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Wisconsin Alzheimer’s Institute: Dementia Diagnostic Clinic Network
Mark A. Sager, MDProfessor of Medicine and Population Health Sciences and Director, Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health
Wisconsin Alzheimer’s Institute (WAI)1998-2008
• Dementia Diagnostic Clinic Network
• Public and Health Professional Education
• Research
WISCONSIN ALZHEIMER’S INSTITUTE
The Goals of the WAI Program are to:
• Improve access to quality dementia diagnostic services throughout Wisconsin
• Improve access to education and supportive services for family caregivers
• Participate in systematic and high quality data collection for research and public policy purposes
WAI-Affiliated Dementia Diagnostic Clinic Network
Guidelines:
1. Interdisciplinary assessment
2. Affiliation with a medical organization
3. Physician, physician’s assistant or nurse practitioner
4. Neuropsychological testing
5. Data collection
6. Tied to local Alzheimer’s Association Chapter
WISCONSIN ALZHEIMER’S INSTITUTE
WISCONSIN ALZHEIMER’S INSTITUTE
Marquette, MI
WAI-AffiliatedDementia Diagnostic
Clinic Network
33 clinics total as of 5/08
3000 new evaluations annually
Treatment prescribed n
Cholinesterase inhibitors
171
Memantine 38
Non-pharmacologic 257
Other: Activate POA-HC, antidepressant, etc
240
Diagnosis %
Normal 6%
MCI 17%
SDAT 31%
Vascular 7%
Mixed 12%
LBD 1%
FTD 2%
Sleep disturbance 1%
Depression 4%
Other: Bipolar, alcohol abuse, , parkinsons, epilepsy, ADD, anxiety,etc
18%
TEST Mean (SD)
MMSE (0-30) 23 (6)
Animal Fluency 12 (5)
CERAD
Trial 1 3 (2)
Trial 2 5 (2)
Trial 3 6 (2)
Delayed Recall 3 (3)
NCSE
Orientation (4-12) 9 (3)
Attention (1-7) 7 (2)
Comprehension (2-6) 5 (1)
Repetition (5-13) 11 (2)
Naming (2-9) 7 (2)
Construction (0-5) 3 (2)
Memory (4-12) 6 (3)
Calculations (0-4) 3 (1)
Similarities (2-8) 5 (2)
Judgment (1-6) 4 (2)
WAI-Affiliated Dementia Diagnostic Clinic Network
November 2007 – June 2008 (N = 622)
WAI Dementia Diagnostic Clinic Network
•Clinic staff provide introductions to health systems and communities across Wisconsin
•Provide UW with opportunities for education and research
•Serve as models of care in their communities
•Provide opportunities to implement new discoveries in medical practice
WISCONSIN ALZHEIMER’S INSTITUTE
Continuing MedicalEducation
General Public
Promoting the Wisconsin IDEA –
Education
MMSE – Diagnostic Accuracy
Abnormal (< 24)
(%)
Normal (≥ 24)
(%)
Normal 0 100
AD 60 40
Vascular 52 48
Mixed 71 29
Lewy Body 71 29
Frontal Lobe 31 69Sensitivity – 47
Specificity - 100
WISCONSIN ALZHEIMER’S INSTITUTE
184
Clock Draw – Diagnostic AccuracyAbnormal(≤8)
%
Normal(> 8)
%
Normal 26 74
AD 87 13
Vascular 82 18
Mixed 86 14
Lewy Body 95 5
Frontal Lobe 71 29Sensitivity – 77
Specificity - 74
WISCONSIN ALZHEIMER’S INSTITUTE
Animal Fluency – Diagnostic Accuracy
Sensitivity – 90
Specificity - 76
Abnormal (< 17)
(%)
Normal (> 17)
(%)
Normal 24 76
AD 91 9
Vascular 90 10
Mixed 100 0
Lewy Body 100 0
Frontal Lobe 100 0
WISCONSIN ALZHEIMER’S INSTITUTE
186
Wisconsin Dementia Research Consortium Study
WISCONSIN ALZHEIMER’S INSTITUTE
Animal Naming
Diagnostic group Abnormal (< 14) Normal (≥ 14)
Normal Cognition 12% 88%
AD 85% 15%
Other dementia 85% 15%
WISCONSIN ALZHEIMER’S INSTITUTE
Wisconsin MemoryScreening Initiative
and Memory Care Connections
Milwaukee
La Crosse
Richland
Memory Screening Initiative
Eau Claire Door
Kewaunee
Jefferson
Rock
Barron
DunnChippewa
Memory Care Connections
WISCONSIN ALZHEIMER’S INSTITUTE
2004 Medicaid Costs for WisconsinNH Residents with Dementia
10,140 persons at $117 per day $455,235,120
State / County Share (40%) $182,094,120
( In 2004, 1600 persons with dementia were served in COP,COP-W and CIP at a cost of $16.7 million)
WISCONSIN ALZHEIMER’S INSTITUTE
5 years+42%
Under 6 months
6%
6-11 months17%
Don't know4%
12-23 months
12% 2-5 years19%
Length of Stay at Nursing Home
WISCONSIN ALZHEIMER’S INSTITUTE
Animal Naming screen
Adults > 60 years with possible memory problems
Diagnose and Treat Refer to Dementia Diagnostic Clinic
Re-Screen at Intervals
–
Cognistat
+
Referral to MD
_
+
Memory Screening Process
County Services and/or Alzheimer’s Association
County Services and/or Alzheimer’s Association
Animal NamingWISCONSIN ALZHEIMER’S INSTITUTE
Introduction: “I’d like to ask a question to check your memory.”
