On Alert: What All Doctors Need to Know About Alzheimer’s Disease

Cynthia Morrison, RN, ARM, CPHRM, CPPS, Patient Safety Risk Manager, The Doctors Company

According to the Alzheimer’s Association, Alzheimer's disease is the leading cause of dementia, accounting for about 65 percent of dementia cases in individuals over age 60. Early diagnosis of Alzheimer's provides several important benefits to diagnosed individuals, their caregivers and loved ones, as well as society. “The development of biomarkers for Alzheimer's disease is making it possible to detect Alzheimer's disease and provide an accurate diagnosis earlier than at any other time in history. In addition to providing significant medical, emotional and social benefits and facilitating participation in important clinical trials, early diagnosis enables individuals to prepare legal, financial and end-of-life plans while they are still cognitively able to make decisions and share their wishes.” Other facts to consider:1

  • Alzheimer's disease is the sixth-leading cause of death in the United States, and the fifth-leading cause of death among those age 65 and older. It also is a leading cause of disability and poor health.
  • Almost two-thirds of Americans with Alzheimer's are women.
  • Although deaths from other major causes have decreased significantly, official records indicate that deaths from Alzheimer's disease have increased significantly. Between 2000 and 2015, deaths from Alzheimer's disease as recorded on death certificates increased 123 percent, while deaths from the number one cause of death (heart disease) decreased 11 percent.

Physicians of all specialties should become familiar with the early signs of this disease to refer patients with symptoms to a specialist for further testing.

Typically, Alzheimer's progresses slowly in three stages—mild (early-stage), moderate (middle-stage), and severe (late-stage), with symptoms worsening over time. On average, a person with Alzheimer's lives four to eight years after diagnosis, but can live for 20 years, depending on other factors.2

The early signs of Alzheimer’s are:

  • Memory loss that disrupts daily life (e.g., forgetting important dates or events).
  • 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.
  • New problems with words in speaking or writing.
  • Decreased or poor judgment.
  • Changes in mood and personality.

Physicians should also assess for other conditions that may mimic or exacerbate dementia, such as vitamin deficiencies, heart conditions, or sleep apnea.

Only 45 percent of people with Alzheimer’s disease or their caregivers report being told of the diagnosis, whereas 90 percent of people with the most common types of cancer have been told of their diagnosis.1 Studies have revealed that physicians and other healthcare providers recognize the benefits of disclosing Alzheimer’s, but despite this, there is a reluctance to do so.

The benefits of clearly explaining the 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 be compliant.
  • Access to services. Knowing the diagnosis allows caregivers to obtain information about support services and plan.
  • Safety. Awareness of the diagnosis allows caregivers to take steps to ensure the patient is in a safe environment and identify certain activities that may need to be curtailed, such as driving.
  • 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 illness, physicians should:

  • Educate caregivers and patients on ways to promote activity. As the disease progresses and cognitive and functional abilities decline, patients have difficulty moving and, therefore, are more vulnerable to infection. Pneumonia is often a contributing factor to the death of patients with Alzheimer’s disease.
  • Facilitate consults and have a system in place to track and recall patients to ensure there is appropriate follow-up.
  • Consider referring patients to a mental health professional. Depression occurs in 40 percent of Alzheimer’s patients and a mental health professional can help provide treatment. Other team members may include home healthcare workers, social workers, and psychologists.

There is strong evidence 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. As a treating provider, is important to teach and monitor patients within these areas along with appropriate referrals as indicated.


References

  1. 2018 Alzheimer’s disease facts and figures. Alzheimer’s Association Website. (https://www.alz.org/alzheimers-dementia/facts-figures). Accessed July 11, 2018.
  1. Dementia Advocacy and Support Network. http://www.dasninternational.org. Accessed June 11, 2015.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

09/18

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