Alzheimer Plan Research Articles

Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations.

Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization's jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled "university/peripheral"; organizations for which only part of the territory is in rural areas, labeled "mixed"; and organizations in remote or isolated areas, labeled "remote/isolated") and according to different types of participants (managers, leading clinicians, and other participants). Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards.

Research protocol of the Laval-ROSA Transilab: a living lab on transitions for people living with dementia

BackgroundThe Laval-ROSA Transilab is a living lab that aims to support the Laval Integrated Health and Social Services Centres (Quebec, Canada) in consolidating the Quebec Alzheimer Plan. It aims to improve care transitions between different settings (Family Medicine Groups, home care, and community services) and as such improve the care of people living with dementia and their care partners. Four transition-oriented innovations are targeted. Two are already underway and will be co-evaluated: A) training of primary care professionals on dementia and interprofessional collaboration; B) early referral process to community services. Two will be co-developed and co-evaluated: C) developing a structured communication strategy around the dementia diagnosis disclosure; D) designation of a care navigator from the time of dementia diagnosis. The objectives are to: 1) co-develop a dashboard for monitoring transitions; 2) co-develop and 3) co-evaluate the four targeted innovations on transitions. In addition, we will 4) co-evaluate the impact and implementation process of the entire Laval-ROSA Transilab transformation, 5) support its sustainability, and 6) transfer it to other health organizations.MethodsMulti-methods living lab approach based on the principles of a learning health system. Living labs are open innovation systems that integrate research co-creation and knowledge exchange in real-life settings. Learning health systems centers care improvement on developing the organization's capacity to learn from their practices. We will conduct two learning cycles (data to knowledge, knowledge to practice, and practice to data) and involve various partners. We will use multiple data sources, including health administrative databases, electronic health records data, surveys, semi-structured interviews, focus groups, and observations.DiscussionThrough its structuring actions, the Laval-ROSA Transilab will benefit people living with dementia, their care partners, and healthcare professionals. Its strategies will support sustainability and will thus allow for improvements throughout the care continuum so that people can receive the right services, at the right time, in the right place, and from the right staff.

Ten Years after the National Alzheimer's Plan: Dementia Remains a Hidden Syndrome in France.

Ten years after the implementation of the French Plan on Alzheimer's Disease (2008-2012), the present study aimed at describing the situation of the persons living with dementia in terms of diagnosis and high-risk situations (living alone, continuing driving, inability to handle budget and to manage medication). Among the 115 dementia cases followed-up in the AMI population-based cohort on aging in 2018 (i.e. ten years after the launch of the Plan), the prevalence of under-diagnosis was similar to the one estimated ten years earlier (53.0% vs. 55.6%). Almost all cases (95.3%) were concerned by high-risk situations (61.2% were unable to handle finances, 48.2% were living alone, 27.1% continued driving). Being diagnosed as demented was not associated with a lower frequency of high-risk situations, excepting for driving (16.7% vs. 37.2%). Ten years after the beginning of the French Alzheimer's Plan, dementia remains a hidden syndrome, with a frequent inadequate management of high-risk situations.

Needs of patients with dementia and their caregivers in primary care: lessons learned from the Alzheimer plan of Quebec

BackgroundPersons living with dementia have various health and social care needs and expectations, some which are not fully met by health providers, including primary care clinicians. The Quebec Alzheimer plan, implemented in 2014, aimed to cover these needs, but there is no research on the effect this plan had on the needs and expectations of persons living with dementia. The objective of this study is to identify persons living with dementia and caregivers’ met and unmet needs and to describe their experience.MethodsThis is a sequential mixed methods explanatory design: Phase 1: cross-sectional study to describe the met and unmet health and social care needs of community-dwelling persons living with dementia using Camberwell Assessment of Need of the Elderly and Carers’ Assessment for Dementia tools. Phase 2: qualitative descriptive study to explore and understand the experiences of persons living with dementia and caregivers with the use of social and healthcare services, using semi-structured interviews. Data from phase 1 was analyzed with descriptive statistics, and from phase 2, with inductive thematic analysis. Results from phases 1 and 2 were compared, contrasted and interpreted together.ResultsThe mean total number of needs reported by the patients was 5.03 (4.48 and 0.55 met and unmet needs, respectively). Caregivers had 0.52 met needs (3.16 unmet needs). The main needs for both were memory, physical health, eyesight/hearing/communication, medication, looking after home, money/budgeting. Three categories were mentioned by the participants: Persons living with dementia and caregiver’s attitude towards memory decline, their perception of community health services and of the family medicine practice.ConclusionsOur study confirms the findings of other studies on the most common unmet needs of the patients and caregivers that are met partially or not at all. In addition, the participants were satisfied with access to care, and medical services in primary practices, being confident in their family. Our results indicate persons living with dementia and their caregivers need a contact person, a clear explanation of their dementia diagnosis, a care plan, written information on available services, and support for the caregivers.

