For Medical Professionals

Partnering with you to help those living with dementia. 

A New Approach to Dementia Care

At Central Minnesota Dementia Community Action Network we recognize the importance of a dementia risk factor assessment, dementia prevention, early diagnosis, deficit rehabilitation, medication management, therapy prescriptions, and on-going care management. Consequently, with our surging over age 65 population and the expected increase in the prevalence of dementia in our community, we need to improve our dementia care not only for patients, but also for their 3-5 or more caregivers and families dealing with the stress of dementia in their loved one. 

Early dementia diagnosis remains a problem in most American medical settings for a variety of reasons. However, differentiation of a dementia diagnosis from the presentation of multi-medical problem patients is critical. The symptoms of medication side effects, inadequate brain circulation, oxygenation or nutrition can all masquerade as dementia as can many others. These other medical problems may either be the actual cause of dementia symptoms or may, at least, be contributing to the earlier or more severe presentation of a true dementia illness like Alzheimer’s disease. This new model of dementia care promotes a greater effort by medical providers to assess for risk factors and prescribe specific ameliorating treatments before dementia symptoms develop or at least earlier once symptoms present. Thus, more clinical effort is spent on the front end of the clinical course of dementia than providers currently practice. However, with this new model of dementia care at no time in the clinical course are patients and families sent off with plans for only infrequent visits and with families wondering what to do about specific behaviors or deficits that their loved one patient has right now. 

Doctor with patient looking at X-ray in office

Our new dementia care model offers patients and families more clinical and expert guidance along the full duration of their dementia journey from prevention, to earlier diagnosis with more on-going clinical and collaborative contact to optimize care management and patient/family support along the way.  Our Dementia Resource Center not only maintains a current directory of all the local dementia-related services and services providers, but also actively works to promote frequent contact among the services providers while also encouraging full utilization and knowledge of their expertise by community medical providers. 

However, unlike a wound center or a cancer center, with this new care model dementia, treating providers will retain full control and direction along the full journey of their dementia patients and families. The DRC will collaborate initially but also along the full clinical course allowing busy specialists and primary care physicians and other providers to offload much of the documentation and work of full-spectrum dementia care. With the current alarming rates of provider burnout, we could expect that this new model would minimize this added stress for them. 

How We Work with Dementia Clinicians

Our Central MN Dementia Resource Center (DRC) is the product of 3+ years of study and fact finding within our medical community, particularly our dementia care system.  We have been working with dementia services providers, primary care and specialty dementia clinicians and many older adults either living with dementia or providing caregiver help to a loved one with dementia. Our analysis determined that creation and operation of a DRC, a permanent, identifiable center of dementia care excellence would provide the most efficient and effective solution to the dementia care gaps we were all experiencing.  

While our main goal is to promote better and more accessible dementia care in our community, we realized that our solution must offer something of value to our community’s primary care and specialist dementia clinicians.  Buy in and support by these physicians, nurses, therapists, physician assistants, counselors and educators will be critical for the success of our DRC model of community-based dementia care. So, we would like to offload much of their work evaluating and managing dementia patients in a collaborative effort that allows them to do a better, more thorough job while the DRC saves them time and effort doing so.  We will do this by performing extensive history and information gathering at CRC consultations that will go right back to the clinicians, and eventually back into their same electronic medical record system (EPIC) that they use for regular clinic work. The DRC evaluation reports may even recommend additional testing or consultations when indicated by the intake or follow up evaluations at the DRC. The DRC will emphasize dementia risk assessment and develop care plans that set goals for patients to commit to risk reduction by specific recommended lifestyle adjustments and educational activities.  We plan to continue to follow patients 3-4 times per year for as long as they find us to be helpful toward achieving their care plan goals.

Group of young doctor during home visit senior people

Risk Factors

According to the international dementia experts of the UK’s Lancet Commission on Dementia, at least 40% of late-onset (past age 65) dementia may be preventable.

