Alzheimer’s and Dementia Resources You Can Use - PowerPoint Presentation

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Alzheimer’s and Dementia Resources You Can Use

2017 ACL/CDC/NIA Webinar Series on Alzheimer’s & Related DementiasMarch 1, 2017Slide2

DISCLOSURE STATEMENTS

In compliance with continuing education requirements, all presenters must disclose any financial or other associations with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters as well as any use of unlabeled product(s) or product(s) under investigational use.  CDC, our planners, presenters, and their spouses/partners wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Planners have reviewed content to ensure there is no bias. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use.

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Webinar Series Goals

Inform Aging & Disability, Public Health, and Dementia Research professionals about federal resources to help people with dementia and their families and caregiversImprove coordination of Federal resources

Encourage awareness of research participation opportunities

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Archived webinars (2012-2015)

Archived webinars (2012-2015) available at: http://www.aoa.acl.gov/AoA_Programs/HPW/Alz_Grants/index.aspx#resources

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Today’s Webinar

National Alzheimer’s Project Act/Plan UpdateAlzheimer’s and Dementia ResourcesFor consumers, families, and caregiversFor professionalsSpecial focus areas:Veterans and Their Caregivers Financial Exploitation DepressionSlide6

BackgroundSlide7

Amy Wiatr-RodriguezAdministration for Community Living

National Alzheimer’s Plan Updates

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Prevent and Effectively Treat Alzheimer’s Disease by 2025

Optimize Care Quality and EfficiencyExpand Supports for People with Alzheimer’s Disease and Their Families Enhance Public Awareness and Engagement Track Progress and Drive Improvement

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National Alzheimer’s Plan GoalsSlide9

National Alzheimer’s Plan Updates

National Alzheimer’s Project Act: https://aspe.hhs.gov/national-alzheimers-project-act 2016 Updated Plan: https://aspe.hhs.gov/report/national-plan-address-alzheimers-disease-2016-update2016 ADRD Summit – Prioritized Research Milestones: https://aspe.hhs.gov/alzheimers-disease-related-dementias-adrd-summit-2016-prioritized-research-milestonesNational Research Summit on Care, Services and Supports for Persons with Dementia and their Caregivers – scheduled for October 16-17, 2017Slide10

Amy Wiatr-RodriguezAdministration for Community Living

Resources for Consumers, Families, and Caregivers

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NIA Alzheimer’s Disease Education

and Referral (ADEAR) Center1-800-438-4380 https://www.nia.nih.gov/alzheimers

Focus on latest research-based information on Alz & other dementiasFree consumer & professional publications

Bilingual (English/Spanish) Information Specialists

Referral to government & organization resources, clinical trials

Call Center:

Mon-Fri, 8:30am-5:00 pm Eastern

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NIA-funded Alzheimer’s Disease Centers (ADCs)

ADCs conduct research to improve diagnosis and care and test treatmentsHelp with obtaining diagnosis and medical managementOpportunities to participate in researchhttps://www.nia.nih.gov/alzheimers/alzheimers-disease-research-centers

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National Alzheimer’s Call Center

24/7 Helpline (800)272-3900 http://www.alz.org/

Alzheimer’s Assn. is grantee of Administration for Community Living

National Contact Center partners with Alzheimer’s Association chapters

Provide information, support and referrals to local resources

300,000+ calls/year

Staffed by dementia care experts and Master’s prepared care consultants

Bilingual agents and translation line enable calls in 200 languagesSlide14

Selected Other Resources

http://www.alz.org/i-have-alz/i-have-alzheimers-dementia.asp

: website redesigned with input from Early Stage Advisors

https://www.alzconnected.org/

: free online community for anyone affected by Alzheimer's or another dementia

https://www.alzheimersnavigator.org/:

guided online tool to

create a customized action plan and link to local resources

http://www.alz.org/care/alzheimers-dementia-and-driving.asp

: information on discussing driving and planning ahead

http://www.communityresourcefinder.org/

: comprehensive lists of resources, services and community programs (including Aging & Disability Resource Centers and Area Agencies on Aging)Slide15

Eldercare Locator

1-800-677-1116 or http://www.eldercare.gov

Brochures to download and print or order online

Have Questions? Chat or Call

Search by Location

OR

Topic

Links

to:

BenefitsCheckUP

Federal Websites that offer valuable information on a range of critical eldercare issues.