Sex differences in the management of persons with dementia following a subnational primary care policy intervention

BackgroundThe influence of sex and gender on the risk of dementia, its clinical presentation and progression is increasingly being recognized. However, current dementia strategies have not explicitly considered sex and gender differences in the management of dementia to ensure equitable care. The objective of this study was to examine the moderating effect of sex on the quality of care following the implementation of the Quebec Alzheimer Plan (QAP).MethodsWe conducted a secondary analysis of the evaluation of the QAP consisting of a retrospective chart review of 945 independent, randomly-selected patient charts of males and females 75+ years old with dementia and a visit to one of 13 participating Family Medicine Groups before (October 2011–July 2013) and after (October 2014 – July 2015). The quality of dementia care score, based on Canadian and international recommendations and consensus guidelines, consisted of documented assessments in 10 domains. We used a mixed linear regression model to measure the interaction between sex and the implementation of the QAP on the quality of dementia care score, adjusting for age and number of medications.ResultsWe found that improvements in the quality of dementia care following the QAP were larger for men than women (mean difference = 4.97; 95%CI: 0.08, 9.85). We found that men had a larger improvement in four indicators (driving assessments, dementia medication management, Alzheimer Society referrals, and functional status evaluation), while women had a smaller improvement in three (home care needs, behavioural and psychological symptoms of dementia, and weight). Men were prescribed fewer anticholinergics post-QAP, while women were prescribed more. Cognitive testing improved in men but decreased for women following the QAP; the opposite was observed for caregiver needs.ConclusionWhile the overall quality of care improved after the implementation of the QAP, this study reveals differences in dementia management between men and women. While we identified areas of inequalities in the care received, it is unclear whether this represents inequities in access to care and health outcomes. Future research should focus on better understanding sex and gender-specific needs in dementia to bridge this gap and better inform dementia strategies.

Validation of a Questionnaire for Family Physicians: Knowledge, Attitude, Practice on Dementia Care.

Our study objective was to develop and validate a questionnaire assessing the knowledge, attitude, and practice (KAP) of family physicians regarding dementia care and dementia strategies in Canada. Using a multistage process with a panel of experts, we developed and distributed an 83-item questionnaire to 542 eligible family physicians in 42 interdisciplinary primary care teams participating in the Quebec Alzheimer Plan implementation. Altogether, 369 physicians (68%) returned questionnaires. Median item-specific non-response rate was 0.8 per cent (0.3%-8.1%). Exploratory factor analyses and scale correlation supported the questionnaire validity. The final questionnaire contained five factors and 31 items. The KAP questionnaire has proved to be a reliable instrument for assessing the KAP of family physicians regarding dementia care and dementia strategies. This questionnaire provides researchers, clinicians, managers, and decision-makers with a tool to assess an intervention, a program, or a policy change implemented in primary health care for patients with dementia.

Impact of the Quebec Alzheimer Plan on the detection and management of Alzheimer disease and other neurocognitive disorders in primary health care: a retrospective study.

