Literature Review

Alzheimer dementia among individuals with down syndromeJAMA Network Open; Eric Rubenstein, PhD; Salina Tewolde, ScM; Amy Michals, MPH; Jennifer Weuve, ScD; Juan Fortea, MD; Matthew P. Fox, ScD; Marcia Pescador Jimenez, PhD; Ashley Scott, MPH; Yorghos Tripodis, PhD; Brian G. Skotko, MD; 9/24In this cohort study of  ... adults with Down syndrome enrolled in Medicaid or Medicare between 2011 to 2019, 23.3% of adults had Alzheimer dementia diagnoses, and the mean age of death was 59.2 years. These findings suggest that Alzheimer dementia is almost universal among people with Down syndrome, and administrative claims data may offer valuable insights into improving care for this diverse population.

Improv for Caregivers receives a grant from the New Hampshire State Council on the Arts EINPressWire; by A. A. Cristi; 9/23/24 The New London Barn Playhouse received an arts in health grant from the New Hampshire State Council on the Arts to continue and expand their Improv for Caregivers program through a larger umbrella program titled “Improv for a Cause.” “Improv for a Cause” will encompass two communication programs that use a similar process to reach different communities. The first, Improv for Caregivers, in partnership with Lake Sunapee Region VNA & Hospice, is an ongoing communication workshop series for those who care for loved ones with dementia and Alzheimer's. ... Each improv workshop session combines insight from healthcare professionals with improvisational theatre techniques, with a goal of developing new communication skills, strategies to cope with stress, flexibility in relationships, and an understanding of loved ones' changing perspectives. With guidance from the VNA and caregivers in the community, the team of actors prepare short scenarios that portray situations caregivers commonly face, such as sundowning, taking away car keys, collaborating with care staff, and hallucinations. ...

The persistent stigma attached to dementia encourages denial InForum; by Carol Bradley Bursack; 9/14/24 Dear Carol: ... At age 70, I was diagnosed with mild cognitive impairment (MCI). Theoretically, that diagnosis means that I have a few more memory glitches than normal for my age. A percentage of people with MCI will develop Alzheimer’s disease, but not all. Yet, some family members treat me like I shouldn’t make decisions beyond what I want for dinner. ...Dear Al: The stigma attached to mental illness, cognitive decline, and even aging, illustrates widespread ignorance of facts. The more people like you speak up the better the future will be for others. ... For now, work on educating your family about MCI.  ... Here's a start: 

Adoption of artificial intelligence-enabled robots in long-term care homes by health care providers: Scoping reviewJournal of Medical Internet Research; Karen Lok Yi Wong, Lillian Hung, Joey Wong, Juyoung Park, Hadil Alfares, Yong Zhao, Abdolhossein Mousavinejad, Albin Soni, Hui Zhao; 8/24Long-term care (LTC) homes face the challenges of increasing care needs of residents and a shortage of health care providers. Literature suggests that artificial intelligence (AI)-enabled robots may solve such challenges and support person-centered care. We identified three barriers to AI-enabled robot adoption: (1) perceived technical complexity and limitation; (2) negative impact, doubted usefulness, and ethical concerns; and (3) resource limitations. Yet, our findings show that health care providers might not use robots because of different considerations. The implication is that the voices of health care providers need to be included in using robots.

Long-term dementia risk in Parkinson DiseaseNeurology; Julia Gallagher, Caroline Gochanour, Chelsea Caspell-Garcia, Roseanne D Dobkin, Dag Aarsland, Roy N Alcalay, Matthew J Barrett, Lana Chahine, Alice S Chen-Plotkin, Christopher S Coffey, Nabila Dahodwala, Jamie L Eberling, Alberto J Espay, James B Leverenz, Irene Litvan, Eugenia Mamikonyan, James Morley, Irene H Richard, Liana Rosenthal, Andrew D Siderowf, Tatyana Simuni, Michele K York, Allison W Willis, Sharon X Xie, Daniel Weintraub, Parkinson's Progression Markers Initiative; 9/24It is widely cited that dementia occurs in up to 80% of patients with Parkinson disease (PD), but studies reporting such high rates were published over two decades ago, had relatively small samples, and had other limitations. We aimed to determine long-term dementia risk in PD using data from two large, ongoing, prospective, observational studies. Participants from the Parkinson's Progression Markers Initiative (PPMI), a multisite international study, and a long-standing PD research cohort at the University of Pennsylvania (Penn), a single site study at a tertiary movement disorders center, were recruited. Results from two large, prospective studies suggest that dementia in PD occurs less frequently, or later in the disease course, than previous research studies have reported.

