-10 %
– Stroke related
Frontotemporal Dementia: 2-5 %
– Personality or language
disturbance
Alzheimer’s Disease:
Challenges and Opportunities
Alzheimer’s: A Public Health Crisis
• Scope of the problem
– 5.3M Americans with AD in 2015
– Growing epidemic expected to impact 13.8M Americans by
2050 and consume 1.1 trillion in healthcare spending
– Almost 2/3 are women (longer life expectancy)
– If disease could be detected earlier incidence would be
much higher
• Pre-clinical stage 1-2 decades
• Some populations at higher risk
– Older African Americans (2x as whites)
– Older Hispanics (1.5x as whites)
Alzheimer’s Association Facts
and Figures 2015
12
The Lens of Health Equity
• Take into consideration health
disparities and inequities
• Seek the attainment of the
highest level of health for all
people
• Help create a new style of
“curb cut” by promoting
cultural competence
13
Base Rates
• 1 in 9 people 65+ (11%)
• 1 in 3 people 85+ (32%)
Age Range
Percent with Alzheimer’s
< 65
4%
65 -74
13%
75 -84
44%
85 +
38%
Alzheimer’s Association Facts
and Figures 2014
14
Challenges & Opportunities
• AD under-recognized by providers
– Only 50% of patients receive formal diagnosis
• Millions unaware they have dementia
– Diagnosis often delayed on average by 6+ years
after symptom onset
– Significant impairment in function by time it is
recognized
• Poor timing: diagnosis frequently at time of crises,
hospitalization, failure to thrive, urgent need for
institutionalization
Boise et al., 2004; Boustani et al., 2003; Boustani et al., 2005; Silverstein & Maslow, 2006
15
Patients with Dementia
• A population with complex care needs
2.5 chronic
conditions
(average)
5+
medications
(average)
3 times more
likely to be
hospitalized
Many
admissions
from
preventable
conditions,
with higher
per person
costs
• Indisputable correlation between chronic conditions and costs
Alzheimer’s Association Facts
and Figures 2014
16
Cognitive Impairment ID
Practice Tips
• Unfortunately, most of us do not recognize signs
and symptoms until they are quite pronounced
– Attribution error: “What do you expect? She is 80
years old.”
– Subjective impressions FAIL to detect dementia in
early stages
• Clinical interview
– Let patient answer questions without help
– Remember: Social skills remain intact until late stage dementia
– Easy to be fooled by a sense of humor, reliance on old
memories, or quiet/affable demeanor
Practice Tips
• Red flags
– Chart Review: memory concerns, forgetfulness, memory
complaints; emergency contact is main contact; Aricept /
Donepezil or other ACHI in record
– Ask “How are you xxx?” instead of “Are you xxx?”
– Repetition (not normal in 7-10 min conversation)
– Tangential, circumstantial responses
– Losing track of conversation
– Frequently deferring answers to family member
– Over reliance on old information/memories
– Inattentive to appearance
– Unexplained weight loss or “failure to thrive”
Practice Tips
• Family observations:
– ANY instances whatsoever of getting lost while driving, trouble
following a recipe, asking same questions repeatedly, mistakes
paying bills
– Take these concerns seriously: by the time family report
problems, symptoms have typically been present for quite a
while and are getting worse
• Raise your expectation of older adults:
– If this patient was alone on a domestic flight across the country
and the trip required a layover with a gate change, would
he/she be able to manage that kind of mental task on his/her
own?
• If answer is “not likely” for a patient of any age: RED FLAG
Practice Tips
• Intact older adult should be able to:
– Describe at least 2 current events in adequate detail (who,
what, when, why, how)
– Describe events of national significance
• 9/11, New Orleans disaster, etc.
– Name or describe the current President and an immediate
predecessor
– Describe their own recent medical history and report the
conditions for which they take medication
Cognitive Screening
22
Provider Perspective
“Avoiding detection of a serious and life
changing medical condition just because there
is no cure or ‘ideal’ medication therapy seems,
at worst, incredibly unethical, and, at best, just
bad medicine.”
