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.
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.
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, 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.
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.
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.
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)
Homocysteine elevation in blood associated with more dementia risk.
Dementia starts 20-30 years before symptoms show up.
Mouth germ implicated in development of Alzheimer's
TOOLS & RESOURCES FOR MEDICAL PROVIDER
Read helpful documents and articles to dementia care.
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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.