Alzheimer’s Disease and Dementia: What Healthcare Practitioners Need to Know

Julie Brightwell, JD, RN, Director, Healthcare Systems Patient Safety, The Doctors Company

According to the Alzheimer’s Association, Alzheimer’s disease, the most common cause of dementia, accounts for 60 to 80 percent of all dementia cases. An estimated 6.7 million Americans are currently living with Alzheimer’s dementia and the number of new cases is projected to double by 2050—affecting 12.7 million Americans aged 65 and older.¹ Additional facts to consider:

• For 2020–2021, Alzheimer’s disease is officially listed as the seventh-leading cause of death in the United States. It is also a leading cause of disability and poor health, often for many years prior to death.
• Almost two-thirds of Americans with Alzheimer’s are women.
• Between 2000 and 2019, the death rates from Alzheimer’s increased 33 percent for individuals aged 65 through 74; 51 percent for those 75 through 84; and 78 percent for those 85 and older.¹
• The large increase in the number of patients with dementia will be met with an extreme shortage of specialists, particularly geriatricians, to diagnose and manage treatment.¹

Diagnosing Alzheimer’s Disease

Early diagnosis of Alzheimer’s, often with the primary care practitioner as the first point of contact,² provides several important benefits to diagnosed individuals and their caregivers, loved ones, and society. Alzheimer’s may begin 20 years or more before the onset of symptoms. Advances in research, including the identification of biomarkers, provide patients with an increased opportunity to intervene with actions such as addressing risk factors, using known medications, and participating in clinical studies in anticipation of new treatments.

Typically, Alzheimer’s progresses slowly in three stages: mild (early-stage), moderate (middle-stage), and severe (late-stage), with symptoms worsening over time. It is helpful for practitioners in all specialties to be able to recognize the early signs of this disease so they can refer patients with symptoms to specialists for further testing. According to the Alzheimer’s Association, the 10 early signs of Alzheimer’s are:

• Memory loss that disrupts daily life (e.g., forgetting important dates or events or repeatedly asking the same questions).
• Challenges in planning or solving problems (e.g., unable to follow a recipe or track monthly bills).
• Difficulty completing familiar tasks at home, work, or leisure (e.g., trouble driving to a familiar location or remembering the rules of a favorite game).
• Confusion with time or place (e.g., losing track of dates, seasons, or the passage of time or location).
• Trouble understanding visual images and spatial relationships (e.g., problems judging distance or determining color or contrast).
• New problems with words in speaking or writing (e.g., unable to name a familiar object or using the wrong name).
• Misplacing things and losing the ability to retrace steps (e.g., may accuse others of stealing).
• Decreased or poor judgment (e.g., difficulty handling money matters or neglecting personal grooming).
• Withdrawal from work or social activities (e.g., due to an inability to hold or follow a conversation).
• Changes in mood and personality (e.g., becoming easily upset, suspicious, depressed, or fearful).

Use cognitive assessment tools to identify patients who require further testing. Mobile applications are available. (For more information, see our article “Cognitive Assessments in Primary Care: Preparation and Tools May Mitigate Diagnosis Risks.”)

Assess for other conditions that may mimic or exacerbate dementia, such as vitamin deficiencies, heart conditions, mood disorders, drug interactions or side effects, and sleep apnea.

Disclosing an Alzheimer’s Diagnosis

Although ethical obligations require that physicians and other healthcare practitioners disclose an Alzheimer’s diagnosis, a reluctance to do so remains.

The benefits of revealing and clearly explaining an Alzheimer’s diagnosis include:

• Improved decision making. When patients are fully aware of their diagnosis in the early stages of the disease, they are more likely to be competent to understand options and provide informed consent for current and future treatment options. When patients are actively involved in decision making about their care, they are more likely to follow a care plan. (For more information, see our practice tool “Quick Check: Informed Consent Process.”)
• Access to services. Knowing the diagnosis allows caregivers to obtain information about support services and make plans.
• Safety. Awareness of the diagnosis allows caregivers to take steps to ensure the patient is in a safe environment and identify activities (such as driving) that may need to be curtailed.
• Social support. Knowing the diagnosis helps affected people focus on spending quality time with loved ones.

Managing Patient Care

Once a patient has learned of the diagnosis, healthcare practitioners can:

• Educate caregivers and patients on ways to promote activity. As the disease progresses and cognitive and functional abilities decline, patients have difficulty moving and they become more vulnerable to infection. Pneumonia is often a contributing factor to the death of patients with Alzheimer’s disease.
• Facilitate consults and implement a system to track and recall patients to ensure appropriate follow-up.
• Consider referring patients to a mental health professional. Because depression occurs in 40 percent of Alzheimer’s patients, a mental health professional can help provide treatment.
• Coordinate care with other team members, including home healthcare workers, social workers, and psychologists.
• Recommend appropriate dietary and lifestyle changes. Strong evidence suggests that the risk of cognitive decline may be decreased by making key lifestyle changes that include regular physical and social activity and maintaining good heart health.

For additional resources and screening tools, see the Alzheimer’s Project Clinical Roundtable, Physician Guidelines for the Screening, Evaluation, and Management of Alzheimer’s Disease and Related Dementias.

For assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.