Links to non-profit organizations that focus on eldercare and other aging issues.

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Eldercare Locator

1-800-677-1116 http://www.eldercare.gov

Hours of Operation: Monday – Friday 9:00am – 8:00pm ET

Redesigned website coming soon

New brochure on social isolation,

“Expand Your Circles”

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BrainHealth.govSlide18

Participating in Alzheimer’s Research

https://www.nia.nih.gov/

alzheimers

/volunteer

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FDA Clinical Trials Resources

What Patients Need to Know: http://www.fda.gov/forpatients/clinicaltrials/default.htmWomen in Clinical Trials: http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118508.htmSlide20

Registries and Matching Serviceshttps://www.nia.nih.gov/alzheimers/

registries-and-matching-services Alzheimer’s Prevention Registry: Open to individuals age 18 and older who are interested in learning about and possibly participating in Alzheimer’s prevention clinical studies and trials.Brain Health Registry: Open to individuals age 18 and older who want to promote healthy brain function by preventing brain diseases, disorders, and injuries. Take online tests, learn about opportunities to participate in a wide range of studies.GeneMatch:

Open to adults age 55 to 75 who are interested in enrolling in Alzheimer’s genetics studies.ResearchMatch: A service, funded by the National Institutes of Health, that helps match people of all ages interested in clinical trials with researchers. Requires an email address.

TrialMatch

:

The Alzheimer’s Association’s clinical studies matching service for individuals with Alzheimer’s, caregivers, and healthy volunteers.Slide21

Veteran and Caregiver Resources

Tanya Friese, DNP, RN, CNL USN(ret)Educational Director - The Road Home Program at Rush The Center for Veterans and their FamiliesAsst. Professor- Dept. of Community, Systems, and Mental Health Rush University College of NursingSlide22

Statistics

218,000 veterans will be diagnosed with a form of dementia in 2017 (U.S. Department of Veterans Affairs, 2017).U.S. Veterans who were prisoners of war (POWs) and developed PTSD secondary to their experience are two times more likely to develop dementia compared to veterans who were not POWS (Meziab et al., 2014).Barnes et al. (2014) found that veterans with traumatic brain injuries (TBI) are 60% more likely to develop dementia that those without, as well as have an earlier onset of approximately 2 years.Slide23

Research

The VA is invested in determining why veterans are so vulnerable to dementia (U.S. Department of Veteran Affairs, 2017)Alzheimer’s Disease Neuroimaging Initiative (ADNI) developed in 2006Evaluated insulin as an effective treatment in 2011In 2014, discovered the use of Vitamin E to delay cognitive declineDeveloped a blood test for diagnostic purposes in 2015Continually assessing environmental causes associated with war and combatSlide24

Veteran Resources

VA healthcare resources included in the standard benefit package (U.S. Department of Veteran Affairs, 2017):Home based primary carehomemakers/ home health aideAdult day careRespite careOutpatient clinicsInpatient hospitalizationsNursing homesPalliative carehospiceSlide25

Caregivers

In the U.S., 5.5 million individuals are currently serving as caregivers for veterans (Ramchand, 2014)Common negative effects of caregiving include (Bass et al., 2013):Unmet needsRole captivityPhysical health strainRelationship straindepressionSlide26

Partners in Dementia Care (PDC) (Bass et al., 2013)

Program designed to integrate community based care and medicine for both the patient and caregiver Developed to mirror success of BRI Care Consultation– an evidence based program for caregivers and patients with chronic conditionsUtilizes coaches and trained counselors to touch base and “mentor” care givers Reassessment occur every 6 months to ensure that the caregiver’s needs are being met Slide27