The Quebec Alzheimer Plan aims to improve care provided to patients with neurocognitive disorders in Family Medicine Groups (FMGs) (multidisciplinary team-based primary care practices). The objective of this study was to determine changes in the detection and management of neurocognitive disorders following implementation of the plan, in 2014. This was a retrospective chart review before and after implementation of the Quebec Alzheimer Plan in 13 FMGs. We reviewed 1919 randomly selected charts of patients aged 75 years or more and 945 randomly selected charts of patients in this age group with neurocognitive disorders. In the first group, selected outcomes were proportion of patients with documentation of cognitive status, documented diagnosis of neurocognitive disorder, documented cognitive testing and referral to a memory clinic. In patients with neurocognitive disorders, the outcomes were number of contacts with an FMG, quality of follow-up score (documented assessments in 10 domains: cognitive testing, functional status, behavioural and psychological symptoms of dementia, weight, caregiver needs, driving status, home care needs, community service needs, absence of anticholinergic medication and management of dementia medications) and proportion referred to a memory clinic. Significantly more patients aged 75 or more had documentation of cognitive status in their chart after plan implementation than before implementation (440 [45.1%] v. 351 [37.2%]) (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.18-1.81). No significant changes were found in documented diagnosis of neurocognitive disorders, cognitive testing or referral to a memory clinic. Among patients with neurocognitive disorders, the number of contacts with an FMG (adjusted mean difference 1.6, 95% CI 0.3-2.8) and quality of follow-up score (adjusted mean difference 6.6, 95% CI 3.9-9.2) increased significantly, without significant changes in the number of referrals to a memory clinic. The results suggest that the Quebec Alzheimer Plan is feasible and beneficial in terms of detection and management of neurocognitive disorders, without an increase in referral to specialists. The findings will be used to scale up the Quebec Alzheimer Plan and to develop the Canadian federal dementia strategy.

Estudio de prevalencia de demencias en adultos mayores de la comunidad de Santo Domingo de Heredia, Costa Rica.

Antecedentes: Los países de bajos y medianos ingresos están experimentando tasas de crecimiento de envejecimiento de la población, así como de la incidencia de personas con deterioro cognitivo. Este estudio tuvo como objetivo estimar la prevalencia de deterioro cognitivo o demencia, y frecuencia de factores asociados en personas adultas mayores del cantón de Santo Domingo de Heredia, Costa Rica. Metodología: Se realizó un estudio descriptivo de prevalencias en adultos mayores de 65 años en la comunidad mencionada. Se seleccionó una muestra de 101 adultos mayores identificados mediante la estrategia “tocando puertas” (casa por casa detectando aquellas donde residía al menos un adulto mayor). Se utilizó el protocolo desarrollado por el Grupo 10/66 Dementia Research Group de la Asociación Internacional de Alzheimer, el cual cuenta con seis de cuestionarios a saber: 1. Entrevista sobre el hogar, 2. Entrevista sociodemográfica y de factores de riesgo, 3. Entrevista clínica, 4. Batería de prueba cognitiva, 5. Examen físico y neurológico y 6. Entrevista al informante (en los casos que se contara con acompañante). Se calcularon prevalencias de deterioro cognitivo y frecuencia de algunos factores asociados al riesgo de demencia. Resultados: El desempeño promedio en las pruebas fue de 32,62 puntos (DS: 5,99; rango: 10-43). El 60,4% de los participantes se ubicaron por debajo de este percentil 50 (34 puntos), punto de corte que determina algún grado de deterioro cognitivo. Se encontraron cifras significativas de hábito de fumado en algún momento de la vida y consumo de alcohol; la presencia de condicionantes de riesgo como hipertensión, diabetes mellitus y evidencia de daño como cardiopatía en 20% de los casos; de igual manera 20% de los casos reportaron historia de enfermedad demencial en familiares y problemas que afectan su vida diaria. Finalmente se pudo establecer en pruebas de fluidez verbal cambios significativos en capacidad cognitiva y percepción de problemas de memoria en cerca de un 45% de los habitantes. Conclusiones: El estudio arrojó cifras de prevalencia de demencia similares a las reportadas por otros estudios a nivel mundial. Esto refleja la necesidad de avocarse a las estrategias en salud pública de reducción de riesgo así como la urgencia de activar acciones del Plan Alzheimer de Costa Rica.

Implementation of an Occupational Therapy Program for Alzheimer's Disease Patients in France: Patients' and Caregivers' Perspectives.

The French National Alzheimer Plan 2008-2012 created specialized Alzheimer teams, which provide up to 15 sessions of cognitive rehabilitation in the patient's home for 3 months. Sessions are conducted by an occupational therapist and a gerontological nursing assistant. As the patient's experience is one determinant of successful implementation, we explored the usefulness of these teams as viewed by the patient and his or her main caregiver. Thirteen patients and their caregiver, previously assisted by a specialized Alzheimer team, were individually given semi-structured interviews (n = 26, duration 20 to 180 minutes). Our study showed that although patients and caregiver had no initial expectations, most of them appreciated the support provided by the specialized Alzheimer teams. Patients valued the "human" component, and favored interventions that improved quality of life over those intended to maintain functional capacities. Caregivers observed improved mood and behavior in patients. Those involved in sessions felt empowered by contact with a specialized Alzheimer team. We discuss how patients' and caregivers' feedback influenced the implementation process through comprehensive use of the five dimensions of the RE-AIM framework. Whereas intervention by specialized Alzheimer teams was largely accepted by health care professionals, patients, and caregivers, its effectiveness is questioned in view of its deviation from the evidence-based model. Interviews with patients and caregivers shed light on some reasons for this deviation, as what they value in the intervention differs from the functional focus of the model.

