Expanding the use of brief cognitive assessments to detect suspected early-stage cognitive impairment in primary care.

INTRODUCTION: Mild cognitive impairment remains substantially underdiagnosed, especially in disadvantaged populations. Failure to diagnose deprives patients and families of the opportunity to treat reversible causes, make necessary life and lifestyle changes and receive disease-modifying treatments if caused by Alzheimer's disease. Primary care, as the entry point for most, plays a critical role in improving detection rates. METHODS: We convened a Work Group of national experts to develop consensus recommendations for policymakers and third-party payers on ways to increase the use of brief cognitive assessments (BCAs) in primary care. RESULTS: The group recommended three strategies to promote routine use of BCAs: providing primary care clinicians with suitable assessment tools; integrating BCAs into routine workflows; and crafting payment policies to encourage adoption of BCAs. DISSCUSSION: Sweeping changes and actions of multiple stakeholders are necessary to improve detection rates of mild cognitive impairment so that patients and families may benefit from timely interventions.

Training dementia care professionals to help caregivers improve the management of behavioral and psychological symptoms of dementia using the DICE Approach: A pilot study.

Most persons living with dementia (PLWD) exhibit behavioral or psychological symptoms of dementia (BPSD) over the course of the illness. The DICE Approach (DICE) is a framework that enables caregivers to identify, evaluate, and manage BPSD. This pilot pre-post test study examined the effects of DICE training on dementia care professionals' self-efficacy, knowledge, and attitudes regarding care of patients with BPSD. Participants underwent either in-person DICE training or, during the pandemic, online training. Case consultations were offered as additional learning opportunities in challenging situations. Of 134 participants in the trainings, 122 (91.0%) provided survey data for one or more instruments before and after training. Participants experienced significant improvement in knowledge and attitudes with respect to BPSD and improvement in self-efficacy with respect to helping caregivers respond to BPSD. Training dementia care professionals in DICE can improve their capacity to support caregivers in the management of BPSD.

Language-enriched exercise plus socialization for older adults with dementia: translation to rural communities.

Interventions that stimulate and engage individuals with dementia physically, cognitively, and socially offer promise for improving health and well-being and for potentially slowing functional losses with disease progression. We describe a volunteer-based intervention that combines physical exercise, cognitive-linguistic stimulation, and social outings for older persons living with dementia in rural communities. One-year follow-up data, although clearly preliminary (n = 8), suggest stability in global cognition, mood, and aspects of physical fitness. Challenges to implementing dementia interventions in rural areas are discussed.

External Validity of the New York University Caregiver Intervention: Key Caregiver Outcomes Across Multiple Demonstration Projects.

Purpose of the Study: The Administration on Aging funded six New York University Caregiver Intervention (NYUCI) demonstration projects, a counseling/support intervention targeting dementia caregivers and families. Three sites (Georgia, Utah, Wisconsin) pooled data to inform external validity in nonresearch settings. This study (a) assesses collective changes over time, and (b) compares outcomes across sites on caregiver burden, depressive symptoms, satisfaction with social support, family conflict, and quality of life. Design and Methods: Data included baseline/preintervention (N = 294) and follow-up visits (approximately 4, 8, 12 months). Results: Linear mixed models showed that social support satisfaction increased (p < .05) and family conflict decreased (p < .05; Cohen's d = 0.49 and 0.35, respectively). Marginally significant findings emerged for quality of life increases (p = .05) and burden decreases (p < .10). Depressive symptoms remained stable. Slopes did not differ much by site. Implications: NYUCI demonstrated external validity in nonresearch settings across diverse caregiver samples.

Intervention of multi-modal activities for older adults with dementia translation to rural communities.

A Language-Enriched Exercise Plus Socialization (LEEPS) Program for older adults with Alzheimer's disease and related disorders (ADRD) was implemented in rural Wisconsin communities. Patterned after a university-based research intervention, (1) the LEEPS protocol entailed ongoing weekly to biweekly sessions with a trained volunteer and an individual with dementia, with exercise and language stimulation sessions interspersed with social or volunteer outings. Of 64 persons with ADRD who enrolled, 29 completed an initial follow-up assessment at an average of 10.65 months, and 8 completed a second follow-up at an average of 20.55 months. Results generally show stability in cognition, mood, and physical performance. Improvement was noted at the initial retest on 1 of the 3 physical fitness measures (arm curls; t = 2.61, P = .015), but self-rated quality of life declined slightly from baseline to the first retest (t = -2.09, P = .048). Change in the Mini-Mental State Examination at the first and second follow-ups (mean = +0.18 and -1.0, respectively) was negligible. The maintenance of function observed with LEEPS is an encouraging outcome, given the progressive nature of ADRD, but controlled investigations are needed to establish the efficacy of LEEPS. Barriers to implementation of an intensive activities-focused intervention in rural communities are discussed.