Dementia Caregiver Support

Support Website: http://www.caregiver.va.gov/Support phone line: 1-855-260-3274Caregiver video series: http://www.ruralhealth.va.gov/vets/resources.asp/Decision making guide: https://www.va.gov/GERIATRICS/Guide/LongTermCare/Shared_Decision_Making.aspContact your local VA clinic for a caregiver workbook!(U.S. Department of Veteran Affairs, 2017)Slide28

References

Barnes, D. E., Kaup, A., Kirby, K. A., Byers, A. L., Diaz-Arrastia, R., & Yaffe, K. (2014). Traumatic brain injury and risk of dementia in older veterans. Neurology, 83(4), 312–319.

http://doi.org/10.1212/WNL.0000000000000616Bass, D. M., Judge, K. S., Lynn Snow, A., Wilson, N. L., Morgan, R., Looman

, W. J., ... & Garcia‐Maldonado, M. (2013). Caregiver outcomes of partners in dementia care: Effect of a care coordination program for veterans with dementia and their family members and friends. 

Journal of the American Geriatrics Society

, 

61

(8), 1377-1386.

Meziab

, O., Kirby, K. A., Williams, B.,

Yaffe

, K., Byers, A. L., & Barnes, D. E. (2014). Prisoner of war status, posttraumatic stress disorder, and dementia in older veterans. 

Alzheimer's & Dementia

, 

10

(3), S236-S241.

doi

: 10.1016/j.jalz.2014.04.004

Ramchand

, R.,

Tanielian

, T., Fisher, M. P., Vaughan, C. A., Trail, T. E.,

Batka, C., ... & Ghosh-Dastidar, B. (2014). Key Facts and Statistics from the RAND Military Caregivers Study. Retrieved from

https://www.rand.org/pubs/presentations/PT124.html

U.S. Department of Veteran Affairs. (2017). Office of research and development. Retrieved from

http://www.research.va.gov/topics/alzheimers.cfm

Weiner, M. W.,

Friedl

, K. E.,

Pacifico

, A., Chapman, J. C.,

Jaffee, M. S., Little, D. M., ... & Yaffe, K. (2013). Military risk factors for Alzheimer's disease. Alzheimer's & Dementia, 9(4), 445-451Slide29

Resources for Professionals

Lisa McGuireCenters for Disease Control and Prevention

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The Public Health Road Map for State and National Partnerships 2013-2018

https://www.cdc.gov/aging/healthybrain/roadmap.htm

35 action items for public health officials to:

Promote cognitive functioning

Address cognitive impairment and Alzheimer’s disease

Meet the needs of caregivers

CDC’s Public Health Road MapSlide31

Using Data to Identify Disparities: Optional BRFSS Modules

Subjective Cognitive DeclineWorsening memory problems Potential difficulties Discussions with health care professionalsRevised in 2015

35 States in 2015

Caregiving

Characteristics of caregivers

Problems they face

Greatest care needs

24 states in 2015

DC

Puerto Rico

http://www. cdc.gov/

brfssSlide32

Data for Action: 2015 BRFSS

http://www.alz.org/publichealth/data-collection.asp#cognitiveSlide33

Data for Action: Data Portal

http://www.cdc.gov/aging/agingdata/index.htmlSlide34

NHANES: Cognitive Data

Administered during 2011-12 and 2013-14 cyclesInterview questionsDuring the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?During the past 7 days, how often have you had trouble remembering where you put things, like your keys or your wallet?Mobile exam center CERAD word recallCategorical verbal fluency (Animal naming)

WAIS Digit symbol 2500 persons aged 60+ years completed the modules

Publically available Spring 2017Slide35

Alzheimer’s Association: Developing and Revising Plans

http://www.alz.org/documents_custom/public-health/

spotlight-assessment.pdf

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A Public Health Approach to Alzheimer’s and Related Dementias

Recently released and revised, flexible curriculum linked to public health competenciesPurpose: Increase understanding of Alzheimer’s disease and related dementias as a multi-layered, growing public health issue Designed for faculty to use with undergraduate public health courses

Developed & evaluated

by the Alzheimer's Association, CDC, and the Emory Centers for Training and Technical Assistance at Emory University

http://www.cdc.gov/aging

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http://www.cdc.gov/agingSlide38