George Schoephoerster, MD
Family Practice Physician
23
Screening Measures
• Wide range of options
–
–
–
–
Mini-Cog™ (MC)
Mini-Mental State Exam© (MMSE)
St. Louis University Mental Status Exam™ (SLUMS)
Montreal Cognitive Assessment™ (MoCA)
• All but MMSE free, in public domain, and online
Borson et al., 2000; Folstein et al., 1975; Nasreddine 2005; Tariq et al., 2006
Alternative Screening Tools
• Virtually all screening tools based upon a
euro-centric cultural and educational model
• Consider: country and language of origin,
type/quality/length of education, disabilities
(visual, auditory, motor)
• Alternative tools my be less biased
25
Screening Administration
• Try not to:
– Use the words “test” or “memory”
• Instead: “We’re going to do something next that
requires some concentration”
– Allow patient to give up prematurely or skip
questions
– Deviate from standardized instructions
– Offer multiple choice answers
– Be soft on scoring
– Score ranges already padded for normal errors
– Deduct points where necessary – be strict
Mini-Cog™
Contents
• Verbal Recall (3 points)
• Clock Draw (2 points)
Advantages
• Quick (2-3 min)
• Easy
• High yield (executive fx,
memory, visuospatial)
Borson et al.,
2000
Subject asked to recall 3 words
Leader, Season, Table
+3
Subject asked to draw clock,
set hands to 10 past 11
+2
DATE_________ ID_________________________AGE____GENDER M F LOCATION ______________________ TESTED BY________
MINI-COG ™
1) GET THE PATIENT’S ATTENTION, THEN SAY: “I am going to say three words that I want you to remember now and later. The words are
Banana
Sunrise
Chair.
Please say them for me now.” (Give the patient 3 tries to repeat the words. If unable after 3 tries, go to next item.)
(Fold this page back at the TWO dotted lines BELOW to make a blank space and cover the memory words. Hand the patient a pencil/pen).
2) SAY ALL THE FOLLOWING PHRASES IN THE ORDER INDICATED: “Please draw a clock in the space below. Start by drawing a large
circle.” (When this is done, say) “Put all the numbers in the circle.” (When done, say) “Now set the hands to show 11:10 (10 past 11).” If
subject has not finished clock drawing in 3 minutes, discontinue and ask for recall items.
-------------------------------- -------------------------------- -------------------------------- -------------------------------- -------------------------------- -------------------------------- --------------
-------------------------------- -------------------------------- -------------------------------- -------------------------------- -------------------------------- -------------------------------- ------------3) SAY: “What were the three words I asked you to remember?”
_
Score the clock (see other side for instructions):
(Score 1 point for each) 3-Item Recall Score
Normal clock
Abnormal clock
Total Score = 3-item recall plus clock score
2 points
0 points
Clock Score
0, 1, 2, or 3 = clinically important cognitive impairment likely;
4 or 5 = clinically important cognitive impairment unlikely
28
CLOCK SCORING
NORMAL CLOCK
A NORMAL CLOCK HAS ALL OF THE FOLLOWING ELEMENTS:
All numbers 1-12, each only once, are present in the correct
order and direction (clockwise).
Two hands are present, one pointing to 11 and one pointing to
2.
ANY CLOCK MISSING ANY OF THESE ELEMENTS IS SCORED
ABNORMAL. REFUSAL TO DRAW A CLOCK IS SCORED
ABNORMAL.
SOME EXAMPLES OF ABNORMAL CLOCKS (THERE ARE MANY OTHER KINDS)
Abnormal Hands
Missing Number
.................................................................................................................................................................................................................................
Mini-CogTM, Copyright S Borson. Reprinted with permission of the author, solely for clinical and teaching use. May not be modified or
used for research without permission of the author (soob@uw.edu). All rights reserved.