Mapa de la enfermedad de Alzheimer y otras demencias en España. Proyecto MapEA

IntroductionIn the current context of increased life expectancy and progressive aging of the population a very significant increase in the number of people with cognitive impairment and dementia is expected.Consequently, Spain will face an enormous social and health problem in the next decades. The Mapa de la enfermedad de Alzheimer y otras demencias en España project aims to analyse plans, prevention and early diagnosis activities, process of care and resources available across the 17 Spanish regions for the management of cognitive impairment and dementia in order to identify improvement areas, as well as to provide a list of recommendations. MethodsThe working group consisted of an Advisory Committee of 5 national experts and a Committee of Experts from each region made up of professionals in the field of Neurology, Geriatrics, Psychiatry, and Primary Care, as well as representatives of Family Associations of People with Alzheimer's and other dementias. The Expert Committee of each region held meetings in which the current situation of care was reviewed. ResultsPlans available in Spain for dementia management are mostly obsolete or have not been implemented. Prevention and early detection activities are generally not carried out. There is great variability of care process that patients must follow for the diagnosis, treatment, and follow-up of the disease, and not all diagnostic test are available in different regions. In general, resources are considered scarce and unknown. ConclusionsThe Mapa de la enfermedad de Alzheimer y otras demencias en España study has been able to detect the main points that require changing n the management, organisation, and coordination of resources, such as information and training of the personnel involved. Furthermore, the study has revealed that, in Spain, the necessary conditions are in place in Spain, such as the availability and capacity of professionals involved, as well as there being the potential diagnostic and health care resources to address this room for improvement through the approval and development of a National Alzheimer's Plan, supported by a deep and truthful political commitment, which will be the ideal framework for the development of these possibilities.

The identity building process of case management profession in France can be approached trough professionals who early leaving their function

Introduction: Health and social services integration is a recent policy in France (2008-2012 National Alzheimer Plan). One of the core components of this policy was the launching of a new professional field: case In a recent national based study 75% of case managers express a need for recognition of the professional identity of case management. In previous work, the construction of a professional identity was described as a process based on four mechanisms: the individual, the training, the company and the membership of a group. Methods: To study the professional identity of case managers, we supposed that there was a relationship between leaving the case manager function and the identity building process. In the aim to collect information on it, we called for participation in an online-survey via the web-based network of the French Association of Case Managers and a national survey delivered on February 2016. The online-survey included 24 closed and 2 open questions. Firstly, we did a descriptive analysis of the answers. Secondly, in view of studying the identity building process, we regrouped questions around the four previously defined mechanisms. Results: Twenty-seven professionals answered the questionnaire. Of these, 74% were from sanitary work and 26% from social work. A large majority (91%) had a previous professional experience in coordination of care. Concerning the four mechanisms: - Individual: 56% had specifically looked for this particular professional position (case management). That’s mean that the choice of this working position was probably made for “internal” motivation. - Training: 87% were willing to be trained at the beginning of their job. Nevertheless, in 43% of cases the training course has not or just partially met expectations. On contrary, professionals for whose training met their expectations have exercised longer. - Company: 22% reported non-supportive working conditions and 56% were unsatisfied with their relationships with their direct supervisors (less frequently when these relations were frequent). - Membership of a group: 87% adopted new professional practices using specifics tools developed for this work. They judged the utility of the job to be positive in 65% of cases in the current context. In open questions, some “specific” aspects of the professional field were underlined by respondents as important factor to take into account in their difficulties: solitude facing person with complex needs, long distance journey, frustration feeling between expectations and reality. Discussions: For professionals who leaving early their case management function after being hired, factors defining the most this new profession seems to be the use of new professionals practices particularly specifics tools. We find the main mechanisms of identity building process even during the process leading to leave their function. A qualitative study coming after this first step, the interviewed case managers having let their email for being call back. Conclusions: We have studied motivations of professionals leaving early case management after being hired. Our mains results suggest, even if at this step, we can find elements of birth of identity building. A qualitative study is in progress and will be presented.