NIA ADEAR Resources for Professionals

Tools for assessment, diagnosis, treatment & managementProfessional trainingPatient care & education

https://www.nia.nih.gov/alzheimers/alzheimers-and-dementia-resources-professionals

Assessing Cognitive Impairment Quick GuideSlide39

National Alzheimer’s and Dementia Resource Center (NADRC):

https://nadrc.acl.gov/Issue Papers, Articles, Toolkits, and ReportsFaith-Related Programs in Dementia Care, Support, and EducationGuides & PresentationsTranslating Evidence-Based Dementia Interventions to the CommunityTo register to attend live webinars go to: http://asaging.org/series/110/national-alzheimers-and-dementia-resource-center-series

Dementia-Capability ToolsState Entities: Dementia Capability Quality Assurance Assessment Tool

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Dementia Friendly America: http://www.dfamerica.org/about-dfa/ Slide41

National Partnership to Improve Dementia Care in Nursing Homes:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.htmlResource repository: https://www.nhqualitycampaign.org/dementiaCare.aspxCMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident

Centers for Medicare & Medicaid Services

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In December CMS issued Frequently Asked Questions to clarify how providers can assist Medicaid beneficiaries with ADRD receiving home and community-based services (HCBS) to live self-determined lives in fully integrated community settings

The guidance addresses person-centered planning, promising practices, staff training, and care delivery and includes many suggestions HCBS settings should not restrict individuals unless it is in the person-centered plan, all less restrictive interventions have been exhausted, and any restriction is regularly reassessedInformation at: https://www.medicaid.gov/medicaid/hcbs/guidance/index.html

Centers for Medicare & Medicaid Services

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Guidance on Unsafe Wandering and Exit-SeekingSlide43

Primary Care and Care Coordination: CMS covers enhanced payment for chronic care management, including payment for enhanced care management furnished following the initiating visit for beneficiaries with multiple chronic conditions

Mental and Behavioral Health: CMS pays for specific behavioral health services and other approaches to behavioral health integration including the “Collaborative Care Model,” and other team-based care Cognitive Impairment Care Assessment and Planning: A new code pays for cognitive and functional assessment and care planning for beneficiaries with cognitiveNEJM article by Patrick Conway, CMS’s Acting Administrator et al.: http://www.nejm.org/doi/full/10.1056/NEJMp1614134?af=R&rss=currentIssue

Centers for Medicare & Medicaid Services

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New Codes in Medicare’s 2017 Physician Fee Schedule Slide44

CMS’s New Person and Family Engagement Strategy

Enhances person and family engagementEstablishes definitions and consistency for frequently used terms to help people engage in their healthcareServes as a guide to support meaningful, intentional application of person and family engagement principles to all policies and programs addressing health, and wellbeingCreates a foundation for expanding awareness and enhance person and family engagement across CMS programs Strategy at:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo

/Person-and-Family-Engagement.htmlSlide45

Geriatrics Workforce Enhancement Program (GWEP)

Integrates geriatrics with primary careTrains providers who can assess and address the needs of older adults and their families or caregivers at the individual, community, and population levels Provides Alzheimer’s disease and related dementias education to patients, families, caregivers, direct care workers, and health professions students, faculty, and providers

Maximizes patient and family engagement

Awardee abstracts & contact information can be found at:

https://ersrs.hrsa.gov/ReportServer/Pages/ReportViewer.aspx?/HGDW_Reports/FindGrants/GRANT_FIND&ACTIVITY=U1Q&rs:Format=HTML4.0

BHW’s geriatrics program aims to improve health outcomes for older adults.