29
Mini-Cog
Pass
• >4
Fail
• 3 or less
Borson et al., 2000
Mini-Cog Research
• Performance unaffected by education or language
• Borson Int J Geriatr Psychiatry 2000
• Sensitivity and specificity similar to MMSE (76% vs.
79%; 89% vs. 88%)
• Borson JAGS 2003
• Does not disrupt workflow & increases rate of
diagnosis in primary care
• Borson JGIM 2007
• Failure associated with inability to fill pillbox
• Anderson et al Am Soc Consult Pharmacists 2008
Case Study: Colleen
•
•
•
•
•
•
•
•
66 y/o presents to primary care with memory complaints
Daughter c/o short-term memory is poor
Began 1-2 years ago, getting worse
Hx Low blood sugar, history of heart attack, repeat
hospitalizations for atrial flutter
Frequent medication changes, managing independently
Patient is a retired accountant for family business
Lives with husband who is still running the family
business
Referred to Care Coordination
Mini-Cog: Colleen
http://youtu.be/DeCFtuD41WY
33
Colleen’s Clock
Colleen’s Score
Mini-Cog Exercise
Form groups of 2
• Administer MiniCog to each other
• Score sample clocks
36
Clock #1
Clock #2
Clock #3
Clock #4
Clock #5
Clock #6
Clock #7
SLUMS
Tariq et al., 2006
SLUMS
High School Diploma
Less than 12 yrs education
Pass
> 27
> 25
Fail
26 or less
24 or less
Tariq SH, Tumosa N, Chibnall et al. Comparison of the Saint Louis University mental
status examination and the mini-mental state examination for detecting dementia
and mild neurocognitive disorder--a pilot study. Am J Geriatr Psychiatry. 2006
Nov;14(11):900-10.
45
SLUMS: Colleen
http://youtu.be/jyp0ShPiUH8?list=UUOPv8U5bHcdDCm4edmQDY9g
46
SLUMS Scoring: Colleen
47
SLUMS Scoring: Colleen
48
SLUMS Scoring: Colleen
49
MoCA
Nasreddine et al., 2005
MoCA
Pass
• > 26
Fail
• 25 or less
Nasreddine 2005
51
MoCA: Sam
http://youtu.be/ryf8SG0NQLQ?list=UUOPv8U5bHcdDCm4edmQDY9g
52
MoCA Scoring: Sam
• Interactive scoring exercise
53
MoCA Scoring: Sam
54
MoCA Scoring: Sam
55
MoCA Scoring: Sam
56
MoCA Scoring: Sam
57
Screening Tool Selection
Montreal Cognitive Assessment (MoCA)
• Sensitivity:
• Specificity:
90% for MCI, 100% for dementia
87%
St. Louis University Mental Status (SLUMS)
• Sensitivity:
• Specificity:
92% for MCI, 100% for dementia
81%
Mini-Mental Status Exam (MMSE)
• Sensitivity:
• Specificity:
18% for MCI, 78% for dementia
100%
Larner 2012; Nasreddine et all, 2005; Tariq et al., 2006; Ismail et al., 2010
Family Questionnaire
www.actonalz.org/pdf/Family-Questionnaire.pdf
AD8 Dementia Interview
http://knightadrc.wustl.edu/About_Us/PDFs/AD8form2005.pdf
Dementia Work-up,
Diagnosis and Treatment for
Providers
61
Dementia Work-Up
• H&P
• Objective cognitive measurement
• Diagnostics
– Labs
– Imaging ?
– More specific testing (e.g., neuropsychometric)?
• Diagnosis
• ‘Family’ meeting
Treatment: Medications
• Anticholinergics
– Donepezil, Rivastigmine, Galantamine, Cognex
– Possible side effects: nausea, vomiting, syncope,
dizziness, anorexia
• NMDA receptor antagonist
– Memantine
– Possible side effects: tiredness, body aches,
dizziness, constipation, headache
63
Treatment: Medications
• Antipsychotics
• Antidepressants
• Mood stabilizers
64
Care and Treatment
• The care for patients with Alzheimer’s has
very little to do with pharmacology and
much to do with psychosocial interventions
• Care Coordination
65
Dementia Care Coordination
66
Care Coordination
What are some of the challenges
you face when working with people
with dementia and their families?