Controllable or treatable dementia risk factors are divided into Early Life, Midlife and Late Life risks. Less education in Early Life contributes an 8% increased risk for dementia. In Midlife, hearing loss contributes an increased risk of 9%, Hypertension – 2% and Obesity contributes another 1% risk to dementia risk. In Late Life, smoking contributes another 5%, depression – 4%, physical inactivity – 3%, social isolation – 2%, and diabetes – 1%.

Although these represent the common risk factors, many other potentially controllable or treatable risk factors need to be accounted for. These include a history of sleep apnea and other sleep disorders, head trauma, cancer and its treatment, COPD or other hypoxia, cardiovascular disease of multiple types, multiple medication use, substance abuse, chronic infections, poor nutrition and many others. Studies show that dementia prevalence would be halved if its onset were delayed by 5 years.

Social Isolation

Social Isolation, now worse due to Covid 19 restrictions can lead to loneliness that leads to worsening of several known dementia risk factors including poor sleep, worsening depression, substance abuse, weakened immunity, weight gain and interpersonal conflict. While offering love and social opportunities may help, most experts in this area recommend engaging your loved one to help develop a charitable or social activity that they participate in with like-minded others that they can relate to in the shared activity.

Friendships

Studies where autopsies were done on brains of people who died with NO symptoms of dementia showed that many of them had Alzheimer’s disease findings in their brain tissue, but still had no dementia symptoms while they were alive. Most of these patients, it turns out had at least 8 or more close friends or practiced multiple additional healthy life style behaviors.

Diabetes

Our Western diet with high sugar and starches, eating many times a day, minimal fiber and lots of processed foods has experts worried that half of us may be diabetic by 2050. Nearly half of adults now are pre-diabetic – have evidence of insulin resistance – all made much worse by our diet, sedentary lifestyle, unmanaged stress, poor sleep and so on. Insulin resistance means that even the excess insulin we make in this condition fails to help our brain cells -neurons- take in and use enough glucose for energy production and function. And, to make matters worse, as we age past 50 or so, our neurons lose their natural ability to use glucose anyway. But, when we restrict low-fiber carbs and replace the calories with enough good protein and fat, then we break down body fat to make ketones instead of glucose. Our brain cells, neurons, continue to be able to use these ketones very well for energy and function even well into advanced age. Fixing insulin resistance can cut off at least this one common path to cognitive dysfunction – dementia, and Type 2 diabetes too.

Sleep

Getting enough and proper sleep is vital for cognitive function now and in years to come. During sleep, our cleanup crew of special brain cells and tissue removes cellular and chemical debris that happens during our stressful days – specially so if we fail to correct our other dementia risk factors. For most adults, anything less than 7 1/2 hours of quality sleep will not be enough to clear our brains for the next day.

Brain Derived Neurotrophic Factor (BDNF)

One of the best things we could do for our brain and its cognitive function is to raise or prolong the level of BDNF in our brains. This stuff makes our brains work better, but also regulates many body functions including blood sugar balance, appetite, and reducing likelihood of depression and being overweight. Good news – it works really well even well into advanced age if we have enough of it. You get more of it mostly by exercise, especially when we have to concentrate on it like dancing lessons, etc. Certain meds can increase levels a little, but not as much as exercise. Alzheimer’s disease dementia and similar conditions, like Parkinson’s and Huntington’s – all have low BDNF levels. However, swallowing or injecting it doesn’t work because it only lasts a few minutes in the blood and doesn’t cross into the brain very well. They’re still looking for a way to figure this out because it helps lab animals with their version of these diseases when injected directly into their brains. I’ll stick with exercise, for now.
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Homocysteine elevation in blood associated with more dementia risk.

