- Email: [email protected]
Integrating comprehensive dementia care into the medical home: The geriatrics in primary care demonstration
P118
PC-007
Primary Care Preconference Poster Presentations: PC
IMPACT OF AN ALZHEIMER’S SOCIETY AND PRIMARY CARE PARTNERSHIP: A SURVEY OF HEALTH CARE PROVIDERS
Linda Lee1, David Harvey2, 1Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada; 2Alzheimer Society of Ontario, Toronto, Ontario, Canada. Contact e-mail: [email protected] Background: The Alzheimer Society (AS) offers education programs, support, and system navigation support to assist persons with dementia and caregivers throughout the disease process. However, access to the AS at the time of crisis or late in the disease process is not uncommon. A partnership has been created between the AS and memory clinics based within multidisciplinary group primary care practices (Family Health Teams, FHT) to improve access to the AS and other community-based services and programs. This study explored the impacts associated with this partnership. Methods: Fifty-two memory clinic team members across 11 FHTs, serving 424 medical practices with a combined patient base of over 661,000, completed an on-line survey (61% response rate) to assess the usefulness of and benefits associated with this partnership. Results: 82% of respondents reported that “most” or “all” patients newly diagnosed with dementia were referred to at the AS. Ratings of the usefulness of the AS in the clinic were high (mean ¼ 4.7, SD ¼ .54, on a 5-point scale; 5 ¼ extremely useful) as were ratings of satisfaction with the role played by the AS (mean ¼ 4.7, SD ¼ .60). Greater than 95% of respondents indicated that the AS had a positive impact on early access to information about dementia and community services, access to peer support, and health provider awareness of available community resources; 96% reported that the AS had a positive impact on patient and caregiver ability to cope with dementia and 82% reported that this partnership reduced the burden of care for health care providers. Moreover, greater than 73% of respondents reported that the AS had a positive impact on increasing care provider knowledge of available resources, interventions/ strategies for managing dementia and information about assessment and diagnosis. Conclusions: AS membership within primary carebased memory clinics contributes to capacity building regarding assessment and management of Alzheimer Disease and related dementias. Connecting patients and caregivers to the AS at the time of diagnosis has the potential to increase the use of available services throughout the disease process, reduce crises, and improve the caregiving experience. PC-008
INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) ASSESSMENTS USED BY OCCUPATIONAL THERAPISTS IN THE MANAGEMENT OF INDIVIDUALS WITH MILD COGNITIVE IMPAIRMENT
Patricia Belchior1, Nicol Korner-Bitensky1, Melanie Holmes2, Alexandra Robert3, 1McGill University, Montreal, Quebec, Canada; 2 MUHC-RVH site, Montreal, Quebec, Canada; 3McGill University and H^ opital du Haut-Richelieu, CSSS Haut-Richelieu/Rouville, Montreal, Quebec, Canada. Contact e-mail: [email protected] Background: Evidence is accumulating to show that instrumental activities of daily living (IADL) such as: financial management, medication management and shopping is already restricted at early stages of the Alzheimer’s disease process, specifically in individuals with mild cognitive impairment (MCI). In fact, IADLs assessments are the most sensitive tools to capture early cognitive decline. IADL’s is a core concept of occupational therapy but to date we are unaware of the practices of occupational therapists (OTs) in this domain. With better screening criteria health professionals would be able to identify concerns and educate patients and family members. In addition, OTs would be able to address safety issues and propose interventions. Interestingly, there is also preliminary evidence that there is a link between the type of IADL restriction and MCI subtype. This is logical given that the different types of MCI impact on different skills required to perform IADLs. Thus, the goals of this study are: 1) To conduct a scoping literature review to identify standardized IADL assessments appropriate to use in the screening/assessment of clients with potential MCI and 2) To identify screening and assessment practices of Canadian OTs specific to
MCI. Methods: First, we conducted a systematic review of the literature by searching MEDLINE, CINAHL, PsychINFO, ERIC and COCHRANE from their inception to 2012 to look for IADL assessments that have been used to detect MCI. Second, we created an online survey to identify screening and assessment practices of Canadian OTs. The questionnaire includes case vignettes and a series of open-ended and close-ended questions regarding their actual clinical practices in the management of individuals with MCI. Results: Through our literature search, we have identified IADL assessments that have been used in previous studies to assess cognitive functional impairment in individuals with MCI. The questionnaires have been sent and we will present the results at the conference. Specifically, the literature conducted will aid the classification tools of the instruments reported being used by OTs in the management of individuals with MCI. Conclusions: Once classification is complete we will be able to identify gaps between research and clinical practice in this domain. PC-009
