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Delaying Progression of Mild Cognitive Impairment to Dementia:

Benefits to the Senior Living Community

Lead the market - your Community can prevent Alzheimer’s

Delaying Progression of Mild Cognitive Impairment to Dementia: Benefits to the Senior Living Community

SESSION OVERVIEW

DR. BRUCE BROTTER, Vice President of Training and Clinical Services, Memory Training Centers of America (MTCA) • Discussion of the Benefits of Cognitive Training: Empirical Evidence

EVAN A. KAPLAN, Vice President of Operations, MTCA

• Positive Impact of a Memory Training Program on the Senior Living Community STEPHEN SWARTZ, Vice President Administration, MTCA

• Positive Impact of a Memory Training Program on the Senior Living Corporation: Marketing, Sales and Financial Benefits

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ANTICIPATING & RESPONDING TO CHANGES IN THE MARKETPLACE

Baby Boomers have reached a new milestone. This is the single greatest transformation to occur in Senior Living. Individuals born between 1946 and 1964 (Approximately 76 million in the US) are the generation that reshaped

the social landscape, revolutionized how we live, work and play, changed politics, popular music, technology, business and lifestyles.

Now, they’re bringing changes to Senior Living Communities. They are researching the optimal residential setting for their parents, but they are taking notes for themselves. Savvy consumers

This generation has vastly different expectations than their predecessors (GI Generation...“the Greatest Generation”)

They desire active adult communities because that’s how they see themselves. They expect more from their communities than just bingo and card games...they will downplay many activities

associated with growing older. Boomers want to stay engaged and purposeful in life during retirement.

Capitalize: Use the above to your advantage.

Healthcare....provide as many elements of care as you can within the community. A connected network Extend your brands outside their communities ... Be proactive!

Many have stated that the Beatles song ‘Revolution’ is a perfect interpretation for how Baby Boomers envision their golden years. They see themselves (as the song goes), as capable of “evolution, solution, & [making a] contribution.”

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Prevention Programs enabled by Senior Living Communities are an absolute with this new marketplace

The FUTURE IS NOW! How are you staying ahead of the curve:

Mr. Andy Smith (CEO of Brookdale) recently and accurately stated “There’s a huge opportunity around brand, a white space out there which nobody has taken control of….to capitalize where healthcare policy is going….As many elements of care you can provide in a campus or as part of connected network, the better”.

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INCIDENCE OF MILD COGNITIVE IMPAIRMENT, ALZHEIMER’S DISEASE & DEMENTIA

Almost 60% of Assisted Living residents suffer from cognitive impairment, with the vast majority not receiving any treatment.

The incidence of Mild Cognitive Impairment (MCI) Increases with age.

The incidence of MCI is approximately 10% in those aged 70-79 years & 25% in those aged 80-89

Alzheimer’s disease is the leading cause of dementia in the U.S., responsible for 60-70% dementia cases. Over 5 million individuals are diagnosed with Alzheimer’s in the U.S. today, and this rate is expected to

triple to nearly 15 million by 2050, as ‘baby-boomer’s age. Alzheimer’s disease is the 3rd leading cause of death in the U.S.

The incidence of dementia doubles every 5 years from ages 65-90. By age 90, 50% of individuals suffer from dementia, and this increases exponentially with every year of age beyond 90. The overall incidence of progression from MCI to Dementia increases anywhere from 3-10% each year.

Reduction of this progression is the target of a professional cognitive treatment program. 1. (American Geriatrics Society, Jan, 2005); 2. (NIA, Alzheimer’s Disease Progress Report, 2012); 2a. (Dementia & Geriatric Cognitive Disorders, Feb, 2010); 2b. (Mayo Clinic Study of Aging, Aug, 2010); 3. (WHO, 2012,National Institute on Aging, 2014); 3a&b. (Alzheimer’s Disease Facts and Figures, Alzheimer’s Association of America, 2013); 3c. (American Academy of Neurology, 2014); 4. (Annals of Neurology, Jan 2010; Alzheimer’s Disease Facts and Figures, 2013.); 5. (Archives of Neurology, Dec. 2009; Neurology, Jan, 2014)

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PREVENTIVE TREATMENT: THE FUNCTIONS WE NEED TO PROTECT

EFFECT OF COGNITIVE TRAINING IN REDUCING RATE OF PROGRESSION MCI TO DEMENTIA

CONCEPT OF NEUROPLASTICITY

“The Juggling Study” “The PETscan Study” CONCEPT OF STRUCTURAL CHANGE/DISEASE, WITHOUT SYMPTOMS! “The Nun Study” BENEFITS OF COGNITIVE TRAINING- The Clinical Research Systematic computer-based training improves cognitive functioning for healthy adults & patients with

MCI Harvard Medical : “When considering a memory-enhancement program, one that is run by a health

professional with specialized training in cognitive rehab is recommended.” Improved cognitive function resulting from cognitive training transfers over into improved daily life

function NIH new system of ‘staging’ and the value of early intervention, even during the “’pre-clinical’ phase of

Alzheimer’s Benefits last over time: “The Ten-Year Study”

1. (Journal of Neuroscience, 2008); 2. (Swedish Medical University Karolinska Institutet, Klingberg, 2009); 3. (Gerontologist, April, 1997); 4. (NIH, Evidence Report Technology Section, April, 2010); 5. (BRAIN- A Journal of Neurology, 2011); 6. (Journal of Nutrition, Health and Aging, Jan, 2010); 7. (PETRA, June, 2010 ); 8. (Alzheimer’s and Dementia, 2011); 9. Scientific American, Oct, 2013); 10. Harvard.edu/special health reports/improving memory, 2007; 11. (Journal of Gerontology, Dec, 2006); (12) (Journal of the American Geriatrics Society, Jan, 2014)

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WHAT HAVE WE LEARNED SO FAR & WHY IS IT SO IMPORTANT?!

