A Team-Based Approach to Alzheimer Disease

July 29, 2019
MD Magazine

Drs. Alireza Atri and Ronald C. Petersen remark on the important roles a community neurologist, as well as other members of a patient’s health care team, can play in the management of Alzheimer disease.

Ronald C. Petersen, MD, PhD: Community neurologists can play a key role in the development of new therapies for Alzheimer disease. One of the limiting factors in trial designs and trial execution these days is our ability to get people to enroll. Sometimes we project it’s going to take 12 months to enroll people in a particular trial, but it takes 2 or 3 years to do it, and that really degrades the ability of the study to test its hypotheses.

So when community neurologists encounter people who may meet the diagnosis of Alzheimer disease, even if it’s just clinical, refer the person on to a center that is doing a study. The center will then do some of these biomarker tests to see if the person qualifies for the trial. This will enhance the enrollment in these trials, and hopefully complete them in a more efficient fashion.

Alireza Atri, MD, PhD: I think the role of the neurologist as a frontline consultant, and in many cases, a primary consultant or primary care is very important, as well as the timely detection, diagnosis, and appropriate management of cognitive impairment and dementia. Even though we can’t cure Alzheimer disease, we can absolutely mitigate decline. We can care for individuals. It’s a meaningful trajectory that we can put people on by, in the earliest way, actually supporting them, getting a triadic relationship with a patient, with a care partner, and engaging other professionals. It’s not just neurologists.

I think primary care clinicians really are looking for help in this domain, to be educated by a neurologist. They want to know that what they do actually makes a difference. And it does, in managing comorbidities, which oftentimes go unmanaged for many years, and in being able to shore up support systems for people to go into clinical trials if they want. But really having the autonomy to be masters and mistresses of their own fate early on, so they can do whatever they want with their life for what they have left….

What I hear is primary care clinicians really look to neurologists for that support and that knowledge. As part of a team, I think neuropsychologists are very important on the evaluation and diagnostic side, particularly when there are questions about atypical syndromes that are not just memory. Maybe there’s motor involvement or visual-spatial, language involvement, and rapid progression, and early onset conditions. This is a collaborative effort with geriatricians, geriatric psychiatrists, PT [physical therapy], OT [occupational therapy], speech therapists, RNs [registered nurses], PAs [physician assistants], and really a whole spectrum of folks.

On the care management side, I think care managers are really important. If we can somehow get that involvement with social workers, or psychologists, or other folks and engage societies and associations like the Alzheimer’s Association, making those connections is really important. This is something our patients and families depend on us for. We’re in it together. None of us are going to be spared. If you see the demographics of this, we’re all in it and we’re going to be affected. So we appreciate any help that neurologists can give for patients and families that are very deserving.

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