67
ACT Practice Tool
Dementia Care Plan Checklist
Identify Care Partner(s)
• Inform the patient that this disease requires
a team approach
• Ask the patient to identify team members or
care partners
– Be task specific (e.g., doctor visits, medication
management)
– Think outside the box / family (e.g., friends,
neighbors, religious congregation members,
colleagues, community organization volunteers
or workers)
70
Comprehensive Assessment
71
Comprehensive Assessment
HCH Care Coordination Tool
Kit: http://mn4a.org/wpcontent/uploads/HCH-ClinicCoordinator-Toolkit_3-1915_ADA-FINAL.pdf
72
Comprehensive Assessment
• Patient & Primary Care Partner / Caregiver
– Identify language, cultural, health equity barriers
– Identify physician(s)
– Assess substance use / misuse
– Behavioral health, depression
• PHQ9, CES-D, GDS
73
Comprehensive Assessment
• Primary Care Partner / Caregiver
– Consider assessing cognition (if over 65 or signs /
symptoms present)
– Caregiver burden (Zarit Burden Interview Short)
http://www.uconnaging.uchc.edu/patientcare/memory/pdfs/zarit_
burden_interview.pdf
74
Care Plan
75
Care Plan Tool Highlights
•
•
•
•
•
•
•
Disease Education
Medication Therapy and Management
Maximize Abilities
Health, Wellness and Engagement
Home & Personal Safety
Legal Planning
Advance Care Planning
76
Disease Education
• ASK the patient / care partner:
– What the doctor told them about their memory
loss / diagnosis
– What they know about the disease / questions
about the diagnosis / disease
– Biggest concerns; barriers to care / health
77
Education Resources for Patients
& Caregivers
78
Disease Education: Print Materials
79
After A Diagnosis
-
Partner with doctors
Understand the disease
Use team approach
Plan ahead
Ask for help
Use community
resources
- Role of care coordinator
http://www.actonalz.org/sites/default/file
s/documents/ACT-AfterDiagnosis.pdf
Disease Education
http://youtu.be/zEst_VxwA4U
81
Taking Action Workbook
- Understanding the
disease
- Partnering with doctors
- Telling others about the
diagnosis
- Strategies for managing
symptoms & coping
- Safety
- Legal / financial issues
http://www.alz.org/documents/mndak/taki
ng_action_workbook.pdf
Education for Care Coordinators
83
Disease Education: Facts & Figures
https://youtu.be/kcI5UVwFyN0
84
Stages of Alzheimer’s Disease
Disease Education: What is AD?
http://youtu.be/ECbjK4Ra-Ys
86
Maximize Abilities
• Identify / treat conditions that may worsen
symptoms or lead to poor outcomes
• Diabetes, HTN, sleep dysregulation
• Encourage patient to stop smoking / limit alcohol
• Refer to OT to maximize independence (e.g.,
simplify environment, maximize independence &
self-care abilities)
• Educate families on communication and approach
to prevent or reduce dementia-related behavioral
symptoms
87
Medication Therapy & Management
• Discuss prescribed and OTC medications
• simplify medication regimen
• reduce / eliminate anticholinergics,
benzodiazepines, hypnotics, narcotics
• Create plan with care team
• Family plan for managing meds
• Med management aids (pill boxes, alarms)
• Create & review medication log
88
Medication Therapy & Management
89
Health, Wellness & Engagement
Encourage lifestyle changes that may reduce
disease symptoms or slow progression
- Exercise
- Nutrition
- Stress reduction
- Meaning & purpose
- Relationships
- Health management
- Routine
90
http://www.alz.org/documents/mndak/alz_living_well_workbook_2011v2_web.pdf
Maximize Abilities: Routine
91
Patient Engagement:
Research Participation
• Alzheimer’s Association Trial Match
– Free, easy-to-use clinical studies matching
service that connects individuals with
Alzheimer's, caregivers, healthy volunteers and
physicians with current studies.