INTEGRATED MEDICAL AND CASE MANAGEMENT DEMENTIA MODEL
Margaret Noel, Virginia Templeton, MemoryCare, Asheville, North Carolina, United States. Contact e-mail: [email protected] Background: MemoryCare, in its 13th year of operation in Asheville, NC, is an independent, non-profit organization dedicated to providing medical care to older adults with cognitive impairment inclusive of a case management component that provides support and education to their families and caregivers. With almost twenty percent of the population in western North Carolina over age 65 compared to thirteen percent in the rest of the state and country, the need for such a program came sooner than in many communities. Methods: This presentation is descriptive of our program and based on observational data on client characteristics, outcomes and satisfaction surveys from our program in 2012. Results: Three physician and case manager teams coordinated diagnostic work-up, disease management, caregiver training, counseling and individualized support for 980 patients and 2927 caregivers enrolled at MemoryCare in 2012. They provided guidance and medical assistance in managing difficult behaviors and care needs specific to each family’s circumstance, helped facilitate access to community resources, and counseled families regarding safety and end of life issues. Families received a written individualized care plan that was amended at each visit. Staff was available for information and support via phone and electronic communication. Ninety-seven percent of caregivers reported improved knowledge of memory disorders, 94% reported improved ability to manage dementia related behaviors, 84% reported improved ability to manage caregiver stress, 96% reported our caregiver support fee was reasonable, and 83% reported the program assisted them to keep their loved one in the home setting longer. Conclusions: MemoryCare has 13 years of solid experience delivering an integrated medical and case management model for persons with Alzheimer’s disease and other types of dementia. Surveys reveal high levels of client satisfaction, improved caregiver ability to manage challenging aspects of dementia, and willingness to cost-share to receive these services. Our experience, as well as ongoing replication in other communities, supports the premise that such a program holds promise for improving dementia care services as we face a future of rapidly accelerating need for good models of care. PC-010
INTEGRATING COMPREHENSIVE DEMENTIA CARE INTO THE MEDICAL HOME: THE GERIATRICS IN PRIMARY CARE DEMONSTRATION
Peter Engel, Annette Morgan, Jacqueline Spencer, VA Boston Healthcare System, Boston, Massachusetts, United States. Contact e-mail: peter. [email protected] Background: More than 4,300 Veterans aged 75 receive primary care in two large practices of the VA Boston Healthcare System. Of these >300 have complex cognitive, health and care management needs that may exceed available or appropriate resources. As a result frail or demented Veterans often experience care that is inefficient, fragmented and costly. Methods: Geriatrics in Primary Care (GPC) addresses this problem by
Primary Care Preconference Poster Presentations: PC embedding geriatric services directly into primary care. Key to the program is the on-site presence of a consulting geriatrician and geriatric nurse care manager. These clinicians collaborate with primary care colleagues in medicine, nursing, social work, pharmacy and mental health within the evolving VA medical home or PACT (Patient Aligned Care Team). This integration effectively functions as an interdisciplinary geriatric team that is accessible, efficient and relevant to patient needs. The program promotes earlier recognition of cognitive or functional decline, care management, planned care transitions and a shift in care from multiple subspecialties to PACT. Results: 250 patients have been enrolled and care managed since project inception. Complex, fragmented care is evident in the first 50 (aged 8267). In the year prior to referral these patients made 15614 clinic visits. 46% attended 5 subspecialty clinics, 48% were demented and 18% lacked family caregivers. One year follow-up suggests reduced care fragmentation with significantly reduced subspecialty visits, (7.6610 to 4.765.0, p¼0.01) and unchanged PACT visits (3.161.5 to 3.361.5 p¼0.5). In the dementia subgroup (n¼24, AD 15, vascular 5, FTD 3, DLB 1) subspecialty visits dropped to a lesser degree (5.669.5 to 3.364.5 p¼0.2) while PACT visits increased (2.561.1 to 3.261.1 p¼0.05). Phone contact by GPC (2.362.0) and collaboration with primary care clinicians replaced routine follow-up geriatric care. Overall GPC facilitated planned transitions to rehabilitation centers (5), home hospice (1), dementia units (3) and VA home care (14). Conclusions: GPC provides convenient, comprehensive geriatric care and care management within primary care while preserving established patient-healthcare team relationships. The program simplifies care, facilitates transitions and is broadly applicable. Benefits are similar for patients with or without dementia. PC-011
PREVALENCE OF COGNITIVE IMPAIRMENT BASED ON THE ANNUAL WELLNESS VISIT