Instruction: “Tell me the names of as many animals as you can think of, as quickly as possible.”
Procedure: Time for 60 seconds and record all responses.
If the person stops before 60 seconds, say “Any more animals?”
If the person says nothing for 15 seconds, say “A dog is an animal.Can you tell me more animals?”
1. _______________________ 12. _______________________2. _______________________ 13. _______________________3. _______________________ 14. _______________________4. _______________________ 15. _______________________5. _______________________ 16. _______________________6. _______________________ 17. _______________________7. _______________________ 18. _______________________8. _______________________ 19. _______________________9. _______________________ 20. _______________________10. _______________________ 21. _______________________11. _______________________ 22. _______________________
Scoring: Count the total number of animals (NOT including repetitions or non-animal words): ______________________
Next step: If the score is less than 14, do the Cognistat exam
dogcatcowpigsheephorseliontigercatmouseant
spraydandelionbird
Name:_________________________ ID #:_______________ Date:___________
WISCONSIN ALZHEIMER’S INSTITUTE
LOC ORI ATT LANGUAGECONS
TMEM
CALC
REASONING
COMP
REP NAM SIM JUD
†AVG. RANGE
-ALERT-
--12--
--10--
-(S)7-
--6--
-(S)6-
--5--
--(S)--
--12--
--11--
--(S)--
--8--
--7--
--6--
-(S)5-
--4--
--12--
--10--
-(S)4-
--3
--8--
-(S)6-
--5--
--6--
-(S)5-
--4--
MILD
MODERATE
SEVERE
--IMP--
--8--
--6--
--4--
--5--
--3--
--1--
--4--
--3--
--2--
--9--
--7--
--5--
--5--
--3--
--2--
--3--
--2--
--0--
--8--
--6--
--4--
--2--
--1--
--0--
--4--
--3--
--2--
--3--
--2--
--1--
Write in lower scores
12 7 6 12 8 5 10 4 7 5
COGNITIVE STATUS PROFILE
Healthy Older Adult
WISCONSIN ALZHEIMER’S INSTITUTE
LOC ORI ATT LANGUAGECONS
TMEM
CALC
REASONING
COMP
REP NAM SIM JUD
†AVG. RANGE
-ALERT-
--12--
--10--
-(S)7-
--6--
-(S)6-
--5--
--(S)- -
--12--
--11--
--(S)- -
--8--
--7--
--6--
-(S)5-
--4--
--12--
--10-
-(S)4-
--3
--8--
--(S)6-
--5--
--6--
-(S)5-
--4--
MILD
MODERATE
SEVERE
--IMP--
--8--
--6--
--4--
--5--
--3--
--1--
--4--
--3--
--2--
--9--
--7--
--5--
--5--
--3--
--2--
--3--
--2--
--0--
--8--
--6--
--4--
--2--
--1--
--0--
--4--
--3--
--2--
--3--
--2--
--1--
Write in lower scores
8 6 4 10 6 2 4 3 4 4
COGNITIVE STATUS PROFILE
Person with Dementia
Cognitive Screening Results – 8 Wisconsin Counties
WISCONSIN ALZHEIMER’S INSTITUTE
Persons approached 1244
Persons screened 1120 (90%)
Persons screened positive 370 (33%) (range 22%-58%)
Abnormal Cognistat 92%
Take ChargeA Memory Wellness Program
Asenath La Rue, PhD
Senior Scientist, Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public
Health
WISCONSIN ALZHEIMER’S INSTITUTE
Target populationIndividuals 65 and older diagnosed with MCI
Pilot program -- open trial design Participants recruited at four memory clinics:
Beloit La Crosse (Franciscan Skemp) Richland Center UW Madison1st subject enrolled in June, 2007; last enrolled in November, 2007
Take ChargeA Memory Wellness Program
WISCONSIN ALZHEIMER’S INSTITUTE
• One-year program
• Individualized “activity care plans” - “personal trainer approach”
• Education on healthy diet and stress management
• Cognitive stimulation and stress management
• Longitudinal monitoring of exercise, mental activity, everyday cognitive function, self-reports of memory and mood
WISCONSIN ALZHEIMER’S INSTITUTE
Take ChargeProgram Structure
What’s unique about Take Charge
• Offered through a memory clinic system
• Individualized programming of activities
• Systematic measurement of outcomes
• One year duration
Take Charge
WISCONSIN ALZHEIMER’S INSTITUTE
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