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

Wisconsin Alzheimers Institute (WAI) Dementia Diagnostic Clinic Network Public and Health Professional Education Research WISCONSIN ALZHEIMERS INSTITUTE

The Goals of the WAI Program are to: 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

WAI-Affiliated Dementia Diagnostic Clinic Network Guidelines: 1.Interdisciplinary assessment 2.Affiliation with a medical organization 3.Physician, physicians assistant or nurse practitioner 4.Neuropsychological testing 5.Data collection 6.Tied to local Alzheimers Association Chapter WISCONSIN ALZHEIMERS INSTITUTE

Marquette, MI WAI-Affiliated Dementia Diagnostic Clinic Network 33 clinics total as of 5/ new evaluations annually

Treatment prescribed n Cholinesterase inhibitors171 Memantine38 Non-pharmacologic 257 Other: Activate POA- HC, antidepressant, etc 240 Diagnosis% Normal6% MCI17% SDAT31% Vascular7% Mixed12% LBD1% FTD2% Sleep disturbance1% Depression4% Other: Bipolar, alcohol abuse,, parkinsons, epilepsy, ADD, anxiety,etc 18% TESTMean (SD) MMSE (0-30)23 (6) Animal Fluency12 (5) CERAD Trial 13 (2) Trial 25 (2) Trial 36 (2) Delayed Recall3 (3) NCSE Orientation (4-12)9 (3) Attention (1-7)7 (2) Comprehension (2-6)5 (1) Repetition (5-13)11 (2) Naming (2-9)7 (2) Construction (0-5)3 (2) Memory (4-12)6 (3) Calculations (0-4)3 (1) Similarities (2-8)5 (2) Judgment (1-6)4 (2) WAI-Affiliated Dementia Diagnostic Clinic Network November 2007 – June 2008 (N = 622)

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

WISCONSIN ALZHEIMERS INSTITUTE Continuing Medical Education General Public Promoting the Wisconsin IDEA – Education

MMSE – Diagnostic Accuracy Abnormal (< 24) (%) Normal ( 24) (%) Normal0100 AD6040 Vascular5248 Mixed7129 Lewy Body7129 Frontal Lobe3169 Sensitivity – 47 Specificity WISCONSIN ALZHEIMERS INSTITUTE 184

Clock Draw – Diagnostic Accuracy Abnormal(8) % Normal(> 8) % Normal2674 AD8713 Vascular8218 Mixed8614 Lewy Body955 Frontal Lobe7129 Sensitivity – 77 Specificity - 74 WISCONSIN ALZHEIMERS INSTITUTE

Animal Fluency – Diagnostic Accuracy Sensitivity – 90 Specificity - 76 Abnormal (< 17) (%) Normal (> 17) (%) Normal2476 AD919 Vascular9010 Mixed1000 Lewy Body1000 Frontal Lobe1000 WISCONSIN ALZHEIMERS INSTITUTE 186

Wisconsin Dementia Research Consortium Study WISCONSIN ALZHEIMERS INSTITUTE Animal Naming Diagnostic groupAbnormal (< 14)Normal ( 14) Normal Cognition12%88% AD85%15% Other dementia85%15%

WISCONSIN ALZHEIMERS INSTITUTE Wisconsin Memory Screening Initiative and Memory Care Connections Milwaukee La Crosse Richland Memory Screening Initiative Eau Claire Door Kewaunee Jefferson Rock Barron Dunn Chippewa Memory Care Connections

WISCONSIN ALZHEIMERS 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)

WISCONSIN ALZHEIMERS INSTITUTE Length of Stay at Nursing Home

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

Animal Naming WISCONSIN ALZHEIMERS INSTITUTE Introduction: Id 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 dog cat cow pig sheep horse lion tiger cat mouse ant spray dandelion bird Name:_________________________ ID #:_______________ Date:___________

WISCONSIN ALZHEIMERS INSTITUTE LOCORIATTLANGUAGE CONS T ME M CAL C REASONIN G COM P REPNAMSIMJUD AVG. RANGE - ALERT (S) (S) (S) (S) (S) (S) (S) (S) MILD MODERATE SEVERE --IMP Write in lower scores COGNITIVE STATUS PROFILE Healthy Older Adult

WISCONSIN ALZHEIMERS INSTITUTE LOCORIATTLANGUAGE CONS T ME M CAL C REASONIN G COM P REPNAMSIMJUD AVG. RANGE -ALERT (S) (S) (S) (S) (S) (S) (S) (S) MILD MODERATE SEVERE --IMP Write in lower scores COGNITIVE STATUS PROFILE Person with Dementia

Cognitive Screening Results – 8 Wisconsin Counties WISCONSIN ALZHEIMERS INSTITUTE Persons approached1244 Persons screened1120 (90%) Persons screened positive370 (33%) (range 22%-58%) Abnormal Cognistat92%

Take Charge A Memory Wellness Program Asenath La Rue, PhD Senior Scientist, Wisconsin Alzheimers Institute, University of Wisconsin School of Medicine and Public Health WISCONSIN ALZHEIMERS INSTITUTE

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 1 st subject enrolled in June, 2007; last enrolled in November, 2007 Take Charge A Memory Wellness Program WISCONSIN ALZHEIMERS INSTITUTE

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 ALZHEIMERS INSTITUTE Take Charge Program Structure

Whats unique about Take Charge Offered through a memory clinic system Individualized programming of activities Systematic measurement of outcomes One year duration Take Charge WISCONSIN ALZHEIMERS INSTITUTE