Junko Hara1, Denise Macias2, Julie Russell3, Dennis Fortier4, Dori Holnagel2, Celine Keeble2, Michael Brant-Zawadzki2, William Shankle2, 1Shankle Clinic, Newport Beach, California, United States; 2Hoag Neurosciences Institute, Newport Beach, California, United States; 3Pepperdine University, Los Angeles, California, United States; 4 Medical Care Corporation, Newport Beach, California, United States. Contact e-mail: [email protected] Background: The Medicare Annual Wellness Visit (AWV) requires detection of cognitive impairment (CI) among beneficiaries, through direct observation and consideration of subjective reports from patients or reliable informants. This AWV directive will help detect CI earlier in primary care settings, and lead to earlier, more effective treatment. However, prevalence of CI in the Medicare AWV setting is not well characterized. Methods: The Orange County Vital Aging Program (OCVAP) coordinates community and healthcare professional resources, plus educates the public and physician communities to apply proactive principles for managing cognitive health in the at-risk population. OCVAP-affiliated primary care physicians (PCP) implemented the MCI Screen (MCIS) as part of their routine practice for assessing CI. OCVAP conducted a pilot study to examine how well PCPs integrated cognitive healthcare into their practices. Charts of 239 patients were reviewed at 4 PCP practices employing 13 physicians (i.e., HMO/IPA, Medicare, Concierge, Executive Health). 157 patients were excluded (117 under 65 years old, 40 assessed outside of the AWV). The present analysis sample, therefore, consisted of 82 patients. Prevalence of CI detected by the MCIS during the Medicare AWV was determined and stratified by type of practice. Results: Overall CI prevalence during Medicare AWV was 24% (range: 0% to 38% across practice type). The HMO/IPA group conducted no AWV cognitive assessments. The executive health practice had lower CI prevalence due to younger age group (age: 69.4+/-3.4) than other practices (age: 73.8+/-5.5). 22% (N¼18) expressed cognitive concerns during the AWV, but only 44% (8) of these patients had CI. Among patients detected with CI, physicians did not evaluate for poorly controlled medical conditions as a possible cause. Conclusions: The 24% prevalence of CI detected during the Medicare AWV is consistent with that of many published studies. However, the majority of CI patients did not express cognitive concerns, suggesting that objective assessment is needed to avoid
P119
missing CI among patients without subjective concerns. Among CI-detected patients, there was inadequate physician follow-up to look for existing medical conditions as a potential cause of CI. Further PCP guidance for assessing CI etiology is needed.
PC-012
VALIDATION OF THE HEALTHY BRAIN CHECKLIST SCREENING QUESTIONNAIRE IN A COMMUNITY SETTING
William Shankle1, Celine Keeble1, Denise Macias1, Dennis Fortier2, Junko Hara3, Dori Holnagel1, Michael Brant-Zawadzki1, Julie Russell4, Nichole Guillen Nguyen5, 1Hoag Neurosciences Institute, Newport Beach, California, United States; 2Medical Care Corporation, Newport Beach, California, United States; 3Shankle Clinic, Newport Beach, California, United States; 4Pepperdine University, Los Angeles, California, United States; 5Hoag Memorial Hospital Presbyterian, Newport Beach, California, United States. Contact e-mail: [email protected] Background: The Healthy Brain Checklist (HBC) is a 16-item, self-administered screening questionnaire that assesses cognitively related functional abilities, cognitive change, and depression. The HBC takes a few minutes, does not require physician or staff time, and is suitable for the annual Medicare wellness visit in routine clinical practice settings. The HBC was designed to discriminate normal cognitive aging (NC) from depression, mild cognitive impairment (MCI) and mild dementia (MD) due to Alzheimer’s disease and related disorders (ADRD). Previous analysis of HBC classification performance on a community sample of 295 subjects (93 [32%] normal, 137 [46%] MCI, 65 [22%] MD), gave specificity for normal aging ¼ 82%, plus sensitivities for MCI and MD were 85% and 92% respectively. The present study validates the HBC on a larger community sample. Methods: The HBC was administered as part of the cognitive assessment service of the Orange County Vital Aging Program (OCVAP)-a population-based cognitive healthcare program designed to educate public and professionals, plus provide effective screening for maintaining cognitive health. The Functional Assessment Staging Test procedure was used to independently classify 2,016 subjects into normal aging (FAST 1: N¼323 [16%]), subjective cognitive impairment (FAST 2: N¼1097 [54%]), MCI (FAST 3: N¼433 [21%]), and MD (FAST 4: N¼163 [8%]). The HBC scoring rule-developed from the initial HBC study, and listed on the instrument-was used to classify 707 subjects as normal (FAST 1) or impaired (FAST 3,4). As previously done, FAST 2 subjects were excluded because they are a mix of normal and ADRD subjects. Results: HBC specificity for normal ¼ 85.6%, sensitivity for MCI/MD ¼ 87.2%, and overall accuracy ¼ 86.4% 6 2.6%. Conclusions: The HBC appears to be a valid instrument for differentiating normal aging from MCI and MD in routine clinical practice or population healthcare settings.
