Alzheimer’s Disease and Dementia: What Healthcare Providers Need to Know

Julie Brightwell, JD, RN, Director, Healthcare Systems Patient Safety, The Doctors Company

According to the Alzheimer’s Association, Alzheimer's disease, the most common cause of dementia, accounts for 60 to 80 percent of all dementia cases. An estimated 6.2 million Americans are currently living with Alzheimer’s dementia and the number of new cases is projected to double by 2050—affecting 12.7 million Americans aged 65 and older.¹ Additional facts to consider:

• Alzheimer's disease is officially listed as the sixth-leading cause of death in the United States, and the fifth-leading cause of death among those age 65 and older. It is also a leading cause of disability and poor health.
• Almost two-thirds of Americans with Alzheimer's are women.
• Between 2000 and 2019, the death rates from Alzheimer’s increased 33 percent for individuals aged 65 through 74; 51 percent for those 75 through 84; and 78 percent for those 85 and older.¹
• The large increase in the number of patients with dementia will be met with an extreme shortage of specialists, particularly geriatricians, to diagnose and manage treatment.²

Diagnosing Alzheimer’s Disease

Early diagnosis of Alzheimer’s provides several important benefits to diagnosed individuals and to their caregivers, loved ones, and society. Alzheimer’s may begin 20 years or more before the onset of symptoms. Advances in research, including the identification of biomarkers, provides patients with an increased opportunity to intervene with actions such as addressing risk factors and participating in clinical studies in anticipation of new treatments.

Typically, Alzheimer's progresses slowly in three stages: mild (early-stage), moderate (middle-stage), and severe (late-stage), with symptoms worsening over time. It is helpful for providers in all specialties to be able to recognize the early signs of this disease so they can refer patients with symptoms to a specialist for further testing. According to the Alzheimer’s Association, the 10 early signs of Alzheimer’s are:

• Memory loss that disrupts daily life (e.g., forgetting important dates or events).
• Challenges in planning or solving problems.
• Difficulty completing familiar tasks at home, work, or leisure (e.g., trouble driving to a familiar location or remembering the rules of a favorite game).
• Confusion with time or place.
• Trouble understanding visual images and spatial relationships.
• New problems with words in speaking or writing.
• Misplacing things and losing the ability to retrace steps.
• Decreased or poor judgment.
• Withdrawal from work or social activities.
• Changes in mood and personality.

Assess for other conditions that may mimic or exacerbate dementia, such as vitamin deficiencies, heart conditions, or sleep apnea.

Disclosing an Alzheimer’s Diagnosis

Although ethical obligations require that physicians and other healthcare providers disclose an Alzheimer’s diagnosis, a reluctance to do so remains.

The benefits of revealing and clearly explaining an Alzheimer’s diagnosis include:

• Improved decision making. When patients are fully aware of their diagnosis in the early stages of the disease, they are more likely to be competent to understand options and provide informed consent for current and future treatment options. When patients are actively involved in decision making about their care, they are more likely to follow a care plan. (For more information, see our article “Best Practices in Patient-Centered Care and Shared Decision Making.”)
• Access to services. Knowing the diagnosis allows caregivers to obtain information about support services and make plans.
• Safety. Awareness of the diagnosis allows caregivers to take steps to ensure the patient is in a safe environment and identify activities (such as driving) that may need to be curtailed.
• Social support. Knowing the diagnosis helps affected people focus on spending quality time with loved ones.

Once a patient has learned of his or her diagnosis, healthcare providers can:

• Educate caregivers and patients on ways to promote activity. As the disease progresses and cognitive and functional abilities decline, patients have difficulty moving and they become more vulnerable to infection. Pneumonia is often a contributing factor to the death of patients with Alzheimer’s disease.
• Facilitate consults and implement a system to track and recall patients to ensure appropriate follow-up.
• Consider referring patients to a mental health professional. Because depression occurs in 40 percent of Alzheimer’s patients, a mental health professional can help provide treatment.
• Coordinate care with other team members, including home healthcare workers, social workers, and psychologists.
• Recommend appropriate dietary and lifestyle changes. Strong evidence suggests that the risk of cognitive decline may be decreased by making key lifestyle changes that include regular physical and social activity and maintaining good heart health.

For additional resources and screening tools, see the Alzheimer’s Project Clinical Roundtable, Physician Guidelines for the Screening, Evaluation, and Management of Alzheimer’s Disease and Related Dementias.

For assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.

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