Case managers in France: Impact of seniority and graduation on practices and professional representations

In France, integrated care is a recent process, initially experimented during the National Alzheimer Plan 2008-2012. One of the key measures of this policy concerned the training of case managers (CMs) for elderly subjects presenting complex situations at home. All CMs received the same formation; they began exercising between 2008 and 2015. Few data are available on their opinions and professional practices. Objectives: 1/description of CMs professional practices and 2/analysis of the influence of seniority and graduation on these practices and CMs opinions on their profession. Methods: A national survey was conducted by questionnaire sent to all CMs between January and February 2016; multivariate analysis of the influence of seniority and graduation on professional practices and opinions was performed. Results: Participation rate was 78% (n = 546). Among the participants, 93% were women (median age 35 years) and 48% had a seniority of more than 2 years. At the time of the survey 52% of the CMs were graduated. On average, each CM was monitoring 23 situations. The CMs whose seniority was > 24 months had more situations in charge: 27± 8 vs 18±9 when the seniority was ≤ to 24 months (p = 0.0005). Those who were graduated also had more situations in charge: 26±8 for graduated vs 17±9 for non-graduated (p = 0.0005). CMs whose seniority was > 24 months seemed less likely to continue with case management when they met with reluctance from the patient (OR 0.4 CI 0.23-0.72 p = 0.002), and reported less often to negotiate with the person upon refusal (OR 0.44 CI 0.22-0.89 p = 0.024). When they encountered difficulties, CMs declared to be more likely to discuss situations with their colleagues rather than with their superiors (OR 1.80 CI 1.01-3.22 p = 0.046). They expressed more frequently the wish to manage fewer situations (OR 1.56 CI 1.08-2.26 p = 0.017). They considered more often that one of the specific contributions of their profession was the strengthening of the ambulatory- hospital links (OR 1.95 CI 1.07-3.57 p = 0.03). Graduated CMs reported less systematic use of the Individualized Service Plan tool than non-graduated (OR 0.43 CI 0.25- 0.75 p = 0.003). They also expressed the wish to manage fewer situations (OR 1.57 CI 1.05-2.25 p = 0.026), and to have more ethical reflection (OR 1.97 CI 1.14-3.39 p = 0.014). They considered more often that the specific contribution of their profession was an improvement in the quality of life of the accompanied persons (OR 2.81 CI 1.07-7.37 p = 0.036). Graduated CMs declared more frequently that they wanted to stop this function in the future (OR 7.78 CI 2.05-29.48 p = 0.003). Conclusion: Seniority and graduation seem to favor certain arrangements with CMs practice and modify representations. Unexpectedly, the graduation does not seem to encourage the CMs in the pursuit of their task. More studies are needed to understand why training does not strengthen CMs in their professional practice.

Factors influencing time between onset of signs/symptoms and referral for dementia in elderly outpatients

BackgroundThe few studies that have focused on Time between Onset of Signs and Symptoms and Referral (TOSR) for dementia to a memory center suggest a substantial delay of 1–3 years. This delay has a negative impact on both patients’ and their caregivers’ quality of life. ObjectiveThis study aimed to evaluate this delay and the factors associated with it in a cohort of community-dwelling elderly people attending a memory clinic, as well as assess the impact of the Third French National Alzheimer Plan (2008–2012). MethodsAll patients referred to the Bretonneau Memory Clinic for the first time between January 2006 (the clinic has maintained a specific database since then) and March 2016 were included in the study. ResultsOf the 8543 patients attending our Memory Clinic during the study period, 3353 attending for the first time and with complete data were included. Briefly, their ages were 82±7 years, and 67.2% were female; MMSE score was 21.2±6.6, IADL was 4.06±0.78 and the social-needs category of the Groupes Iso Ressources (GIR); Iso-Resource Group (IRG) scale was 4.04±0.37. The TOSR was, on average, 35.4±30.24 months, and increased after implementation of the Third French National Alzheimer Plan, from 26.68±26.28 months before 2009 to 40.08±31.2 months after 2009. Age and MMSE were associated with TOSR, but not the type of dementia, household composition and social characteristics. Also, there was a shorter TOSR for mild cognitive impairment than for dementia patients. ConclusionOur results emphasize the need for more education and information among the general public about the early signs of cognitive impairment, especially in elderly people.