PC-013
PRIMARY PROGRESSIVE APHASIA: FACTORS DELAYING DIAGNOSIS AND CARE
Frank Jan Jong1, John van Swieten2, 1Erasmus MC, Rotterdam, Netherlands; 2Erasmus University Medical Center, Rotterdam, Netherlands. Contact e-mail: [email protected] Background: Primary progressive aphasia (PPA) is a rare neurodegenerative disease characterized by progressive speech and language deterioration. The absence of prominent dysfunction in other cognitive domains renders a diagnosis difficult in the early stages. Methods: Case-report to illustrate factors that delay diagnosis and as a consequence adequate care for patients with PPA. Results: We report the case of a 49-year old man, who was referred to our academic memory clinic with an 8-year history of progressive speech difficulties in the presence of epilepsy. He was known with a multidrug resistant frontal-lobe epilepsy since childhood, with a frequency of up to 1-3 seizures per week, only at night hours. Ten years ago he developed periods of word-finding difficulties for several days after seizures, attributed to his epilepsy although an MRI showed mild asymmetry regarding the left perisylvian fissure. Two years later word-finding difficulties progressed even in the absence of seizures. EEGs showed lower left hemispheric
PC-007
Primary Care Preconference Poster Presentations: PC
IMPACT OF AN ALZHEIMER’S SOCIETY AND PRIMARY CARE PARTNERSHIP: A SURVEY OF HEALTH CARE PROVIDERS
Linda Lee1, David Harvey2, 1Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada; 2Alzheimer Society of Ontario, Toronto, Ontario, Canada. Contact e-mail: [email protected] Background: The Alzheimer Society (AS) offers education programs, support, and system navigation support to assist persons with dementia and caregivers throughout the disease process. However, access to the AS at the time of crisis or late in the disease process is not uncommon. A partnership has been created between the AS and memory clinics based within multidisciplinary group primary care practices (Family Health Teams, FHT) to improve access to the AS and other community-based services and programs. This study explored the impacts associated with this partnership. Methods: Fifty-two memory clinic team members across 11 FHTs, serving 424 medical practices with a combined patient base of over 661,000, completed an on-line survey (61% response rate) to assess the usefulness of and benefits associated with this partnership. Results: 82% of respondents reported that “most” or “all” patients newly diagnosed with dementia were referred to at the AS. Ratings of the usefulness of the AS in the clinic were high (mean ¼ 4.7, SD ¼ .54, on a 5-point scale; 5 ¼ extremely useful) as were ratings of satisfaction with the role played by the AS (mean ¼ 4.7, SD ¼ .60). Greater than 95% of respondents indicated that the AS had a positive impact on early access to information about dementia and community services, access to peer support, and health provider awareness of available community resources; 96% reported that the AS had a positive impact on patient and caregiver ability to cope with dementia and 82% reported that this partnership reduced the burden of care for health care providers. Moreover, greater than 73% of respondents reported that the AS had a positive impact on increasing care provider knowledge of available resources, interventions/ strategies for managing dementia and information about assessment and diagnosis. Conclusions: AS membership within primary carebased memory clinics contributes to capacity building regarding assessment and management of Alzheimer Disease and related dementias. Connecting patients and caregivers to the AS at the time of diagnosis has the potential to increase the use of available services throughout the disease process, reduce crises, and improve the caregiving experience. PC-008
INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) ASSESSMENTS USED BY OCCUPATIONAL THERAPISTS IN THE MANAGEMENT OF INDIVIDUALS WITH MILD COGNITIVE IMPAIRMENT
Patricia Belchior1, Nicol Korner-Bitensky1, Melanie Holmes2, Alexandra Robert3, 1McGill University, Montreal, Quebec, Canada; 2 MUHC-RVH site, Montreal, Quebec, Canada; 3McGill University and H^ opital du Haut-Richelieu, CSSS Haut-Richelieu/Rouville, Montreal, Quebec, Canada. Contact e-mail: [email protected] Background: Evidence is accumulating to show that instrumental activities of daily living (IADL) such as: financial management, medication management and shopping is already restricted at early stages of the Alzheimer’s disease process, specifically in individuals with mild cognitive impairment (MCI). In fact, IADLs assessments are the most sensitive tools to capture early cognitive decline. IADL’s is a core concept of occupational therapy but to date we are unaware of the practices of occupational therapists (OTs) in this domain. With better screening criteria health professionals would be able to identify concerns and educate patients and family members. In addition, OTs would be able to address safety issues and propose interventions. Interestingly, there is also preliminary evidence that there is a link between the type of IADL restriction and MCI subtype. This is logical given that the different types of MCI impact on different skills required to perform IADLs. Thus, the goals of this study are: 1) To conduct a scoping literature review to identify standardized IADL assessments appropriate to use in the screening/assessment of clients with potential MCI and 2) To identify screening and assessment practices of Canadian OTs specific to