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Brain Health Resource

Evidence-based materials to facilitate conversations about brain health as we age Developed by ACL, NIH, CDC of the U.S. Department of Health and Human ServicesPlain languageFor use in community settings with older adults, people with disabilities, and caregivershttp://www.acl.gov/Get_Help/BrainHealth/Index.aspx 46Slide47

Recruiting Older Adults into Research ROAR Toolkit

https://www.nia.nih.gov/health/publication/roar-toolkit47

ACL-NIH-CDC

Toolkit includes:

User Guide:

Tips for use

FAQs

Social media messages

Short & long slide decks with speaker notes

Customizable flyers

Now available in Spanish and Chinese!Slide48

Financial Exploitation of Older Adults

Peter A. Lichtenberg, Ph.D., ABPPDirector, Institute of GerontologyProfessor of PsychologyWayne State UniversityDetroit, MI48202Slide49

Knowledge to Gain from this SectionDefinitions of Financial exploitation

Prevalence and Risk FactorsScreening for Financial exploitationResearch by Alzheimer’s disease Research CentersFederal Consumer Information Slide50

Six Domains of

Financial Exploitation

Conrad et al. (2010)

THEFT & SCAMS

COERCION

SIGNS OF POSSIBLE FINANCIAL EXPLOITATION

FINANCIAL ENTITLEMENT

ABUSE OF

TRUST

MONEY MANAGEMENT DIFFICULTIESSlide51

Hybrid FE

: More likely to co-habitate and suffer from dementia; Lost an average of $185,574; also suffered physical abuse and/or neglectPure FE: Lost an average of $79,422; theft most common form (47%); fraud (32%)

Jackson and

Hafemeister

(2012)

Types of Financial Exploitation CasesSlide52

Acierno

(2010): 5772 National Prevalence Sample 5% older adults victim of FE (not including scams) 2nd only to emotional abuseBeach (2010): 10% older adults victim of FE since age 60 (including scams)

Lichtenberg (2013): 1.1% older adults victim of fraud each year

Predictors

: Psychological factors, financial factors, Vulnerability factors

Lachs

et al. (2013) Under-reporting: 1 in 23 cases get reported.

Financial Exploitation PrevalenceSlide53

Triggers and Screening

Identify new patterns of financial transactions: more frequent withdraws, wiring money, accompanied by others to bankIdentifying cognitive decline and impairment: not recalling transactions, financial management mistakes, change in hygieneNumeracy (Wood, 2016), Financial Skill decline (Marson, 2001-present)Financial decision making (Boyle 2012-present; Lichtenberg 2014-present)Slide54

Research at Alzheimer's disease CentersDaniel

Marson and colleagues, University of Alabama BirminghamPatricia Boyle and colleagues, Rush UniversityPeter Lichtenberg, University of Michigan ADRCSlide55

Highlights of my research

Financial decision making is not simply a cognitive taskPsychological Vulnerability, financial experience and self-efficacy and susceptibility to influence also importantNew Rating and Screening Scales (screening scale 10 items) tied to legal standards and Appelbaum and Grission decisional abilitieshttps://olderadultnestegg.com training site, web, mobile web scale administration and scoringSlide56

Keys to successful interventionPlanning ahead

Skill with difficult conversationsUnderstanding Adult Protective Services, Bank’s roleProbate—conservatorship, guardianship optionsSlide57

Federal websites

https://www.consumerfinance.gov/ insure banks treat you fairlyhttps://www.ftc.gov/ alert consumers to fraud and scamshttps://www.alz.org/documents/centralcoast/Safety_27_Preventing_Financial_Abuse.pdf Alzheimer’s Associationhttps://www.justice.gov/elderjustice/financial-exploitation-1 Slide58

Depression and Dementia: A Confounding Conundrum

Mark Snowden, MD, MPH

Associate Professor

University of Washington

Department of Psychiatry and Behavioral SciencesSlide59

Agenda

Relationship RatesWhy do they occur together?Differential DiagnosisTreatment ImplicationsResourcesSlide60

DSM 5 MAJOR DEPRESSION CRITERIA

1) Depression/Sadness2) Anhedonia(Loss of Interest, Pleasure)

3) Anorexia/Wt

loss

4) Insomnia or Hypersomnia

5) Psychomotor Agitation or Retardation

6) Fatigue

7) Feelings of Worthlessness/Guilt

8) Indecisiveness/Trouble Concentrating

9) Recurrent Thoughts of Death/SuicideSlide61

Depression of Alzheimer’s Disease (Provisional)

