Addressing Complexities of Alzheimer Disease Care Coordination: Tara Carlisle, MD, PhD

Streamlined protocols and early diagnosis are improving outcomes for patients receiving infusion therapies for Alzheimer disease, says Tara Carlisle, MD, PhD, assistant professor at the University of Colorado (CU) Anschutz Medical Campus.

This transcript was lightly edited; captions were auto-generated.

Transcript

What are the biggest challenges in treating patients with Alzheimer disease, and what unmet treatment gaps still need to be addressed?

One of the biggest challenges with these infusion protocols is that they do require extensive safety monitoring. This includes doing pretty frequent MRIs to monitor for brain bleeding and brain swelling. The coordination of making sure that those scans are done at the right time, that they're followed up, and that they are reviewed before the next infusion is going to happen, can be kind of a monumental care coordination task.

Can you share some of the current successes of the Alzheimer service model at the CU Alzheimer's and Cognition Center?

Our specific service model has been really successful, I think, because of those collaborations—especially with neuroradiology. We’ve been able to work with them really closely to make sure that we can get timely scans, that we can get those scans reviewed not only by neuroradiology but by the prescribers prior to a patient’s next infusion. That also includes if we need to get an urgent scan because someone is having symptoms concerning for potential brain bleeding and brain swelling. We have a pretty streamlined process where we've been able to get those pretty quickly.

Can you discuss the role of primary care physicians in early identification of Alzheimer disease and how early identification impacts the rest of a patient’s care and treatment journey?

Early identification is hugely important because these new anti-amyloid therapies are really restricted for use only in the early stages of Alzheimer disease, and so that includes mild cognitive impairment or mild dementia. Historically, we’ve done a really bad job of identifying people early on, so we miss the diagnosis a lot of times. Some estimates as high as 98% to 99% of the time we miss mild cognitive impairment diagnoses.

Part of this stems from the backdrop of the historical reality that we haven’t had a lot of treatments available for Alzheimer disease, and so it didn't make sense to do early identification necessarily because the treatments that we've had don't modify the disease themselves. These new anti-amyloid therapies are creating kind of a new reality for Alzheimer disease and neurodegenerative disorder treatment in general, where there’s a shift where we're focusing earlier and earlier in identification so that hopefully we have more potential benefit from disease-modifying therapies.

Primary care is hugely important for this because they are often the first point of contact a lot of times for patients as well as anyone that knows a patient and is concerned maybe about some cognitive changes. Making sure that we're ruling out other potential medical causes, and then recognizing that someone’s cognitive impairment might not just be due to typical aging but it's something that makes us more worried that we may need to do additional workup to help with diagnosis.