MCI. Methods: First, we conducted a systematic review of the literature by searching MEDLINE, CINAHL, PsychINFO, ERIC and COCHRANE from their inception to 2012 to look for IADL assessments that have been used to detect MCI. Second, we created an online survey to identify screening and assessment practices of Canadian OTs. The questionnaire includes case vignettes and a series of open-ended and close-ended questions regarding their actual clinical practices in the management of individuals with MCI. Results: Through our literature search, we have identified IADL assessments that have been used in previous studies to assess cognitive functional impairment in individuals with MCI. The questionnaires have been sent and we will present the results at the conference. Specifically, the literature conducted will aid the classification tools of the instruments reported being used by OTs in the management of individuals with MCI. Conclusions: Once classification is complete we will be able to identify gaps between research and clinical practice in this domain. PC-009
INTEGRATED MEDICAL AND CASE MANAGEMENT DEMENTIA MODEL
Margaret Noel, Virginia Templeton, MemoryCare, Asheville, North Carolina, United States. Contact e-mail: [email protected] Background: MemoryCare, in its 13th year of operation in Asheville, NC, is an independent, non-profit organization dedicated to providing medical care to older adults with cognitive impairment inclusive of a case management component that provides support and education to their families and caregivers. With almost twenty percent of the population in western North Carolina over age 65 compared to thirteen percent in the rest of the state and country, the need for such a program came sooner than in many communities. Methods: This presentation is descriptive of our program and based on observational data on client characteristics, outcomes and satisfaction surveys from our program in 2012. Results: Three physician and case manager teams coordinated diagnostic work-up, disease management, caregiver training, counseling and individualized support for 980 patients and 2927 caregivers enrolled at MemoryCare in 2012. They provided guidance and medical assistance in managing difficult behaviors and care needs specific to each family’s circumstance, helped facilitate access to community resources, and counseled families regarding safety and end of life issues. Families received a written individualized care plan that was amended at each visit. Staff was available for information and support via phone and electronic communication. Ninety-seven percent of caregivers reported improved knowledge of memory disorders, 94% reported improved ability to manage dementia related behaviors, 84% reported improved ability to manage caregiver stress, 96% reported our caregiver support fee was reasonable, and 83% reported the program assisted them to keep their loved one in the home setting longer. Conclusions: MemoryCare has 13 years of solid experience delivering an integrated medical and case management model for persons with Alzheimer’s disease and other types of dementia. Surveys reveal high levels of client satisfaction, improved caregiver ability to manage challenging aspects of dementia, and willingness to cost-share to receive these services. Our experience, as well as ongoing replication in other communities, supports the premise that such a program holds promise for improving dementia care services as we face a future of rapidly accelerating need for good models of care. PC-010
INTEGRATING COMPREHENSIVE DEMENTIA CARE INTO THE MEDICAL HOME: THE GERIATRICS IN PRIMARY CARE DEMONSTRATION
Peter Engel, Annette Morgan, Jacqueline Spencer, VA Boston Healthcare System, Boston, Massachusetts, United States. Contact e-mail: peter. [email protected] Background: More than 4,300 Veterans aged 75 receive primary care in two large practices of the VA Boston Healthcare System. Of these >300 have complex cognitive, health and care management needs that may exceed available or appropriate resources. As a result frail or demented Veterans often experience care that is inefficient, fragmented and costly. Methods: Geriatrics in Primary Care (GPC) addresses this problem by