One-Year Evolution of Behavioral andPsychological Symptoms of Dementia in Patients Initially Hospitalized inCognitive Behavioral Units: The EVITAL Prospective Cohort.

The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge. The present study investigated the long-term evolution of BPSD over one year after CBU discharge. The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals. BPSD were collected using the Neuropsychiatric Inventory (NPI) at admission and 3, 6, and 12 months after hospitalization. The global NPI score evolution was assessed using a linear mixed-effect model. A four-factor model of the NPI including behavioral dyscontrol, psychosis, mood, and agitation subscores was also analyzed. Our analysis focused on 148 patients followed up during 12 months and evaluated at each visit. The global NPI score was 48.5 (SD 21.7) at baseline, 28.8 (SD 18.7) at 3-month, 23.2 (SD 16.4) at 6-month and 20.9 (SD 15.9) at 12-month follow-up. The score significantly decreased from baseline to follow-up (F = 109.3 p < 0.0001). Moreover, the decrease was observed for each NPI subscores. The Clinical Dementia Rating (CDR) scale score was significantly linked to the baseline NPI score (t = 2.76, p = 0.009). Conversely, the NPI decline was observed whatever the CDR level. The present study showed a decrease in the global NPI score and all its subscores during the year following the CBU hospitalization, regardless of the initial CDR score.

Primary Progressive Aphasia in the Network of French Alzheimer Plan Memory Centers.

Few demographical data about primary progressive aphasia (PPA) are available, and most knowledge regarding PPA is based on tertiary centers' results. Our aims were to describe demographical characteristics of the PPA population in a large sample of PPA patients from the network of French Alzheimer plan memory centers (Sample 1), and to describe the stratification of cerebrospinal fluid (CSF) biomarkers in two different samples of PPA patients (Samples 2 and 3). All registered PPA patients in the French Alzheimer's disease (AD) databank (Sample 1: n = 2,035) and a subsample (Sample 2: n = 65) derived from a multicentric prospective cohort with CSF biomarker analysis were analyzed. A multicentric retrospective cohort from language expert tertiary centers (Sample 3: n = 97) with CSF biomarker analysis was added. Sample 3 was added to replicate the CSF results of the Sample 2 and to evaluate repartition of AD pathology in the three variant of PPA according to the latest classification. Non-Fluent/Agrammatic, Logopenic, and Unclassifiable PPA patients (NF/A-Logo-Unclass PPA) were older and more frequent than Semantic PPA patients (2.2 versus 0.8/100,000 inhabitants; p < 0.00001). Male predominance occurred after the age of 80 (p < 0.00001). A higher level of education was observed in the PPA population compared to a typical amnesic AD group. No demographical significant difference between PPA due to AD and not due to AD was observed. The Logopenic variant was most frequent with 85% of AD CSF biomarker profiles (35% in NF/A PPA; 20% in Semantic PPA). PPA occurs also in an elderly population, especially in male patients over 80. CSF biomarkers are useful to stratify PPA. The epidemiology of PPA should be further investigated to confirm gender and cognitive reserve role in PPA to better understand the factors and mechanisms leading to this language-predominant deficit during neurodegenerative diseases.

Towards a Community-Based Dementia Care Strategy: A Perspective from Quebec.

Morton-Chang et al. highlighted in their article the key strategic pillars of a community-based dementia care strategy: put "people first," support informal caregiving and enable "ground up" innovation and change. In our commentary, we draw upon our experience as authors of the Quebec Alzheimer Plan and evaluators of its implementation by the Quebec Ministry of Health and Social Services (MSSS). To us, a sustainable dementia care strategy entails a patient-centred approach, grounded in primary care, caring for persons with dementia at every stage of the disease. Implementation of such a strategy requires an ongoing effort to allow innovation adoption by clinicians and organizations.

