Innovations in Early Detection and Treatment of Alzheimer's Disease and Related Dementias: Geriatric Psychiatry in Evolving Care Ecosystems

Abstract

Recent advances in Alzheimer's disease and related dementias (ADRD) diagnosis and therapies underscore the urgent need for approaches that facilitate valid detection in multiple care settings, are feasible to administer systematically and equitably, and lead to timely diagnosis and care at early stages of disease. The evolving landscape of AD staging criteria and multimodal biomarkers offers a window of opportunity for early detection and intervention. Yet, translating these advances to clinical settings where geriatric psychiatrists practice presents challenges; our healthcare ecosystems are complex networks of clinicians, facilities, and transactional services that are notorious for fragmented care, underdiagnosis of dementia, and limited appreciation and utilization of Geriatric Psychiatry in reducing disease burden and costs.To face these challenges, it is incumbent upon Geriatric Psychiatry, as a discipline, to begin to ‘think like an ecosystem’ to promote innovations at the frontlines of care. The Care Ecosystem model has been studied in the context of dementia care to provide personalized and cost-effective care to individuals with dementia and their families (Possin et al. JAMA Intern Med 2019). However, it is unclear how Geriatric Psychiatry might best adapt or integrate its ecosystem to advance dementia diagnosis and care. Natural ecosystems, by definition, are diverse, stable, and resilient communities of organisms in physical environments where every factor relies, directly or indirectly, on the other factors. Energy flows through an ecosystem, with both matter and energy conserved, and higher biodiversity rendering more stable and sustainable ecosystems. Conscious attention to the properties of healthy ecosystems holds promise for conceptualizing and designing synergistic care systems with coherent, efficient involvement of geriatric mental health clinicians as multidisciplinary team members and leaders.This session's presentations discuss factors, components, and approaches relevant to current Geriatric Psychiatry ecosystems that can inform innovations in dementia diagnosis and care by Geriatric Mental Health Clinicians. Laura Marsh will introduce the topic of healthcare ecosystems. Brent P. Forester, MSc will discuss innovations in developing dementia care models in general medical and primary care settings based on his work in the Mass General Brigham population health program, including results from an embedded pragmatic trial studying an adaptation of the Care Ecosystem model for nurse care managers. Joshua Hamer, PhD will review the challenges of dementia recognition in primary care and non-specialty settings, and present data from a pilot program designed to increase recognition and diagnostic work up of cognitive impairment without reliance on specialty memory clinic. A neurologist, Jon Toledo, PhD will summarize the state of the art of biomarkers and their application. Jennifer Gatchel, PhD will present an overview of biomarkers in updated staging criteria of Alzheimer's Disease (AD), including neurobehavioral manifestations. Dr. Marsh will moderate the session and ensuing discussion on opportunities for innovations in the Geriatric Psychiatry ecosystem and dementia diagnosis and care.