You’ve probably never had a blood test for elevated homocysteine, but many Americans have elevations. Problem is – our usual “normal” of 13 or lower should probably be more like 7 or lower. Elevations are associated with blood vessel damage, atherosclerosis and clots that are part of cardiovascular problems like stroke and heart attacks. Since Covid 19 can cause endothelial (inside of blood vessels) damage, inflammation and clots, too much homocysteine would not help you if you catch it. Elevated homocysteine causes shrinkage of your brain’s memory processing center – the hippocampus, and elevations corelate with worse Alzheimer’s disease and Parkinson’s too. Deficiency of vitamins B6, B12 and folic acid can lead to homocysteine elevations. This happens more as we get older, but also if we get H. pylori infections in our stomachs. Replacing vitamin deficiencies works better the earlier in the cognitive impairment you are, like Mild Cognitive Impairment. Or better yet, replace these vitamins (if low) as a dementia prevention move before you get any symptoms. If taking B vitamins doesn’t help lower homocysteine, then you may have a genetic problem handling homocysteine and will need to take a special (methylated) form of B vitamins.

Dementia Risks

There are dozens of different kinds of dementia, but Alzheimer’s disease is by far the most common (2/3 of cases). Most people living with dementia have at least 10-15 of many many risk factors, many of which are potentially modifiable with lifestyle and health habit improvements. No wonder our current American bio-medical model (we just need the right drug to fix any problem) has failed to find the “cure” that we want. No doubt, we will discover or make medications to help some day, but not without first resolving the errant metabolic, health habit and lifestyle status that leads us down the road to dementia in the first place. Even those with genetic risk for dementia can alter (minimize) the expression of dementia-related genes by virtue of improved diet, sleep, exercise, stress, social isolation and other factors. In fact, wouldn’t it make more sense to make these healthful improvements as a dementia prevention strategy starting many years BEFORE we develop any dementia symptoms?

Dementia starts 20-30 years before symptoms show up.

The chemical and cellular derangements that ultimately show up as dementia symptoms begin 20-30 years before the symptoms. Our brains are very good at pruning the deadweight brain cells (senescent neurons) that use oxygen and energy, but no longer conduct electrical signals very well for brain function. Just as pruning a growing tree or thinning the radishes in your garden brings on better growth, our brain uses kill messages (autophagy) to get rid of these deadweight neurons as we go. The more dementia risk paths we are on like smoking, poor sleep, severe stress, pre or real diabetes, etc., the more pruning happens. So, our at-risk brains work OK for many years, even on fewer and fewer remaining, but well-functioning neurons, until that last straw of dementia risk piles on. Then, after maybe 20-30 years of (silent) coping, we finally fall into evident cognitive dysfunction. Finally, we lack enough good connections (synapses) between neurons to keep putting on the outward appearance of normal cognitive function. Its just that last 1-2% of neuronal deficit that makes us tip over into diagnoseable dementia or Mild Cognitive Impairment (pre-dementia).
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Mouth germ implicated in development of Alzheimer's

A common (25% of Americans) oral bacteria, Porphyromonas gingivalis (Pg) and its toxic products (gingipains) are found in most Alzheimer’s disease (AD) brains on autopsy and in the spinal fluid of most patients with known AD. Gingipains increase Amyloid Beta and tau protein in infected lab animals and cause neuroinflammation. Antibiotics fail to clear the germ in living subjects due to rapid antibiotic resistance, but an experimental gingipains inhibitor works well in lab animals with no resistance found. Genes that predispose to AD may cause susceptibility to Pg infection or gingipains toxicity. Pg comes in different strains, but is the main causative germ in chronic periodontitis (gum infections). A cousin germ, P. gulae is common in companion animal pets and can transmit to humans. If current trials are successful, we may see gingipains inhibitor treatments become available for prevention or management of AD. Pg gains access to our bloodstream (bacteremia) with brushing or dental work and is found in distant arteries of most cardiovascular disease biopsy or autopsy tissue.
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TOOLS & RESOURCES FOR MEDICAL PROVIDER

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Central MN Dementia Community Action Network

7447 River Bend CT NW
Sauk Rapids, MN 56379

(320) 492-8207

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All content on this website is intended to be informational only and does not create a patient-client relationship and does not intend to constitute medical advice.

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