The Center for Disease Control (CDC) announced their State and Local Public Health Partnerships to Address Dementia, The 2018- 2023 Road Map, as part of the CDC Healthy Brain Initiative. The Road Map helps chart a course for state and local public health agencies to prepare their communities to deal with the ever expanding need for brain-health concerns.
According to CDC and their Healthy Brain Initiative, there are at least five to six million people currently living with age-related dementias in the U.S. This translates into one out of every six women and one out of every 10 men, who live past the age of 55. As the population increases, and more Baby Boomers reach older ages, these numbers are expected to rise.
The CDC wants to stimulate changes in policies, systems, and environments. They convened experts who developed 25 actions for public health leaders to promote brain health, better care for people with cognitive impairment, increased attention to caregivers, and efforts to build public health capacity.
“Dementia is a devastating condition that impacts millions of people annually,” said Dr. Heather Pedersen, a board certified clinical neuropsychologist at the Algiers Neurobehavioral Resource, LLC, located in New Orleans.
“Dementia,” she said “is a generic term that refers to when an individual is experiencing cognitive problems––such as memory loss, difficulty with logic, or trouble with language––to such an extent that they cannot manage aspects of daily life.”
According to the CDC, while there are various forms of dementia, around 70 percent of cases are due to Alzheimer’s and the next most common type is vascular dementia. African Americans, Hispanics, and women are particularly at risk of developing Alzheimer’s and other dementias. More than 95% of people with dementia have one or more other chronic conditions. And, one in three Alzheimer’s caregivers report their health has become worse due to care responsibilities.
“There are many diseases and conditions that can lead to dementia,” Pedersen said, “with Alzheimer’s disease being the leading cause of dementia. Per the CDC, the number of adults with Alzheimer’s disease is expected to triple over the next 40 years. Alzheimer’s disease and other dementiacausing diseases impact individuals, families, friends, caregivers, health-care agencies, and communities in wide-ranging ways,” Dr. Pedersen said.
According to the CDC, they seek to promote the use of effective interventions and best practices to protect brain health, address cognitive impairment, and help meet the needs of caregivers for people with dementia. They aim to improve inclusion of healthcare quality measures that address cognitive assessments, improve the delivery of care planning to people with diagnosed dementia, and improve outcomes.
Another of the CDC’s goals is to educate public health professionals about the best available evidence on dementia, including detection. CDC Director Robert R. Redfield, MD, said. “Early diagnosis is key to helping people and their families cope with loss of memory, navigate the health care system, and plan for their care in the future.
“The importance of early detection and intervention for many dementia processes cannot be overstated,” Dr. Pedersen explained. “Some medications are more effective when started earlier and compensatory strategies can often be put into place so as to be more useful in the long run. However, in order to be able to put these interventions into place, an individual has to first be diagnosed with dementia.”
What are some of the benefits of early diagnosis of dementia?
“Early diagnosis of course allows for individuals to begin appropriate medication earlier on in the process, as there are medications for certain diseases, like Alzheimer’s, that can slow down the disease process. But, early diagnosis also allows for individuals and their families to begin to adjust and adapt their lives in ways to make good years last as long as possible,” Dr. Pedersen said. “By making slight changes to schedules, home management, or other systems, individuals can maintain independence for as long as possible.”
Can neuropsychologists’ findings help with treatments and/or treatment planning?
“Absolutely,” Pedersen said. “By helping with an accurate diagnosis, neuropsychologists can also help other providers make informed decisions about treatment options. Neuropsychologist evaluations also help by determining individual’s cognitive strengths and weaknesses,” she said.
“By maximizing strengths to compensate for weaknesses, neuropsychologists can help make suggestions to make tasks more efficient or easier to complete.”
Neuropsychologists can often help caregivers better understand issues for their loved ones and better cope with and adjust to the caring role.
“It is often very helpful for caregivers and other family members to understand the basics about what is causing the cognitive problems or dementia,” Dr. Pedersen explained. “As part of the evaluation process, clients and loved one’s are provided with feedback about what is likely causing their cognitive problems. We spend time discussing the causes, prognosis, treatments, and other strategies that might be helpful in maximizing the client to live their best life.”
In today’s medical culture, the approach is often the quick screening rather than the comprehensive assessment. Is this a concern? A quick screening may not be able to determine the cause of an individual’s cognitive problems, Pedersen explained.
“A comprehensive assessment is critical in the accurate diagnosis of dementia. There are many conditions that can masquerade as dementia and given the permanent, progressive nature of some dementias, it is vital that one isn’t falsely diagnosed,” she said. “There are many different diseases and conditions that cause dementia, some of which are treatable and some of which are not. Depression and some metabolic conditions can ‘look like’ dementia, but in fact are treatable conditions.”
The American Academy of Neurology (AAN) has recommended neuropsychological testing since 1996 for patients who may have experienced a traumatic brain injury, a stroke, Parkinson disease, multiple sclerosis, a neurotoxic exposure, or dementia. Neuropsychological testing “is particularly valuable in distinguishing between normal aging and mild dementias,” they AAN noted.
Dr. Pedersen, who earned her PhD from the University of North Dakota, and completed her postdoctoral fellowship in clinical neuropsychology at the Memphis Veterans Affairs Medical Center and UT Health Sciences Center Consortium, is licensed in Louisiana, Minnesota, and Arizona.
Among her training and research achievements, Dr. Pedersen has co-authored “The next major neuropsychological and neuropsychiatric breakthrough: Alzheimer’s disease,” for the Handbook of Neuropsychiatry Research. She also co-authored research on concussions for American Journal of Alzheimer’s Disease and Other Dementias, and co-authored “Later life health optimism, pessimism, and realism: Psychosocial contributors and health correlates,” published in Psychology and Health.
“Each person who walks through my door is a unique constellation of traits, strengths, and weaknesses, who is looking for some sort of assistance,” Dr. Pedersen said. “I find it very satisfying to come along side each client to work with them in their treatment goals.”
“That process of collaborating with my clients is a very enjoyable process for me,” she said.