– http://www.alz.org/research/clinical_trials/find
_clinical_trials_trialmatch.asp
• National Institute of Health (NIH)
– http://clinicaltrials.gov
92
Home & Personal Safety
• Educate & develop a plan for 5 F’s: fire, falls,
firearms, finances, freeways
• Refer to OT or PT
•
•
•
•
Fall risk assessment
Sensory / mobility aids
Home safety inspection / modifications
Driving evaluation
• Encourage emergency plans (phone numbers,
hospital, fire, POLST/med list by bed, etc.)
• Encourage enrollment in Medic Alert® Safe
Return®
93
Role of Hospitalization
• More preventable hospitalizations
• Higher rates of delirium, falls, new
incontinence, indwelling urinary catheters,
pressure ulcers, functional decline & new
feeding tubes
• Significantly less likely to regain preadmission
functional abilities at 1 month, 3 months, or 1
year after discharge
• 3-7 times more likely to be living in a nursing
home 3 months after discharge.
94
Role of Hospitalization
• Reduce Unnecessary Hospitalization
–
–
–
–
–
Falls
UTI / other medical conditions
Medications / medication mismanagement
Dementia-related behavior
Hospitalization alternatives
• Hospitalization – Pre-Planning
– http://www.nia.nih.gov/alzheimers/publication/hosp
italization-happens
– http://www.aaa1c.org/docs/healthtips/Hospital_Visi
ts_for_People_with_ALZ.pdf
95
Legal & Advance Care Planning
• Encourage patient / care partner to assign
health care and durable POA
• Refer to elderlaw attorney
• Encourage patient to discuss / document
preferences for care
• Honoring Choices
• MN Healthcare Directive
• POLST
• In mid-stage, discuss palliative and hospice
options
96
Visit Frequency & Communication
• Schedule regular check-ins
• Educate patient / care partner WHEN to
contact you
• Changes in condition
• Assistance with med management
• Before / after hospitalization
• Change in living environment
• New needs
97
Visit Frequency & Communication
• Facilitate physician appointments
• Reminders, transportation
• Educate on physician engagement
strategies
• Encourage care partner(s) to attend medical
appointments
• Educate about HIPAA, as needed
• Educate on use of appointment log,
medication log
98
Appointment Log
HIPAA Q & A
• HIPAA (Health Insurance Portability and
Accountability Act)
• Federal law that protects medical information
• Allows only certain people to see information
– Doctors, nurses, therapists and other health care
professionals on the patient’s medical team
– Family caregivers and others directly involved with
a patient’s care (unless the patient says he/she does
not want this information shared with others)
www.nextstepincare.org/Caregiver_Home/HIPAA/
United Hospital Fund, 2002
100
HIPAA: Sharing Patient Information
• If the patient is present and has the capacity to make
health care decisions, a health care provider may
discuss the patient’s health information with a family
member, friend, or other person if the patient agrees
or, when given the opportunity, does not object.
• If the patient is not present or is incapacitated, a
health care provider may share the patient’s
information with family, friends or others as long as
the health care provider determines, based on
professional judgment, that it is in the best interest
of the patient.
