Wisconsin Alzheimers Institute: Dementia Diagnostic Clinic Network Mark A. Sager, MD Professor of Medicine and Population Health Sciences and Director,

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



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


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


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


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


186

Wisconsin Dementia Research Consortium Study


Animal Naming

Diagnostic group Abnormal (< 14) Normal (≥ 14)

Normal Cognition 12% 88%

AD 85% 15%

Other dementia 85% 15%


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


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)


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


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:___________


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


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


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


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


• 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


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


Documents

Wisconsin Alzheimers Institute: Dementia Diagnostic Clinic Network Mark A. Sager, MD Professor of Medicine and Population Health Sciences and Director,