1) Clinically significant depressed mood (sad, hopeless, discouraged, tearful)2) Decreased positive affect or pleasure to social contact, usual activities3) Social isolation or withdrawal4) Disruption in appetite5) Disruption in sleep6) Psychomotor changes (e.g. agitation, retardation)7) Irritability

8) Fatigue or loss of energy9) Worthlessness, hopelessness, inappropriate guilt10) Recurrent thoughts of death, suicidal ideation

Olin JT et al. Am J

Geriatr

Psychiatry 2002;10:125-128Slide62

DSM 5 Dementia Cognitive Domains

Memory ImpairmentLanguageMotor coordinationRecognition Executive FunctionAttentionSocial CognitionSlide63

Depression risk for MCI and Dementia

Richard, E et al JAMA Neurol 2013;70(3):383-389

At Risk

Cases

HR(95% CI)

All MCI (N=304)

No

Depression

1209

257(21.3%)

Depressed

266

47(17.7%)

0.9(0.7-1.2)

All Dementia (N=207)

No Depression

1567

155(9.9%)

Depression

376

52 (13.8%)

1.7(1.2-2.3)Slide64

Depression risk for incident dementia in those with MCI at Baseline

At Risk

CasesHR(95% CI)

All Dementia (N=67)

No Depression

326

45(13.8%)

Depression

103

22(21.4%)

2.0 (1.2-3.4)

Vascular (with AD)

No Depression

285

4

(1.4%)

Depression

86

5

(5.8%)

4.3 (1.1-

17

)

Richard, E et al JAMA

Neurol

2013;70(3):383-389Slide65

Research QuestionsAre rates of depression higher with dementia?

Is dementia associated with depression onset?SampleDataset from 34 Alzheimer’s Disease Centers, 2005–13 N = 27,776, 57% women, mean age 73.3 (10.5)80% White, 14% African-American, 8% HispanicSnowden, M et al; Am J Geriatric Psych 2015 Sep 23(9):897-905

Dementia as Risk for Depression? Slide66

Findings

Normal

CognitionN = 10,194MCI

N =

7,096

Dementia

N

= 10,486

Depression at index (GDS-SF > 5)

5%

14%

17%

Depression at index (clinical diagnosis)

18%

35%

43%

Adjusted

o

dds

of elevated depression

OR = 2.40 (2.25 – 2.56)

OR = 2.64

(2.43 – 2.86)

Developing

depression over time --2

yrs

: - -4

yrs

:

10%

20%

22%

38%

25%

43%

Snowden, M et al; Am J Geriatric

Psych 2015 Sep 23(9):897-905Slide67

Explanations for the AssociationsBest answer is no one knows. Slide68

Diagnostic HeterogeneityDepression Differential

Dx Major DepressionPersistent Depression/DysthymiaAdjustment Disorder –depressedBereavement/GriefBipolar Mood Disorder-depressedDepression NOSDementia Differential Dx

Alzheimer’s VascularLewy Body/Parkinson’sFrontotemporalTraumaMixedDementia NOSSlide69

Explanations for AssociationsLarge Scale Hypothesis

Frailty/Brain reserve as common denominatorSlide70

FrailtyWeaknessSlowness

FatigueLow ActivityUnintentional weight lossSlide71

Frailty as Mediator

FrailtyDementia

DepressionSlide72

Explanations for the AssociationsPathophysiological

Vascular disease(e.g. micro-ischemia in neuroimaging)Inflammation(e.g. elevated C-reactive Protein, Interleukin)Stress response(e.g. elevated glucocorticoid)Slide73

Treatments

Pimontel M, et al, Am J Geriatr Psychiatry 2016; 24:31-41Nelson JC, Devand

DP; J Am Geriatr

Soc

2011;59(4):577-85

Meta-analyses increasingly show decreased evidence of antidepressant effectiveness as cognitive impairment increases.Slide74

Randomized Controlled PragmaticTrial 2007 - 2010

N= 326 subjectsRandomized to Control, Sertraline, Mirtazapine12 wks treatmentNo benefit of either antidepressant vs placeboAt 13 wks At 39 wksBannerjee

