Doctor and patient smiling

Medication bottles next to the coffee maker or scheduling exercise in the calendar are helpful reminders for managing health conditions and lifestyle behaviors. People of every age rely on reminders, timers, schedules or health apps to keep them on track. Cognitive impairments and various forms of dementia make managing health even more challenging. 

Over five million Americans age 65 and older are living with Alzheimer’s. This number could nearly triple by 2050, according to the Alzheimer’s Association’s 2020 Alzheimer’s Disease Facts and Figures.  The month of June is designated as Alzheimer’s and Brain Awareness Month to increase awareness. As with many chronic conditions, age is a risk factor and symptoms of Alzheimer’s are often missed.  

“Individuals at every age have moments of forgetfulness. Understanding the difference between the common lapse and true cognitive impairment can be difficult,” commented Stacie Fredenburg, quality improvement advisor for Great Plains Quality Innovation Network. “Those with a family history should be especially aware and engage their family and healthcare provider in recognizing early signs.” 

 There are 10 early signs and symptoms of Alzheimer’s to note:  

  1. Memory loss that disrupts daily life 
  2. Challenges in planning or solving problems 
  3. Difficulty completing familiar tasks 
  4. Confusion with time or place 
  5. Trouble understanding visual images and spatial relationships 
  6. New problem with words in speaking or writing 
  7. Misplacing things and losing the ability to retrace steps 
  8. Decreased or poor judgment 
  9. Withdrawal from work or social activities 
  10. Changes in mood or personality 

A cognitive assessment by a healthcare professional is the first step for early diagnosis. The Alzheimer’s Association developed the Medicare Annual Wellness Visit Algorithm to provide guidance for conducting an assessment using either of the two recommended tools: General Practitioner Assessment of Cognition (GPCOG) and the Mini-Cog.  

University of North Dakota Geriatric and Age Friendly Care TeleECHO Sessions/Great Plains QIN Huddles

Dr. Donald Jurivich, geriatric professor at the University of North Dakota, provided an in-depth overview of mild cognitive impairment risks, diagnosis and treatment in the Geriatric and Age-Friendly TeleECHO held on June 9, 2020. The presentation discussed how metabolic syndrome and diabetes increase risk for cognitive impairment and high cholesterol may also play a role. In a follow-up huddle on June 16, the Great Plains Quality Innovation Network team led a conversation on how mild cognitive impairment impacts the lives of our loved ones and offered best practices and resources to support caregivers, family members and individuals living with cognitive impairment. Presentation slides and the recording can be accessed on the Great Plains QIN Web site.

According to the National Council on Aging, 80 percent of Americans 65 and older have at least one chronic condition, such as diabetes or cardiovascular disease, and 68 percent have two or more.  The Centers for Disease Control and Prevention reported over 40 percent in this same age category have five or more prescriptions, some of which may cause cognitive side effects that mirror symptoms of dementia.   

“Mind and body are connected. Actively managing diet, exercise and stress can improve overall health at any age. While easy to say, developing these habits takes time and effort,” added Fredenburg. “We all need support to find the lifestyle changes that work for us. The key is to keep trying.”    

Healthcare providers can offer referrals to nutritionists, health coaches or educators based on individual health issues. In addition, chronic disease self-management programs are available to provide valuable tools, support and resources.  

The Great Plains QIN values collaboration and is bringing together community and healthcare stakeholders to address challenges and seek solutions while also preventing duplication of effort.  Their focus is on five goal areas identified by the Centers for Medicare & Medicaid Service (CMS), many of which directly impact individuals living with Alzheimer’s.  

  1. Improve Behavioral Health Outcomes, with a focus on decreased opioid misuse 
  2. Increase Patient Safety 
  3. Increase Chronic Disease Self-Management 
  4. Increase Quality of Care Transitions 
  5. Improve Nursing Home Quality  

Those interested in joining the Great Plains Quality Care Coalition can learn more on the Great Plains QIN web site.