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Following National Alzheimer’s Disease Awareness Month, the CDC shares what physicians and patients need to know about the disease. Lisa McGuire, PhD, lead epidemiologist at CDC discusses the importance of catching Alzheimer’s early, its risk factors and barriers to make Alzheimer’s screening more pervasive in primary care. AMA Chief Experience Officer Todd Unger hosts.
- Learn more about the types of dementia and causes of Alzheimer's disease on the CDC website.
- Access CDC resources for signs of dementia and symptoms of Alzheimer's disease.
- For more on memory loss chronic and chronic health conditions, visit CDC's Healthy Body, Healthier Brain.
- Check out BOLD Public Health Center of Excellence on Early Detection and Diagnosis.
- Physician resources on Alzheimer's disease management and research on cognitive assessment toolkit in primary care.
- The AMA is your powerful ally in patient care. Join now.
Speaker
- Lisa McGuire, PhD, lead epidemiologist, CDC
Transcript
Unger: Hello and welcome to the AMA Update video and podcast, following National Alzheimer's Disease Awareness Month in November, talking about the importance of screening for Alzheimer's and dementia, and what physicians need to know. I'm joined today by Dr. Lisa McGuire, lead of the Alzheimer's Disease Program at the CDC. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. McGuire, welcome. It's a pleasure to have you today.
Dr. McGuire: Thank you, Todd. I'm excited to be here as well.
Unger: Well, before we dive in, and for those who don't know, can you start by briefly clarifying the difference between Alzheimer's disease and dementia and how the two are related?
Dr. McGuire: That's a really good question, Todd. Alzheimer's disease is a specific type of dementia, whereas dementia is not a specific disease. Rather, it is a general set of symptomology or symptoms that can impair a person's ability to remember, think or make decisions. Really, with dementia or Alzheimer's disease, we do see that it interferes with someone's functioning in their daily lives.
Unger: Well, know the burden of dementia on our health care system. It's already significant. And forecasts suggest that it's only going to get worse. Tell us a little bit more about that burden and what's driving it.
Dr. McGuire: The burden of Alzheimer's disease is significant in the U.S., both on terms of the number of individuals, but really looking at the impact on the people and their caregivers who have the disease as well as the cost and the impact on our health care system. We do see that as people get older, the likelihood of them developing Alzheimer's disease or another type of dementia is likely to increase. We do know that Alzheimer's disease, especially with that increase in—as people get older, sometimes it can also complicate some of the diseases that a person or a provider might be managing or treating. We know Alzheimer's in itself or dementia is underdiagnosed and undertreated and that it really can benefit from early detection. And it will help also manage those other comorbid conditions that a person may have.
Unger: I want to pick up on what—something you just said about it being underdiagnosed, particularly in primary care, where screening is, obviously, key to at least relieving some of that burden. Why is it so important to catch this disease early? And what difference does that end up making for both the patient and our health care system?
Dr. McGuire: Well, being able to get a diagnosis early if it's appropriate is really important not only for the person who has the disease, but also for the family, and also the health care system, as well, too. So we know that there are some benefits of getting a diagnosis preferably as early in the disease process as possible.
So now we have the approval of some new disease-modifying therapies that we haven't had before. So this is a new advance in 2023. And so with that, it is another benefit for people to get a diagnosis, or at least to talk with their health care provider earlier rather than later because the evidence shows that those medications are only effective in the earlier stages of the disease. So even if a person isn't eligible for that disease-modifying therapy, there are some other medications that have been available for quite a while that really have the ability to slow the progress of the disease process.
The other things with the early detection and diagnosis, too—many times, it brings some peace to the family as well as the person with dementia. They may have a recognition that something just isn't quite right, or at least they recognize that something's different and may be searching and going from provider to provider to try to identify what that answer is. And so getting that actual diagnosis may provide some clarity, but also give people an opportunity to do some of the things that they've been wanting to do, whether it's that big whirlwind trip they've always wanted to take, whether it's also joining and participating in clinical trials, or whether it is just spending quality time and make—with their family and their loved ones, or even planning for their own future and their future care.
Unger: Dr. McGuire, are there any risk factors that physicians and patients need to be aware of for Alzheimer's and dementia?
Dr. McGuire: Well, age is the best known risk factor for Alzheimer's disease as well as family history. But the thing is the genetics are not inevitable. We know that there are modifiable risk factors. And the evidence is growing and growing almost daily or weekly on those—the benefits of those healthy behaviors. So these risk factors that are modifiable really are healthy behaviors, or the same behaviors that we know can help prevent other conditions, such as diabetes or heart disease, or can be beneficial in managing those conditions.
Unger: Tell us more about these modifiable behaviors that you can—say could have a positive effect.