The Senior Living Community must have a Professional Memory Training Program in order to maintain the cognitive health and independent functioning of all residents. This includes:

Individuals with Pre-clinical Alzheimer’s disease, not yet showing symptoms

• The clinical research tells us that cognitive training can delay onset of cognitive impairment, progression of cognitive disease, and/or suppression of disease symptoms

Individuals with Mild Cognitive Impairment who are already evidencing symptoms of memory

loss and individuals who may already be showing signs of mild dementia

• The clinical research tells us us that cognitive training can decrease the incidence of MCI giving way to dementia, and can stabilize and/or slow progression of disease as well as suppress expression of disease symptoms in those who are already evidencing early signs of dementia.

WE NOW KNOW CAN PRESERVE AND PROTECT THE COGNITVE HEALTH OF OLDER ADULTS- AND SO WE MUST

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BENEFITS OF HOSTING A MEMORY TREATMENT PROGRAM IN YOUR SENIOR LIVING COMMUNITY

The Missing Link:

Clinical programs by Licensed Professionals for cognitive assessment, rehabilitation, education and support services to individuals suffering from pre-Alzheimer’s and mild-to-moderate cognitive impairment.

Affordability: Cognitive training is a procedure covered by Medicare for residents suffering from memory loss.

Eligible residents don’t have to worry about invoices or payments. No cost to your community

Implementation: Develop onsite Professionals and Management to customize services to fit seamlessly into your

community. Psychologists and Social Workers! Work with your entire staff to target appropriate residents and identify educational initiatives

(scheduled group activities for all residents and families) and community marketing support throughout each calendar year.

Set up in any of the following space opportunities: Physical Therapy rooms, shared common areas, dedicated/assigned community room, private apartments or suites.

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BENEFITS OF HOSTING A MEMORY TREATMENT PROGRAM IN

YOUR SENIOR LIVING COMMUNITY

Support for maintaining and building your census

host the program for any/all seniors in the area and allow them to have their sessions in your community

provide other marketing opportunities, such as Memory Screening events and educational events

Integration of this Clinical program will greatly assist your Community in operations, care department, activities department, accounting, dietary, maintenance and your Memory Care Neighborhood.

Assistance when Residents first move to community. Assistance when Residents have to increase services or change environment (24 hr.

Nursing , Memory Neighborhood)

Offering an on-site Memory Center in your community provides a valuable service not only to your residents, but to your community-as-a whole.

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FINANCIAL BENEFITS FOR YOUR COMMUNITY A “proactive” approach in caring for residents. The following is a sampling of the financial benefits you can expect. These examples come directly from first hand feedback with Senior Living Community partners that provide an on-site Memory Center. Care Department: Demonstrates to residents and their families that the community is doing everything

possible to maintain a healthy lifestyle. Keeps Care costs lower for families and caregivers if residents are able to maintain greater independence.

Sales: Helps to retain current resident population. Helps new resident outreach programs. Ancillary services provide scheduled activities for the entire resident population, their families & outside groups. Brain Fitness workshops and other activities can be offered to non-residents who may one day become residents because they are being serviced in your community.

Activities Department: Anticipate greater participation by residents in all scheduled activities. With improved cognitive function, residents are more eager participants, and show increased attendance of activities because they remember.

Maintenance: When residents remember the little things like running faucets and what not to flush,

maintenance time and costs are reduced.

Accounting Department: If a resident fails to remember to pay their monthly invoice, it has the potential to create a collection nightmare for many communities.

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ALL PATIENTS EVIDENCED STABLE OR MILD/MODERATE IMPROVEMENT ON THE COGNITIVE FUNCTIONS OF:

ATTENTION, ORIENTATION AND REPETITION (IMMEDIATE RECALL); JUDGEMENT, SIMILARITIES & CALCULATIONS

AREAS THAT ARE NOT TARGETS OF TREATMENT SHOWED MILD DECLINE- AS WOULD BE EXPECTED OVER TIME.

MOST STRIKING FINDING: BY THE 3rd QUARTERLY COGNITIVE TESTING, IMPROVEMENT OF MEMORY INCREASED BY APPROXIMATELY 40%,

STABILIZED, AND THEN INCREASED BY AN ADDITIONAL 10% = TOTAL 50% IMPROVEMENT!

THE EFFECTS OF PROFESSIONALLY-ADMINSTERED MEMORY TRAINING SESSIONS ON PATIENTS WITH MILD COGNITIVE IMPAIRMENT, AGE 90 AND ABOVE