Keeping Brain Health Top of Mind: Preserving Cognition and Improving Early Detection and Diagnosis of Alzheimer’s Disease

You don't want to get Alzheimers because your doctor incompetently didn't get research going to prevent it based on your higher risk post stroke. And known since medical school!

Your risk of dementia, has your doctor told you of this?  Your doctor is responsible for preventing this! Is s/he willing to prevent this?

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

The latest here:

 Keeping Brain Health Top of Mind: Preserving Cognition and Improving Early Detection and Diagnosis of Alzheimer’s Disease

Salmon River Clinic Stanley, Idaho Madeline Paczynski, MCMSc, PA-C Washington University School of Medicine George King Please complete and tap Submit at the end to continue. 

Hector, a 64-year-old man with hypertension, obesity, obstructive sleep apnea (OSA), insomnia, and a family history of dementia (his mother died in her 80s with dementia), presents for a clinic visit with his PCP 2 months after the death of his wife. He says, “My memory isn’t what it used to be, but I think that’s just aging. Plus, I’m trying to adjust to life without my wife.” How would you advise him?

• Mild memory changes are expected with aging, so we only need to be concerned if daily functioning worsens
• Because your mother had dementia, we should order APOE genotype testing to help guide our next steps
• Many factors can affect brain health over time, including sleep, cardiovascular health, exercise, and mood. Let’s review areas where we may be able to reduce your future risk
• Your symptoms are most likely related to stress after your wife’s death, so we can wait until your stress levels decrease to discuss lifestyle adjustments
• I’m not sure

Question 2/6

Your 64-year-old patient with treated stage 1 hypertension (BP 138/80 mmHg), obesity (BMI 34), OSA (not yet on CPAP), and insomnia presents for a routine follow-up visit. You are concerned about some of the risk factors that may affect his cognitive health. What would be your priority for today’s visit?

• Start with an attainable goal of addressing his insomnia by recommending a nonprescription sleep aid to achieve 7 to 9 hours of sleep per night
• Begin with pharmacologic management as the primary intervention for reducing his dementia risk by prescribing a statin to lower his LDL cholesterol
• Introduce the American Heart Association’s Life’s Essential 8 framework to assess and set attainable, personalized goals related to his sleep, weight, BP, and other modifiable risk factors
• Defer any discussion of lifestyle modifications until a dedicated cognitive evaluation visit is scheduled with a memory specialist
• Order blood-based biomarker (BBM) testing and plan to address lifestyle factors at the next visit
• I’m not sure

Question 3/6

Jessica, a 68-year-old real estate agent, reports difficulty recalling client names, losing her train of thought mid-task, and relying on reminder alarms to stay on track at work. She receives a normal score on the Mini-Cog screening test. What would be the most appropriate next step to recommend for Jessica?

• Schedule a cognitive evaluation visit with Jessica and a care partner to better characterize Jessica’s symptoms
• Reassure her that she is in good cognitive health and that her symptoms are likely due to normal aging
• Reassure her that she is in good cognitive health and plan to reassess in 12 months or sooner if symptoms worsen
• Refer her to a dementia specialist for neuropsychological testing because mild impairment may not be detected by brief screens
• I’m not sure

Question 4/6

Harold is a 76-year-old widower who has been experiencing progressive memory problems. He recently had an abnormal result on a Mini-Cog that was administered during his annual wellness visit. What would you recommend as the next step to further assess his cognitive function?

• MoCA + test for cerebral amyloid pathology with an amyloid PET scan
• MoCA + obtain input from a family member or close friend
• MoCA + perform an MRI to rule out structural causes of impairment
• MoCA + test for amyloid pathology using BBM testing
• I’m not sure

Question 5/6

A primary care clinician ordered a plasma p-tau217 test for a patient with MCI who is experiencing word-finding difficulties, increased impulsivity, and poor judgment. The test result was negative, and the clinician is unsure whether the patient needs to be referred to specialty care. How would you advise the clinician about this?

• Referral to specialty care is only appropriate for patients with a positive BBM test result
• Referral to specialty care is unnecessary if the BBM test result is negative
• Referral to specialty care should always occur after BBM testing so the specialist can explain the results to the patient and their care partner
• Referral to specialty care may be appropriate for patients with a negative BBM test result when the cause of symptoms is unclear
• I’m not sure

Question 6/6

Your 61-year-old patient presents with word-finding difficulties and increasing forgetfulness. Based on his age, his symptoms, and the results of objective testing (MoCA: 27/30), you estimate his pretest probability of AD pathology to be approximately 20%. You order a BBM test with 90% sensitivity and 75% specificity, and the test result is negative. Based on current clinical guidance, what would be your next step in evaluating this patient?

• Rule out Alzheimer’s-related amyloid pathology and consider other etiologies that may be contributing to his cognitive symptoms (no further testing for AD is necessary)
• Recognize that your patient may have received a false-negative test result and order a test with higher sensitivity and specificity
• Recognize that your patient may have received a false-negative test result and retest him in 6 months
• Recognize that your patient may have received a false-negative test result and perform an amyloid PET or CSF biomarker test
• I’m not sure