Dr. McGuire: Well, many people say what's good for your heart is good for your brain. But I like to say what is good for your brain is also good for your heart. The most notable of those healthy behaviors that can reduce a person's risk or delay the onset of Alzheimer's or dementia are some of the ones that we want to see people engage in regardless as health care providers. We want people to be physically active. We know that that will help their overall health and well-being, but also their brains and their heart, same as quitting or never smoking and really engaging in heart-healthy behaviors, such as managing midlife hypertension if they do have hypertension and really trying to avoid or manage diabetes, and also trying to reduce midlife obesity.
We know that there's a lot of evidence on—really, the strongest evidence that there is is related to those cardiovascular health risk factors. But there's strong evidence on exercise, diabetes, obesity, traumatic brain injury, both tobacco and alcohol, nutrition and diet, sleep, sensory impairments, and also social engagement.
Unger: So interesting to hear you talk about the similarities between those modifiable behaviors, so to speak. And given the huge upside of identifying this disease early in its stages and making people aware of the risks and even prevention factors, what's keeping screening from becoming more pervasive and a regular part of primary care?
Dr. McGuire: That's a really good question, Todd. And I think there's a—it's a really, I think—a—multi-pronged reasons or multi-pronged approaches need to happen to really make that happen. For one, it's from the patient perspective. We know based on CDC data that people who say, "My memory has gotten worse in the past year," less than half of them have spoken with a health care provider about it.
There's also a lot of confusion, I think, from the patient perspective on what is normal aging as you get older and—related to cognition, and also what is not normal or expected. So I think many times, patients don't know when to ask questions of their health care provider. But at the same time, there's also a stigma. Many people have of—have seen someone who has Alzheimer's disease and dementia.
And it's not necessarily—there's some fear related to the disease. And I think it really goes back to many years ago with cancer. We didn't like to say that word. We called it "the C-word." And so as the science evolved and as some of the fear and the stigma reduced, we see patients that are more willing to raise those conversations with their providers.
From the provider side, really, providers have a lot of demands. They have not a lot of time with patients. And they've got to get a whole lot done in that very limited time.
Some of the research shows that some providers may lack confidence, especially in primary care, in diagnosing and treating dementia. And sometimes, they're also—if you wanted to refer a patient out, there may not be a place to easily refer that patient out for some additional testing or diagnostic procedures. Sometimes, the memory centers have extremely long waits or extremely long drives, which can be barriers to the patients, and also barriers to the providers for making those referrals.
Also, we need to think about, too, from a system approach. So with that need for a cognitive evaluation, how can it be integrated into the existing workflow in the clinical environment to make it something that occurs more frequently, especially when there's suspicion of cognitive decline? But I encourage people—providers who are interested in learning more to visit our BOLD Public Health Center of Excellence on Early Detection and Diagnosis—they have a wealth of resources and materials available—as well as Cognition and Primary Care at the University of Washington. And what they're doing is they're really looking at some of those systems issues and some of the provider training issues. And they're doing a pilot implementation within their whole health care system on implementing a specific model that's called KAER. It's K-A-E-R. So K is "kick start the conversation." A is "assess." E is "evaluate." And R is to "refer."
Unger: Dr. McGuire, you outlined a lot of challenges, namely, just the amount of time that folks have to see patients. Tell us a little bit more about how the CDC is working with partners to address so many challenges and what you're trying to achieve.
Dr. McGuire: Well, there's a lot of work that still needs to be done. CDC—we are working to think about that multi-pronged approach. We are working with our BOLD Center of Excellence on Early Detection, as well as other professional medical organizations, to make sure providers have the information, the tools, materials, resources they need to feel comfortable and confident in talking to their patients about their cognition, and also starting to do some of those assessments and diagnosis.
On the other side of the equation, CDC is working through other partner organizations to really educate the public about Alzheimer's disease and dementia, and really talk about what some of the signs and symptoms are and how they might be different than normal aging. So for example, my husband and I have been married for almost 35 years. The entire time that I've known him, he cannot keep track of a set of car keys. He just—he gets out of the car, sometimes leaves them in the car, sometimes drops them in the couch.
But if we used that as a diagnostic procedure for Alzheimer's disease or dementia for my husband, he would have been diagnosed in his 20s. But at this point, buy him an AirTag. And that seems to help him identify where his keys are. So what I'm trying to say here is it's also understanding the person and the way that person was functioning and operating before we started to notice some of these changes.
Unger: Well, Dr. McGuire, thank you so much for joining us today and sharing this important information. That wraps up today's episode. If you enjoyed this discussion, you can support more programming like it by becoming an AMA member at ama-assn.org/join.
We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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