, S et al; Lancet, 2011 Jul 30;378(9789):403-11 Slide75

Community Based Treatments

Collaborative Care Treatments (E.g. IMPACT, PROSPECT, PEARLS)Combine psychosocial treatment with antidepressantExclude persons with dementiaLimited evidence that Tx works for those with MCISlide76

Psychosocial InterventionProblem Adaptation Therapy (PATH)

N=74 subjects(39 with mild-moderate dementia severity)Major DepressionPATHProblem Solving Tx + Environmental Adaptation + Caregiver InvolvementRCT: PATH vs Supportive therapyRemission Rate: PATH= 37.84% vs 13.51% Supportive (p =.02)No difference in remission x dementia category

Kiosses D et al;

JAMA Psychiatry. 2015;72(1):22-30Slide77

Conclusion

Depression is associated with incident DementiaDementia is associated with incident DepressionDepression treatment/prevention offers opportunity toDecrease risk for dementia(Depression as Risk Factor)Decrease the severity of dementia (Depression as prodrome)Depression outside of dementia can be treated effectivelyLimited evidence base for effective treatment of Depression in Dementia patientsExisting evidence points to important role of psychosocial componentSlide78

Resources

Alzheimer’s Association Tools for Early Identification and Treatmenthttps://www.alz.org/national/documents/

brochure_toolsforidassesstreat.pdf

Aging and Disability Evidence-Based Programs and Practices (ADEPP) and top tier for the Older Americans Act Title III-D Disease Prevention & Health Promotion

http://www.acl.gov/Programs/CDAP/OPE/ADEPP.aspx

SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP)‏

http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=29

AHRQ Healthcare Innovations Exchange

http://www.innovations.ahrq.gov/content.aspx?id=2613

PEARLS Evidence Based Treatment for Depression

http://www.pearlsprogram.orgSlide79

Stay Up to Date on Alzheimer’s & Dementia

Social mediaTwitter: @Alzheimers_NIH, @ACLgov, @AoAgovFacebook: www.facebook.com/AoA.gov, www.facebook.com/NIHAgingYouTube: https://www.youtube.com/NatlInstituteOnAgingE-AlertsCDC: http://www.cdc.gov/Other/emailupdates/

ACL: https://public.govdelivery.com/accounts/USACL/subscriber/newNIA:

https://www.nia.nih.gov/contact/stay-connectedSlide80

Slides, audio and transcript will be posted on-line, generally within 2 weeks after the live webinar at

https://nadrc.acl.gov/ and https://www.nia.nih.gov/alzheimers/announcements/2017/02/2017-alzheimers-and-dementia-webinars-professionalsFree CEs for this will be available for up to 2 years after the live webinar (through 4/4/2019).80

Questions?Slide81

Information ON CE CReditSlide82

ACCREDITATION STATEMENTS

CNE: The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Center's Commission on Accreditation. This activity provides 1.5 contact hours. CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 0.2 CEU's for this program.CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to

1.5 total Category I continuing education contact hours. Maximum advanced level continuing education contact hours available are

0

CDC provider number

GA0082.

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Instructions for requesting CE

For best functioning, please use a browser other than Internet Explorer (e.g., Firefox, Chrome)Go to http://www.cdc.gov/TCEOnline, and log in (you may need to register as a new participant). After successful log in, the “Participant Services” menu displays. Select “Search and Register”. Select option 2, “Keyword Search”, and enter the course WC2463

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The post-test is required and will follow the evaluation.

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If you have any questions or problems accessing the continuing education, please contact:

CDC/ATSDR Training and Continuing Education Online 1-800-41TRAIN Email at ce@cdc.govInstructions for Requesting CE (Webcast) (3/1/17-4/3/17):https://www2a.cdc.gov/TCEOnline/registration/detailpage.asp?res_id=6416&Preview=Y Instructions for Requesting CE (Web on Demand) (4/4/17-4/4/19):https://www2a.cdc.gov/TCEOnline/registration/detailpage.asp?res_id=6417&Preview=Y

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