World Alzheimer's Month: September 2024 Alzheimer's Disease International, London, UK and Lincolnshire, IL, USA; retrieved from the internet 8/26/24Each September, people unite from all corners of the world to raise awareness and to challenge the stigma that persists around Alzheimer's disease and all types of dementia.  ... The 2024 World Alzheimer's Month will centre around the taglines 'Time to act on dementia, Time to act on Alzheimer's.' ...  Editor's Note: Click here for Alzheimer's Disease Internationals' 2024 campaign theme materials. Click here for the Alzheimer's Association in your USA location.

Palliative care is a viable option for frail elderly patients with neurocognitive disorders admitted for hip fractures BMC Musculoskeletal Disorders; by Justine Boulet, Etienne L Belzile, Norbert Dion, Chantal Morency, Mélanie Bérubé, Alexandra Tremblay, Stéphane Pelet; 8/10/24 Most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. A growing body of research states that a certain type of elderly patient could benefit more from a palliative approach. ... The presence of [a nuerocognitive disorder] NCD and diminished prefracture autonomy strongly support counseling for palliative care. The high rate of complications when surgery is proposed for frail patients with multiple comorbidities suggests that the concept of palliative surgery needs to be revisited. 

Hospice care for those with dementia falls far short of meeting people’s needs at the end of life University of Michigan; by Maria J. Silveira; 8/18/24 ... Strikingly, only 12% of Americans with dementia ever enroll in hospice. Among those who do, one-third are near death. This is in stark contrast to the cancer population: Patients over 60 with cancer enroll in hospice 70% of the time. In my experience caring for dementia patients, the underuse of hospice by dementia patients has more to do with how hospice is structured and paid for in the U.S. than it does patient preference or differences between cancer and dementia. ... In the U.S., ... Medicare’s rules and regulations make it hard for dementia patients to qualify for hospice when they and their families need support the most – long before death. In Canada, where hospice is structured entirely differently, 39% of dementia patients receive hospice care in the last year of life. ...

Commentary: Prognostication in Alzheimer's disease and related dementias Journal of the American Geriatrics Society / Early View; by Natalie C. Ernecoff PhD, MPH, Kathryn L. Wessell MPH, Laura C. Hanson MD, MPH; 8/8/24  ... Hospice provides comfort-oriented care, emphasizing patient-tailored elements of quality of life, including time with family, access to nature, and music. In late-stage ADRD, studies show that a majority of families prioritize comfort-oriented treatment, and understanding prognosis may help them align treatments accordingly. Yet, only 15% of people enrolled in hospice with a primary diagnosis of ADRD. This is due to difficulty estimating 6-month prognosis required for hospice eligibility—ADRD carries a prognosis of 12–18 months in the latest stage. While low rates of live discharges from hospice are a regulatory requirement for hospices, people who are increasingly experiencing ADRD progression lose access to those beneficial hospice services. ...

CMS unveils services available to patients in the GUIDE Model, integrates palliative care principles Hospice News; by Jim Parker; 8/12/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has outlined the range of services that will be available to patients aligned with the agency’s Guiding an Improved Dementia Experience (GUIDE) payment model. The payment model is designed to improve quality of life for dementia patients and their caregivers by addressing care coordination, behavioral health and functional needs. While the model does not use the term “palliative care,” it does incorporate principles and practices traditionally associated with those services, such as interdisciplinary care and caregiver support, among others. ... Nearly 400 health care organizations are developing Dementia Care Programs (DCPs) to potentially serve hundreds of thousands of Medicare beneficiaries nationwide, the CMS stated in a fact sheet. 

Managing medications among individuals with mild cognitive impairment and dementia: Patient-caregiver perspectivesJournal of the American Geriatrics Society, by Rachel O'Conor, Andrea M Russell, Allison Pack, Dianne Oladejo, Sarah Filec, Emily Rogalski, Darby Morhardt, Lee A Lindquist, Michael S Wolf; 7/24With changing cognitive abilities, individuals with mild cognitive impairment (MCI) and dementia face challenges in successfully managing multidrug regimens. We sought to understand how individuals with MCI or dementia and their family caregivers manage multidrug regimens and better understand patient-to-caregiver transitions in medication management responsibilities. To ease medication management transitions, balance must be sought between preservation of older adult autonomy and early family caregiver involvement. Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate.

Healthcare providers wary CMS dementia pilot will not cover costsModern Healthcare; by Diane Eastabrook;7/23/24Hospitals, primary care practices and other healthcare providers are split over whether Medicare will pay them enough to cover dementia patients at home as part of a new pilot. Nearly 100 providers began enrolling patients July 1 in the Centers for Medicare and Medicaid Services’ Guiding an Improved Dementia Experience model, known as GUIDE. Another 300 others will begin enrolling patients in the program on July 1, 2025. Some participants that previously provided comprehensive wrap-around services for dementia patients at home said getting a monthly care management payment for each fee-for-service beneficiary will cover costs they had been absorbing. But others aren’t sure the reimbursement will be enough to scale up programs or cover the cost of care for these complex patients.