Central MN Dementia Resource Center, June, 2021
You’ve heard the quote, “insanity is doing the same thing over and over again while expecting a different result”. Although neuroscience research and major medical center clinical experience has uncovered a lot of new information about dementia and its neurodegenerative causes, we clinicians have been slow to incorporate the new information into our daily practice for our management of dementia patients and their families.
Granted, it’s not easy to go from, “there’s nothing we can do, come back in a year” to, “lets schedule a complete initial dementia evaluation after you complete a thorough dementia risk assessment”.
Our nonprofit, the Central MN Dementia Community Action Network (D-CAN) will have completed its pilot program seeing patients and operating the Central MN Dementia Resource Center (DRC) by June 30, 2021. We have seen clients with dementia symptoms along with their caregivers, and also some adults without symptoms, but just worried about getting dementia later on in their life. For clients without symptoms, we do a thorough dementia risk assessment, then negotiate a best risk reduction plan for them to make the suggested lifestyle adjustments. Our initial evaluations for symptomatic clients average 3 hours. Follow up visits for any client average one hour apiece. Our initial evaluation reports average 4-5 pages. Clients share these reports with their primary care or specialty clinicians. The reports have a usually lengthy list of clinical impressions and recommendations for additional testing, therapies, medication adjustments, diet and other lifestyle changes among others. Since our reports have resulted in some additional client referrals, it appears that we are on track with our plans to favorably collaborate with dementia clinicians for community-based dementia care.
We approach dementia differently. We don’t expect there to be a magic bullet drug solution any time soon. When useful meds are developed, they are more likely going to be started much earlier in life than the average age of symptom onset. We will need affordable, convenient and predictive biomarker tests to determine who will need such medication and starting when. For now, we will focus much of our effort on dementia risk factor assessment and amelioration. Our dementia risk factor list seems to grow monthly. Examples of risk factor categories include:
- Medications (side effects and interactions) including over-the-counter meds and supplements especially anti-cholinergic meds like Benadryl, etc.
- Unresolved medical issues like sleep apnea, REM sleep behavior disorder, hormone deficiency, vitamin deficiency, insulin resistance, inflammation, chronic infections like Lyme disease, toxin exposure, pollution exposure, others
- Emotional or physical trauma or stress like PTSD, ACE’s, head injuries
- Behavioral health issues like depression (often untreated), anxiety or treatment
- Social isolation, loneliness – worsened by pandemic restrictions
- Poor health lifestyle issues like smoking, poor diet, lack of exercise, learning or expression
- Genetic predisposition – Healthy lifestyle can suppress bad genetic expression
- Cardiovascular risk factors like hypertension, coronary artery disease, other vascular disease, endothelial dysfunction
- Undiagnosed or intreated substance use disorders
- Many others
So far, our DRC staff is all-volunteer, but we will eventually need to hire a DRC/D-CAN executive director, a care navigator and at least partially pay for our medical director – Dr. Chris Tacl. We have applied for State-sponsored grants for some of this but will need to rely on donations and insurance/Medicare/cash fee-for-service income until some of our grant applications come through for us. We are grateful to BerganKDV Accounting, Quinlivan Hughes Law Office, Karin Pauly of Bluestone Marketing, Sarah Baker of Mission Marketing, and CentraCare for their substantial in-kind service contributions to our mission to improve access to quality dementia care in our community. We have begun working on a fundraising activity for late Summer or Fall by the Communications Committee of D-CAN. We are of course also thankful to those who have made donations of all sizes during our last Fall fundraiser and since.
In May, 2021 we were awarded a $2,000 grant from the Minnesota Medical Association Foundation to cover one year of costs for a HIPAA-secure telecommunication software application for follow up visits with DRC clients when they or caregivers live far away or weather is difficult for travel to St. Cloud. Our thanks to the Foundation and director Kristen Gloege for providing us with this valuable tool. We hope to move into office space in the Midsota Building by the end of June, 2021. CentraCare is providing the space and some furniture for us as we move from Whitney Senior Center for DRC clinical and educational sessions with clients and families. We should also be able to hold D-CAN Board meetings here.
Thanks for following our progress and your support. As always, please call me for referrals or any questions at 320-492-8207.
Pat Zook, MD, President
Central MN Dementia Community Action Network (D-CAN)
June 1, 2021