Role of a specialized Alzheimer team in pragmatic analysis of loss of autonomy

Loss of autonomy linked to the existence of a neurodegenerative Alzheimer's disease weakens living conditions in patients’ homes. The measure 6 of the 2008–2012 Alzheimer's plan has enabled the creation of specialized teams Alzheimer's (ESA) to intervene at a stage beginner to moderate disease. This study aims to highlight the loss of autonomy beginners to moderate Alzheimer's patients and to analyze the population supported by ESA on a 6 months period. Retrospective analysis of the population supported by ESA Saint Etienne since October 2014 to May 2015. Quantitative analysis, descriptive questionnaire, in a subgroup of patients, loss of autonomy through stock standardized occupational therapy. Ed teams Alzheimer's (ESA) to intervene at a stage beginner to moderate disease. This study aims to highlight the loss of autonomy beginners to moderate Alzheimer's patients and to analyze the population supported by ESA on a 6-month period. Sixty-nine patients have been supported, with mean age of 81.5 years with a sex ratio of 0.44 and an average MMS to 18.8 (± 5.2). All had a significant loss of autonomy in daily living (ADL average to 4.36 (± 1.6) and IADL 1.3/4 (± 1.1). Twelve patients have benefited from further evaluation by an occupational therapist. The most affected were the control activities of the current equipment, relational and social activities, meal preparation and housekeeping. An increase in the aid plan was carried out in two third of patients at the end of this support. Loss of autonomy occurs in the early stages of Alzheimer's disease. Allowing early treatment at home, the ESA play an important role in home care for patients with Alzheimer's disease.

Quelle est la place d’un hôpital de jour de suivi gériatrique au sein des structures développées par le Plan Alzheimer 2008/2012 ?

The French 2008/2012 Alzheimer Plan is designed to improve the support given to elderly patients and their families. Objective: To describe the typology of the patients managed in a Geriatric multidimensional rehabilitation ambulatory care unit between 2008 and 2012. Programme de médicalisation des systèmes d'information database concerning the number of concomitant diseases and several specific indicators. The number of patients increased between 2008 (109) and 2009 (293) but then remained stable (about 300). The differences between 2008 and subsequent years were statically significant for the number of concomitant diseases (p < 0.001) and the number of days/patients (p < 0.01), but not for 2009-2012. The variations seem to be related to implementation of the Alzheimer Plan and a change in the organization of French gerontology health networks.

Inequalities in dementia incidence between six racial and ethnic groups over 14 years

IntroductionReducing racial/ethnic disparities is a primary objective of the National Alzheimer's Plan (NAPA), yet direct comparisons within large samples representing diversity of the United States are lacking. MethodsDementia incidence from January 1, 2000 to December 31, 2013 and a 25-year cumulative risk in 274,283 health care members aged 64+ (n = 18,778 African-American, n = 4543 American Indian/Alaska Native [AIAN], n = 21,000 Latino, n = 440 Pacific Islander, n = 206,490 white, n = 23,032 Asian-Americans). Cox proportional hazard models were adjusted for age, sex, medical utilization, and comorbidities. ResultsDementia incidence (n = 59,555) was highest for African-Americans (26.6/1000 person-years) and AIANs (22.2/1000 person-years); intermediate for Latinos (19.6/1000 person-years), Pacific Islanders (19.6/1000 person-years), and whites (19.3/1000 person-years) and lowest among Asian-Americans (15.2/1000 person-years). Risk was 65% greater for African-Americans (hazard ratio = 1.65; 95% confidence interval = 1.58–1.72) versus Asian-Americans. Cumulative 25-year risk at age 65 was as follows: 38% African-Americans, 35% AIANs, 32% Latino, 25% Pacific Islanders, 30% white, and 28% Asian-Americans. DiscussionDementia rates varied over 60% between groups, providing a comprehensive benchmark for the NAPA goal of reducing disparities.

Report on milestones for care and support under the U.S. National Plan to Address Alzheimer's Disease

IntroductionUnder the U.S. national Alzheimer's plan, the National Institutes of Health identified milestones required to meet the plan's biomedical research goal (Goal 1). However, similar milestones have not been created for the goals on care (Goal 2) and support (Goal 3). MethodsThe Alzheimer's Association convened a workgroup with expertise in clinical care, long-term services and supports, dementia care and support research, and public policy. The workgroup reviewed the literature on Alzheimer's care and support; reviewed how other countries are addressing the issue; and identified public policies needed over the next 10 years to achieve a more ideal care and support system. ResultsThe workgroup developed and recommended 73 milestones for Goal 2 and 56 milestones for Goal 3. DiscussionTo advance the implementation of the U.S. national Alzheimer's plan, the U.S. government should adopt these recommended milestones, or develop similar milestones, to be incorporated into the national plan.