Updates on the Diagnosis and Management of Alzheimer’s Disease

Target Audience

This activity is intended for primary care providers and other health care professionals involved in the early recognition, diagnosis, and long-term management of Alzheimer’s disease.

There are no prerequisites for this educational activity.

Faculty

Adam S. Fleisher, MD, MAS
Associate Professor
Department of Neurosciences
University of California, San Diego School of Medicine
San Diego, California
Director of Brain Imaging
Banner Alzheimer's Institute
Phoenix, Arizona

Lon S. Schneider, MD, MS
Professor of Psychiatry, Neurology, and Gerontology
Department of Psychiatry
Geriatric Studies Center
Keck School of Medicine, University of Southern California
Director, Alzheimer’s Disease Research and Clinical Center
Co-director, University of Southern California Alzheimer's Disease Research Center (National Institutes of Health)
Los Angeles, California

Dennis J. Selkoe, MD
Vincent and Stella Coates Professor of Neurologic Diseases
Harvard Medical School
Co-Director, Center for Neurologic Diseases
Department of Neurology
Brigham and Women’s Hospital
Boston, Massachusetts

Eric G. Tangalos, MD, FACP, AGSF, CMD
Professor of Medicine
Mayo Clinic
Rochester, Minnesota

Educational Objectives

At the conclusion of this educational activity, participants should be better prepared to:

• Describe the pathophysiologic underpinnings of Alzheimer’s disease, including the role of amyloid β
• Identify patients with risk factors and clinical symptoms that suggest a more formal evaluation for Alzheimer’s disease is warranted
• Employ new diagnostic criteria for mild cognitive impairment and dementia due to Alzheimer’s disease from the National Institute on Aging – Alzheimer’s Association
• Discuss options for biomarker testing and brain imaging in patients who are being evaluated for Alzheimer’s disease
• Evaluate emerging therapeutic approaches that target aberrant amyloid production and deposition in patients with Alzheimer’s disease
• Coordinate Alzheimer’s disease care through open communication with patients, family members, specialists, and other members of the health care team

Needs Assessment and Learner’s Gap

Alzheimer’s disease is the most common form of dementia, affecting approximately 6% to 7% of the population over 65 years of age.^1,2 The multifactorial etiology of Alzheimer’s disease involves complex interplay among genetic, biochemical, and physiologic factors, which manifest clinically as a range of progressive cognitive, affective, and behavioral symptoms.^3-5 Despite its prevalence and significant associated medical, psychosocial, and economic burden, Alzheimer’s disease often remains undiagnosed and untreated.⁶ In particular, studies have shown that rates of diagnosis in primary care are well below epidemiologic estimates.⁷ Primary care providers (PCPs) may incorrectly believe that diagnosing dementia early is not important, and instead may feel that it can be harmful to patients and their families.⁷ Yet PCPs are increasingly called on to provide care for cognitively impaired individuals, playing critical roles in detecting early symptoms of dementia, communicating with patients and caregivers about the disease, coordinating with specialists on multimodal therapeutic plans, and following up to tailor treatment, minimize complications, and head off medical crises.⁸ Appropriately trained PCPs are also best positioned to assess cognition and function over time, identify behavioral symptoms, and manage common comorbidities.⁸ This program is designed to improve patient care by arming participating PCPs with the latest insights into the pathophysiology of Alzheimer’s disease; new staging and diagnostic criteria from national and international study groups; brain imaging modalities and biomarkers to support a differential diagnosis of cognitive impairment; and current and emerging treatment strategies for various stages of disease.^9,10

References

1. Alzheimer's Association. 2012 Alzheimer’s Disease Facts and Figures. Available at: http://www.alz.org/downloads/facts_figures_2012.pdf. Accessed November 7, 2012.
2. Leifer BP. Early diagnosis of Alzheimer's disease: clinical and economic benefits. J Am Geriatr Soc. 2003;51(suppl 5 Dementia):S281-S288.
3. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256:183-194.
4. Citron M. Alzheimer's disease: strategies for disease modification. Nat Rev Drug Discov. 2010;9:387-398.
5. Funke SA, Willbold D. Peptides for therapy and diagnosis of Alzheimer's disease. Curr Pharm Des. 2012;18:755-767.
6. Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord. 2009;23:306-314.
7. Hansen EC, Hughes C, Routley G, Robinson AL. General practitioners' experiences and understandings of diagnosing dementia: factors impacting on early diagnosis. Soc Sci Med. 2008;67:1776-1783.
8. Villars H, Oustric S, Andrieu S, et al. The primary care physician and Alzheimer's disease: an international position paper. J Nutr Health Aging. 2010;14:110-120.
9. Dubois B, Feldman HH, Jacova C, et al. Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurol. 2010;9:1118-1127.
10. Nordberg A. Molecular imaging in Alzheimer's disease: new perspectives on biomarkers for early diagnosis and drug development. Alzheimers Res Ther. 2011;3:34.

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Educational Review Systems, Inc., and Integritas Communications.

Credit Designation

This program has been reviewed and is acceptable for up to 1.0 Prescribed credit hour by the American Academy of Family Physicians. AAFP Prescribed credit is accepted by the AMA as equivalent to AMA PRA Category 1 Credit™ for the American Medical Association (AMA) Physician’s Recognition Award (PRA). When applying for the AMA PRA, Prescribed hours earned must be reported as Prescribed hours, not as Category 1. (This statement applies to all Physicians, not just Family Physicians.)

Conflict of Interest Statement

The Conflict of Interest Disclosure Policy of Educational Review Systems, Inc. requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to his/her contribution to the activity will not be permitted to present.

Educational Review Systems, Inc., also requires that faculty participating in any CME activity and anyone in a position to influence content disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States.

Faculty and Planning Committee Disclosures

Adam S. Fleisher, MD, MAS, is a consultant to Avid Radiopharmaceuticals, Eli Lilly and Company, Merck & Co. Inc., Pfizer Inc., and Quintiles Inc.

Lon S. Schneider, MD, MS, is a consultant to AbbVie Inc., AC Immune, Allon Therapeutics Inc., AstraZeneca, Baxter, Biogen Idec, Inc., Elan Corporation, plc, Eli Lilly and Company, EnVivo Pharmaceuticals, Johnson & Johnson, Kyowa Hakko Kirin Pharma. Inc., Lundbeck, MedAvante, Inc.. Merck & Co., Inc., Novartis Corporation, Phloronol, Inc., Piramal Enterprises, Ltd., Roche USA, Takeda Pharmaceutical Company Ltd., Targacept, Inc., TauRx Therapeutics, Toyama Chemical Co., Ltd., and Zinfandel Pharmaceuticals Inc. He has received grant/research support from Baxter, Eli Lilly and Company, Johnson & Johnson, Lundbeck, Merck & Co., Inc., Novartis Corporation, Pfizer Inc., Roche USA, and TauRx Therapeutics.

Dennis J. Selkoe, MD, is a consultant to and a stockholder of Elan Corporation, plc.

Eric G. Tangalos, MD, FACP, AGSF, CMD, has nothing to disclose.

Jim Kappler, PhD, of Integritas Communications has nothing to disclose.

Method of Participation

Participants must complete the preactivity questionnaire, posttest, and program evaluation. Participants must also score at least 80% on the posttest.