APA, AAN update dementia management guidance

The American Psychiatric Association and American Academy of Neurology recently released an updated dementia management quality measurement set, which included three new measures, removed measures and modified measures.

“The consequential nature of dementia cannot be underestimated. Although not often conceptualized as such, dementia is a terminal disorder. According to the 2015 annual statistics available from the Alzheimer’s Association, one in nine Americans aged 65 and older has Alzheimer’s disease and one in three older adults who dies in a given year has been diagnosed with Alzheimer’s disease or another dementing disorder,” Amy E. Sanders, MD, MS, of SUNY Upstate Medical University, Syracuse, and colleagues wrote. “It is estimated that 14.7% of people older than 70 in the United States have dementia. Alzheimer’s disease is listed officially as the sixth leading cause of death in the United States.”

Further, dementia costs in the U.S. range from $159 billion to $215 billion annually, making it more expensive than heart disease or cancer, according to researchers.

To determine the best possible care for individuals with dementia and their caregivers and optimal processes for delivering such care, the APA and the American Academy of Neurology formed a work group comprising 26 members from 21 organizations. Members included physicians, patients, caregivers, advanced practice providers, psychologists, payers and nursing representatives.

The work group reviewed 249 abstracts and identified 23 guidelines as the evidence base.

As a result, the work group decided to retire or modify three preexisting measures, reaffirm six measures with changes, and develop three new measures.

Retired measures

The staging measure was retired, with consensus that dementia stages constitute “artificial constructs with little intrinsic meaning.” Dementia should instead be classified as mild, moderate or severe.

Depression screening and management of neuropsychiatric symptoms were packaged into an updated measure on screening and management of Behavioral and Psychiatric Symptoms of Dementia.

Retained , revised measures

The driving measure was modified to remove the exception for individuals with dementia who had already stopped driving, due to reports that the exception caused confusion in pay-for-reporting programs.

New exceptions were developed in the caregiver education measure for individuals without caregivers, caregivers with prior training and/or certification, and patient/caregiver pairs already connected with existing supports.

The work group added additional clarity on how to meet assessment requirements of the functional status measure.

The safety measure was altered to specify dual risk domains associated with self/others or the environment.

Assessment and management of neuropsychiatric symptoms were combined into a single measure for evaluation and management of Behavioral and Psychiatric Symptoms of Dementia, which also included the previous standalone measure for depression screening.

New measures

The first new measure pertains to disclosure of dementia diagnosis for both dementia syndrome and the most likely etiologic dementing disorder.

The second measure addresses assessment of vulnerable populations of individuals with dementia for pain.

The third new measure is a treatment measure that emphasizes pharmacologic treatment when appropriate, within treatment rubrics that incorporate nonpharmacologic behavioral and lifestyle changes.

“This update represents the current state of evidence. Given increased funding and research, it is hoped that care for patients with dementia will evolve rapidly in coming years,” the researchers wrote. “The Work Group recognizes that quality care for patients with dementia is often still conducted in a precarious environment of inadequate home-based care and high-risk transitions between levels of care, amid numerous other challenges not limited to care models favoring procedures over so-called cognitive care, inadequate social support systems, and the long-term viability of Medicare.” – by Amanda Oldt

Disclosure: Sanders reports serving as site principle investigator at Upstate for the TCAD/Noble clinical trial, sponsored by the Alzheimer’s Disease Cooperative Study and Toyama Chemical Company LTD. All other researchers report no relevant financial disclosures.