www.nextstepincare.org/Caregiver_Home/HIPAA/
United Hospital Fund, 2002
101
Caregiver Support
102
Dementia Caregiving Risks
• Physical risks: caregiving increases the risk of health
problems
• Social risks: caregivers frequently suffer from feelings
of social isolation
• Psychological risks: caregivers are at increased risk of
depression and burden
• Financial risks: caregiving places significant financial
burdens on caregivers due to lost wages and cost of
care
Care Plan: Caregiver Support
• Providing support for dementia caregivers is a
societal imperative
– 70% of individuals with Alzheimer’s disease live at
home
– In 2012, an estimated 15 million unpaid caregivers
provided an estimated 17.5 billion hours of unpaid
care
– The health care system could not sustain the cost
of care without unpaid caregivers
Common Caregiver Challenges
•
•
•
•
•
•
•
•
•
•
Lack of disease knowledge / education
Emotional stress, burden
Need for support and respite
Role changes
Challenging family dynamics
Communication difficulties
Neglected health
Putting patient needs first
Challenging patient behaviors
Planning for the future
105
Caregiver Support
• There is a strong correlation between the
health and well-being of a care partner and
the quality of care that she can provide.
• A care partner with a balanced outlook and
good self-care practices can provide care for
longer periods of time while maintaining his
own health and well-being.
Top 5 Resources for
Patients and Families
107
#1 Promoting Wellness &
Function
108
#2 Addressing Behavioral
Challenges
109
#3: Addressing Driving
Alzheimer’s Association Driving Center:
www.alz.org/care/alzheimers-dementia-anddriving.asp
http://www.thehartford.com/sites/thehartford/files/at110
the-crossroads-2012.pdf
#4 Planning Assistance
111
#5 Connect to Resources
Alzheimer’s Association
24/7 Helpline | 800.272.3900
www.alz.org/mnnd
Senior LinkAge Line
800-333-2433
www.minnesotahelp.info
112
Case Studies
113
Case Study: Colleen
•
•
•
•
•
•
•
•
66 y/o presents to primary care with memory complaints
Daughter c/o short-term memory is poor
Began 1-2 years ago, getting worse
Hx Low blood sugar, history of heart attack, repeat
hospitalizations for atrial flutter
Frequent medication changes, managing independently
Patient is a retired accountant for family business
Lives with husband who is still running the family
business
Referred to Care Coordination
Case Example: Medications
https://youtu.be/3lp0n9DOEWQ
115
Care Coordination: Colleen
• Discussion
–
–
–
–
–
Observations? What did you notice?
What was done well?
What could have been done differently, better?
What might you incorporate into your practice?
What recommendations / referrals would you make to
Colleen?
– What might you do differently if Colleen was not a
native English speaker or was from a diverse cultural
community?
116
Case Example: Legal Planning
https://youtu.be/a-gIojhzGOY
117
Care Coordination: Colleen
• Discussion
–
–
–
–
–
Observations? What did you notice?
What was done well?
What could have been done differently, better?
What might you incorporate into your practice?
What recommendations / referrals would you make to
Colleen?
– What might you do differently if Colleen was not a
native English speaker or was from a diverse cultural
community?
118
Watch the Complete Session:
https://youtu.be/5Kxj-5Ezlzw?list=PLGu3PyEblnIKVrTqVj9NzR5f_fcCbTd9T
119
Care Plan Exercise
In small groups, develop a 3-5 step care plan for Colleen
and her family.
Consider:
• Which areas of the care plan tool should be incorporated in the
plan?
• What educational materials would you give?
• What referrals would you make?
• When would you like to see the patient again?
• How would you communicate the plan to the care team
(physicians, family, patient, etc.)
Questions?
• Download ACT on Alzheimer’s practice tools at:
www.ACTonALZ.org/provider-practice-tools
• For more information
– email: info@ACTonALZ.org
– Web: www.ACTonALZ.org
121
Questions
122
Evaluation
123
ACKNOWLEDGEMENTS
This project is/was supported by funds from the Bureau of Health Professions (BHPr), Health
Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS)
under Grant Number UB4HP19196 to the Minnesota Area Geriatric Education Center (MAGEC) for
$2,192,192 (7/1/2010—6/30/2015). This information or content and conclusions are those of the
author and should not be construed as the official position or policy of, nor should any
endorsements be inferred by the BHPr, HRSA, DHHS or the U.S. Government.