Primary Care Preconference Poster Presentations: PC embedding geriatric services directly into primary care. Key to the program is the on-site presence of a consulting geriatrician and geriatric nurse care manager. These clinicians collaborate with primary care colleagues in medicine, nursing, social work, pharmacy and mental health within the evolving VA medical home or PACT (Patient Aligned Care Team). This integration effectively functions as an interdisciplinary geriatric team that is accessible, efficient and relevant to patient needs. The program promotes earlier recognition of cognitive or functional decline, care management, planned care transitions and a shift in care from multiple subspecialties to PACT. Results: 250 patients have been enrolled and care managed since project inception. Complex, fragmented care is evident in the first 50 (aged 8267). In the year prior to referral these patients made 15614 clinic visits. 46% attended 5 subspecialty clinics, 48% were demented and 18% lacked family caregivers. One year follow-up suggests reduced care fragmentation with significantly reduced subspecialty visits, (7.6610 to 4.765.0, p¼0.01) and unchanged PACT visits (3.161.5 to 3.361.5 p¼0.5). In the dementia subgroup (n¼24, AD 15, vascular 5, FTD 3, DLB 1) subspecialty visits dropped to a lesser degree (5.669.5 to 3.364.5 p¼0.2) while PACT visits increased (2.561.1 to 3.261.1 p¼0.05). Phone contact by GPC (2.362.0) and collaboration with primary care clinicians replaced routine follow-up geriatric care. Overall GPC facilitated planned transitions to rehabilitation centers (5), home hospice (1), dementia units (3) and VA home care (14). Conclusions: GPC provides convenient, comprehensive geriatric care and care management within primary care while preserving established patient-healthcare team relationships. The program simplifies care, facilitates transitions and is broadly applicable. Benefits are similar for patients with or without dementia. PC-011
PREVALENCE OF COGNITIVE IMPAIRMENT BASED ON THE ANNUAL WELLNESS VISIT
Junko Hara1, Denise Macias2, Julie Russell3, Dennis Fortier4, Dori Holnagel2, Celine Keeble2, Michael Brant-Zawadzki2, William Shankle2, 1Shankle Clinic, Newport Beach, California, United States; 2Hoag Neurosciences Institute, Newport Beach, California, United States; 3Pepperdine University, Los Angeles, California, United States; 4 Medical Care Corporation, Newport Beach, California, United States. Contact e-mail: [email protected] Background: The Medicare Annual Wellness Visit (AWV) requires detection of cognitive impairment (CI) among beneficiaries, through direct observation and consideration of subjective reports from patients or reliable informants. This AWV directive will help detect CI earlier in primary care settings, and lead to earlier, more effective treatment. However, prevalence of CI in the Medicare AWV setting is not well characterized. Methods: The Orange County Vital Aging Program (OCVAP) coordinates community and healthcare professional resources, plus educates the public and physician communities to apply proactive principles for managing cognitive health in the at-risk population. OCVAP-affiliated primary care physicians (PCP) implemented the MCI Screen (MCIS) as part of their routine practice for assessing CI. OCVAP conducted a pilot study to examine how well PCPs integrated cognitive healthcare into their practices. Charts of 239 patients were reviewed at 4 PCP practices employing 13 physicians (i.e., HMO/IPA, Medicare, Concierge, Executive Health). 157 patients were excluded (117 under 65 years old, 40 assessed outside of the AWV). The present analysis sample, therefore, consisted of 82 patients. Prevalence of CI detected by the MCIS during the Medicare AWV was determined and stratified by type of practice. Results: Overall CI prevalence during Medicare AWV was 24% (range: 0% to 38% across practice type). The HMO/IPA group conducted no AWV cognitive assessments. The executive health practice had lower CI prevalence due to younger age group (age: 69.4+/-3.4) than other practices (age: 73.8+/-5.5). 22% (N¼18) expressed cognitive concerns during the AWV, but only 44% (8) of these patients had CI. Among patients detected with CI, physicians did not evaluate for poorly controlled medical conditions as a possible cause. Conclusions: The 24% prevalence of CI detected during the Medicare AWV is consistent with that of many published studies. However, the majority of CI patients did not express cognitive concerns, suggesting that objective assessment is needed to avoid
P119
missing CI among patients without subjective concerns. Among CI-detected patients, there was inadequate physician follow-up to look for existing medical conditions as a potential cause of CI. Further PCP guidance for assessing CI etiology is needed.
