Recognizing and assessing the progression of cognitive impairment and dementia in primary care

Dementia is a growing burden for society, propelling patients and caregivers to increasingly use the health-care system. A year ago, local researchers, health-care professionals, and community advocates came together to form the Indianapolis Discovery Network for Dementia (IDND) to enhance dementia care in the nation's twelfth largest city.

On Oct. 20, IDND will launch RAPID-PC – Recognizing and Assessing the Progression of Cognitive Impairment and Dementia in Primary Care with a summit meeting for researchers, clinicians, nurses, nurse practitioners and physician assistants to share experiences and progress.

The group is drawing upon unique features of the Indianapolis health-care environment, the most wired in the nation, to develop a model which they believe other communities can use to enhance the delivery of dementia care.

“If tomorrow we developed a breakthrough in dementia treatment such as a vaccine, it would take 17 years and $800 million for that development to become available as a prescription and it would reach only a fraction of those who could benefit from it. That isn't acceptable,” said Malaz Boustani, M.D., M.P.H., an assistant professor of medicine at Indiana University School of Medicine, an Indiana University Center for Aging Research investigator and a Regenstrief Institute research scientist. Dr. Boustani, IDND's chief research officer, bases his estimates on a systematic review of drug development literature.

According to Dr. Boustani, in the state of Indiana, which he says is representative of the U.S. as a whole, 60 percent of people with dementia or pre-dementia (also known as mild cognitive impairment) are not recognized as having these conditions when they go to a hospital and 80 percent are not recognized as having dementia or pre-dementia by their primary care physicians. The result is that less than 10 percent receive medications appropriate to their level of cognitive impairment and approximately a quarter receive medications which are inappropriate.

“Nationwide, the health-care system is not delivering good dementia care because we have not presented a comprehensive assessment of the biopsychosocial needs of a person with dementia and have not followed up with solutions that are sensitive to local community needs and resources,” said Dr. Boustani, who is a geriatrician. Eight out of 10 individuals with dementia living in the community have significant behavioral and/or psychological symptoms that require medical and psychological care.

He also notes that caregivers have been largely ignored in spite of the fact that they provide millions of unpaid care hours per year (180 million hours valued at $1.7 trillion in Indiana in 2005) and are hospitalized at a very high rate (24 percent over a six-month period in Indiana).

With Rapid-PC, IDND is taking a major step toward its goal of building efficient, effective, locally sensitive solutions for dementia care.