Minnesota Area Geriatric Education Center (MAGEC)
Grant #UB4HP19196
Director: Robert L. Kane, MD
Associate Director: Patricia A. Schommer, MA
References & Resources
•
•
2012 Updated AGS Beers Criteria:
http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf
After a Diagnosis (ACT): http://www.actonalz.org/sites/default/files/documents/ACT-AfterDiagnosis.pdf
Alzheimer’s Association
•
Basics of Alzheimer’s Disease: https://www.alz.org/national/documents/brochure_basicsofalz_low.pdf
•
Caregiver Notebook - http://www.alz.org/care/alzheimers-dementia-caregiver-notebook.asp
•
Driving Center: www.alz.org/care/alzheimers-dementia-and-driving.asp
•
Facts & Figures video: http://youtu.be/waeuks1-3Z4
•
Facts & Figures Report: https://www.alz.org/facts/downloads/facts_figures_2015.pdf
•
Family Questionnaire: http://www.alz.org/mnnd/documents/Family_Questionnaire.pdf
•
Know the 10 Signs. http://www.alz.org/national/documents/checklist_10signs.pdf
•
Living with Alzheimer’s – Mid Stage: https://www.alz.org/documents_custom/middle-stage-caregiver-tips.pdf
•
Living with Alzheimer’s – Late Stage: https://www.alz.org/documents_custom/late-stage-caregiver-tips.pdf
•
Living Well workbook:http://www.alz.org/documents/mndak/alz_living_well_workbook_2011v2_web.pdf
•
Taking Action Workbook: http://www.alz.org/mnnd/documents/2010_taking_action_e-book(1).pdf
•
Trial Match: http://www.alz.org/research/clinical_trials/find_clinical_trials_trialmatch.asp
125
References & Resources
•
•
•
•
•
•
•
•
•
•
•
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AD8 Dementia Screening Interview: http://knightadrc.wustl.edu/About_Us/PDFs/AD8form2005.pdf
At the Crossroads: http://www.thehartford.com/sites/thehartford/files/at-the-crossroads-2012.pdf
Caring for a Person with Alzheimer’s Disease:
http://www.nia.nih.gov/sites/default/files/caring_for_a_person_with_alzheimers_disease_0.pdf
Coach Broyles Playbook on Alzheimer’s: http://www.caregiversunited.com
Honoring Choices Minnesota: http://www.honoringchoices.org
Health Care Directive (MN): http://www.ag.state.mn.us/pdf/consumer/healtcaredir.pdf
Hospitalization Happens: http://www.nia.nih.gov/sites/default/files/hospitalization_happens_0.pdf
Medicare Annual Wellness Visit: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/MM7079.pdf
MiniCog™ http://www.alz.org/documents_custom/minicog.pdf
MN Health Care Home Care Coordination Tool Kit:
http://www.health.state.mn.us/healthreform/homes/collaborative/lcdocs/cliniccarecoordtoolkit.pdf
Montreal Cognitive Assessment (MoCA)http://www.mocatest.org
National Alzheimer’s Project Act: http://aspe.hhs.gov/daltcp/napa/NatlPlan.pdf
Next Step in Care: http://www.nextstepincare.org
Physician Orders for Life Sustaining Treatment (POLST): http://www.polst.org
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References & Resources
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St. Louis University Mental Status (SLUMS) examination
http://medschool.slu.edu/agingsuccessfully/pdfsurveys/slumsexam_05.pdf
The Alzheimer’s Action Plan:http://www.amazon.com/The-Alzheimers-Action-Plan-Know/dp/0312538715
Understanding Difficult Behaviors:http://www.amazon.com/Understanding-Difficult-Behaviors-suggestionsAlzheimers/dp/0978902009
Zarit Caregiver Burden Interview: http://www.uconnaging.uchc.edu/patientcare/memory/pdfs/zarit_burden_interview.pdf
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