Wisconsin Alzheimer’s Institute: Dementia Diagnostic Clinic Network

1. Wisconsin Alzheimer’s Institute: Dementia Diagnostic Clinic Network Mark A. Sager, MD Professor of Medicine and Population Health Sciences and Director, Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health

2. WISCONSIN ALZHEIMER’S INSTITUTE Wisconsin Alzheimer’s Institute (WAI)1998-2008 • Dementia Diagnostic Clinic Network • Public and Health Professional Education • Research

3. TheGoalsoftheWAIProgramareto: • 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

4. WISCONSIN ALZHEIMER’S INSTITUTE WAI-Affiliated Dementia Diagnostic Clinic Network Guidelines: • Interdisciplinary assessment • Affiliation with a medical organization • Physician, physician’s assistant or nurse practitioner • Neuropsychological testing • Data collection • Tied to local Alzheimer’s Association Chapter

5. WISCONSIN ALZHEIMER’S INSTITUTE WAI-AffiliatedDementia DiagnosticClinic Network Marquette, MI 3000newevaluationsannually 33 clinics total as of 5/08

6. WAI-Affiliated Dementia Diagnostic Clinic Network November 2007 – June 2008 (N = 622)

7. 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

8. WISCONSIN ALZHEIMER’S INSTITUTE Promoting the Wisconsin IDEA – Education Continuing Medical Education General Public

9. WISCONSIN ALZHEIMER’S INSTITUTE MMSE – Diagnostic Accuracy Sensitivity – 47 Specificity - 100 184

10. WISCONSIN ALZHEIMER’S INSTITUTE Clock Draw – Diagnostic Accuracy Sensitivity – 77 Specificity - 74

11. WISCONSIN ALZHEIMER’S INSTITUTE Animal Fluency – Diagnostic Accuracy Sensitivity – 90 Specificity - 76 186

12. WISCONSIN ALZHEIMER’S INSTITUTE Wisconsin Dementia Research Consortium Study Animal Naming Diagnostic groupAbnormal (< 14) Normal (≥ 14) Normal Cognition 12% 88% AD 85% 15% Other dementia 85% 15%

13. WISCONSIN ALZHEIMER’S INSTITUTE Barron Chippewa Dunn Door Kewaunee Eau Claire La Crosse Memory Screening Initiative Memory Care Connections Richland Milwaukee Jefferson Rock Wisconsin MemoryScreening InitiativeandMemory Care Connections

14. WISCONSIN ALZHEIMER’S INSTITUTE 2004 Medicaid Costs for Wisconsin NH 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)

15. WISCONSIN ALZHEIMER’S INSTITUTE Length of Stay at Nursing Home

16. WISCONSIN ALZHEIMER’S INSTITUTE – + _ Re-Screen at Intervals Cognistat + Referral to MD Diagnose and Treat Refer to Dementia Diagnostic Clinic County Services and/or Alzheimer’s Association County Services and/or Alzheimer’s Association Memory Screening Process Animal Naming screen Adults > 60 years with possible memory problems

17. WISCONSIN ALZHEIMER’S INSTITUTE Animal Naming Name:_________________________ ID #:_______________ Date:___________ 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

18. WISCONSIN ALZHEIMER’S INSTITUTE Healthy Older Adult COGNITIVE STATUS PROFILE

19. WISCONSIN ALZHEIMER’S INSTITUTE Person with Dementia COGNITIVE STATUS PROFILE

20. WISCONSIN ALZHEIMER’S INSTITUTE Cognitive Screening Results – 8 Wisconsin Counties Persons approached 1244 Persons screened 1120 (90%) Persons screened positive 370 (33%) (range 22%-58%) Abnormal Cognistat 92%

21. Take ChargeA Memory Wellness Program Asenath La Rue, PhD Senior Scientist, Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health WISCONSIN ALZHEIMER’S INSTITUTE

22. Target population Individuals 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 Madison 1st subject enrolled in June, 2007; last enrolled in November, 2007 Take ChargeA Memory Wellness Program WISCONSIN ALZHEIMER’S INSTITUTE

23. 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 WISCONSIN ALZHEIMER’S INSTITUTE Take ChargeProgram Structure

24. 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 WISCONSIN ALZHEIMER’S INSTITUTE