Hoag presents roadmap for addressing Alzheimer’s disease at international conference

Many causes of memory loss are treatable and even preventable. The key is early primary care involvement, according to findings presented at the 2019 Alzheimer’s Association International Conference (AAIC).

Researchers and physicians from the Pickup Family Neurosciences Institute at Hoag presented several posters at this year’s annual conference, the largest and most influential international meeting dedicated to advancing Alzheimer’s science, highlighting compelling data from Hoag’s Orange County Vital Brain Aging Program (OCVBAP) that shows the benefit of early detection to stave off cognitive impairment and the dementia of Alzheimer’s disease.

 “This represents a shifting attention from Alzheimer’s chronic care to prevention,” said William R. Shankle, M.S., M.D., F.A.C.P., The Judy & Richard Voltmer Endowed Chair and director of the Memory and Cognitive Disorders program at the Pickup Family Neurosciences Institute at Hoag. “What you do in your mid-age affects what happens in your brain in your 70s and 80s.”

Hoag presents Brain Shankle

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Dr. William Shankle

Alzheimer’s disease affects 5.8 million people in the United States. Worldwide, an estimated 44 million suffer from the disease. The AAIC brings together leading researchers from 70 countries to share methods of prevention and treatment and improvements in the diagnosis of Alzheimer’s disease.

The OCVBAP, a multi-disciplinary program involving researchers, community leaders, health care educators and physicians, has been involved for nearly a decade in promoting early detection of memory loss and cognitive impairment as well as the prevention of Alzheimer’s disease.

Hoag’s study was based on published guidelines for preventing Alzheimer’s or dementia, and targets both the public as well as health care professionals. The public outreach included education seminars, an online education web portal, and tools for self-identification of risk factors.

It also includes a pathway for self-referred, confidential in-person cognitive assessments. These assessments are conducted by trained OCVBAP personnel in community settings.

“We’ve seen younger people taking part in the assessments because they are interested in prevention and want to take action,” Dr. Shankle said. “They have seen their parents’ or their grandparents’ decline, and they are scared. The stigma of Alzheimer’s is going away gradually. They are ready to do something.”

One troubling aspect of Hoag’s study, however, was that researchers found that primary care physicians were not always well informed enough to help. Nearly a quarter (24 percent) of all participants in the study were found to be in an impaired range, meaning that their conditions had gone unnoticed or unmentioned by their physicians.

“These people have either never brought up their concerns to their physicians, or their physicians said, ‘Don’t worry, you’re just getting old,’” he said.

That is why another critical component of the program is the education of primary care physicians (PCPs) to act as a first line of defense against Alzheimer’s disease.

“We found that by training PCPs to identify risk factors and early symptoms of cognitive impairment, we are able to help guide doctors to detect Alzheimer’s disease in its earliest, most manageable state,” said Dr. Shankle. “Educating physicians also helps patients rule out Alzheimer’s and dementia in cases where the underlying cause of cognitive impairment turns out to be something else, such as poor sleep, stress or depression.”

The Hoag study also highlights the importance of diet, exercise and social activity in delaying or preventing the onset of Alzheimer’s symptoms.

“We call these ‘below the neck conditions,’ such as high blood pressure, heart disease,” Dr. Shankle said. “We heavily encourage them to take part in social activities and hobbies and to speak to their primary care physicians to get their medical conditions under control.”

To further promote the important role PCPs play in brain health, Pickup Family Neurosciences Institute is hosting internationally renowned cognitive neurologist and clinician-researcher Alireza Atri, M.D., Ph.D., as the keynote speaker for the Neurosciences Symposium on September 13 to speak with physicians about the best clinical practice guidelines for evaluation of cognitive impairment and Alzheimer’s disease. His presentation will provide an overview of the aims, processes and recommendations to help physicians better recognize the effects of Alzheimer’s disease and develop a shared care plan with their patients to delay onset.

Reflecting the recent findings from the “Alzheimer’s Detection in the Primary Care Setting: Connecting Patients and Physicians,” Dr. Shankle encourages patients to speak to their physicians if they are concerned and for physicians to routinely ask about cognitive health.

“What we found was the PCP’s attitude is basically, ‘If something is happening, the patient will bring it up.’ Meanwhile, the patient is thinking, ‘If this is so important, my doctor will ask me about it,’” he said. “In Alzheimer’s, early detection can lead to treatments and interventions that delay the onset of the disease’s worst symptoms. That is why these conversations are so important.”