PC-012
VALIDATION OF THE HEALTHY BRAIN CHECKLIST SCREENING QUESTIONNAIRE IN A COMMUNITY SETTING
William Shankle1, Celine Keeble1, Denise Macias1, Dennis Fortier2, Junko Hara3, Dori Holnagel1, Michael Brant-Zawadzki1, Julie Russell4, Nichole Guillen Nguyen5, 1Hoag Neurosciences Institute, Newport Beach, California, United States; 2Medical Care Corporation, Newport Beach, California, United States; 3Shankle Clinic, Newport Beach, California, United States; 4Pepperdine University, Los Angeles, California, United States; 5Hoag Memorial Hospital Presbyterian, Newport Beach, California, United States. Contact e-mail: [email protected] Background: The Healthy Brain Checklist (HBC) is a 16-item, self-administered screening questionnaire that assesses cognitively related functional abilities, cognitive change, and depression. The HBC takes a few minutes, does not require physician or staff time, and is suitable for the annual Medicare wellness visit in routine clinical practice settings. The HBC was designed to discriminate normal cognitive aging (NC) from depression, mild cognitive impairment (MCI) and mild dementia (MD) due to Alzheimer’s disease and related disorders (ADRD). Previous analysis of HBC classification performance on a community sample of 295 subjects (93 [32%] normal, 137 [46%] MCI, 65 [22%] MD), gave specificity for normal aging ¼ 82%, plus sensitivities for MCI and MD were 85% and 92% respectively. The present study validates the HBC on a larger community sample. Methods: The HBC was administered as part of the cognitive assessment service of the Orange County Vital Aging Program (OCVAP)-a population-based cognitive healthcare program designed to educate public and professionals, plus provide effective screening for maintaining cognitive health. The Functional Assessment Staging Test procedure was used to independently classify 2,016 subjects into normal aging (FAST 1: N¼323 [16%]), subjective cognitive impairment (FAST 2: N¼1097 [54%]), MCI (FAST 3: N¼433 [21%]), and MD (FAST 4: N¼163 [8%]). The HBC scoring rule-developed from the initial HBC study, and listed on the instrument-was used to classify 707 subjects as normal (FAST 1) or impaired (FAST 3,4). As previously done, FAST 2 subjects were excluded because they are a mix of normal and ADRD subjects. Results: HBC specificity for normal ¼ 85.6%, sensitivity for MCI/MD ¼ 87.2%, and overall accuracy ¼ 86.4% 6 2.6%. Conclusions: The HBC appears to be a valid instrument for differentiating normal aging from MCI and MD in routine clinical practice or population healthcare settings.
PC-013
PRIMARY PROGRESSIVE APHASIA: FACTORS DELAYING DIAGNOSIS AND CARE
Frank Jan Jong1, John van Swieten2, 1Erasmus MC, Rotterdam, Netherlands; 2Erasmus University Medical Center, Rotterdam, Netherlands. Contact e-mail: [email protected] Background: Primary progressive aphasia (PPA) is a rare neurodegenerative disease characterized by progressive speech and language deterioration. The absence of prominent dysfunction in other cognitive domains renders a diagnosis difficult in the early stages. Methods: Case-report to illustrate factors that delay diagnosis and as a consequence adequate care for patients with PPA. Results: We report the case of a 49-year old man, who was referred to our academic memory clinic with an 8-year history of progressive speech difficulties in the presence of epilepsy. He was known with a multidrug resistant frontal-lobe epilepsy since childhood, with a frequency of up to 1-3 seizures per week, only at night hours. Ten years ago he developed periods of word-finding difficulties for several days after seizures, attributed to his epilepsy although an MRI showed mild asymmetry regarding the left perisylvian fissure. Two years later word-finding difficulties progressed even in the absence of seizures. EEGs showed lower left hemispheric