Groundbreaking toolkit boosts Alzheimer's awareness in Moro

Anyone who has cared for a loved one with Alzheimer's disease or other forms of dementia knows of its sorrows. Watching loved ones slip away as they struggle to recognize friends and relatives is a cruel final chapter that many families must confront.

But while there is no cure for Alzheimer's disease or dementia, efforts to identify warning signs and to delay its progression are taking shape.

The Sherman County Medical Clinic in Moro is involved in a groundbreaking study that aims to provide early detection for dementia and Alzheimer's disease and to raise awareness among its patients.

The Sherman Co. Medical Clinic and four other clinics around the country are using a special toolkit, which was developed by the prestigious Cleveland Clinic and the American Academy of Physician Associates. The toolkit was designed to identify cognitive decline and to use routine visits to the clinic as an opportunity for intervention.

Landing a place in the three-month study is a big deal and the Sherman Co. Medical Clinic was identified to participate due to its rural focus and on the aging population it serves.

Erin Haines, the physician assistant at the Sherman Co. Medical Clinic, has been using the toolkit for the past two months. Now in the final month of the pilot project, Haines says that she has found the toolkit to be incredibly helpful, and she sees a clear need for its application in rural areas with predominately aging populations.

"Dementia is obviously going to affect our seniors, 65 and above – but other forms of dementia can affect us earlier, in the 50s and even younger ages," Haines says. "We know that age is related to cognition but some of that is mild cognitive impairment and one of the pieces of the toolkit was giving providers the ability to differentiate between age related cognitive decline, mild cognitive impairment, and full dementia."

The toolkit has offered Haines additional resources to support patients and their families when cognition begins to slip.

"You have steps that you can take to intervene and to slow down the progression of dementia," she says.

In Oregon, an estimated 69,000 people are living with Alzheimer's disease. Recently, a county-by-county study found that Sherman County has the highest rates of Alzheimer's disease in Oregon. The data also shows that Sherman County has the highest estimated prevalence among Oregonians 65 and older, at 11.7%. Oregon's most populous counties – Multnomah, Washington and Clackamas are around 10%.

In the coming years, rates of dementia are expected to grow significantly. By 2050, the Davos Alzheimer's Collaborative, which is funding the Cleveland Clinic study, estimates that the number of people with dementia worldwide will triple.

By those estimates, Erin Haines says that 12.7 million people in the United States will suffer from Alzheimer's disease or other forms of dementia.

Currently, only one out of every four people that have dementia will receive a diagnosis, according to the Davos Alzheimer's Collaborative. And often, there are missed opportunities to assess cognitive decline and to address it before it progresses.

For people in rural areas, the local clinic is usually the place to visit for check-ups and for treating the common cold or flu. But the local clinic can also be the place where conversations about cognitive health can begin and where patients can receive guidance.

Haines says that many people are reluctant to talk about memory loss or cognitive decline, often out of worry that they will be forced to move out of their home.

"We have to be very respectful of our patients' desire to live in a rural community that is two and a half hours from a major medical center," Haines says. "They like an independent lifestyle, and they worry that if they're diagnosed with dementia, it means they can't take care of themselves anymore. Now you're talking about taking away their livelihood and there is absolutely a stigma with that."

Haines says that she is working to help people avoid these outcomes and to maintain their independence.

"My practice is based a lot around prevention and steps that we can take in order to make us as healthy as possible, to keep our longevity, and our quality of life," she says.

Haines, who was raised in Montana and finished her Physician Assistant schooling in Maine, is at home in rural areas and understands that independent living is important to people in rural areas.

Earlier this year, Haines received training on how to utilize the toolkit through a series of lectures and training modules. The study began in June and will conclude at the end of the month. Findings will be made available in November.

Haines says that the training and toolkit have been useful.

"They taught us how to recognize the difference in the conditions and how to use their screening tools," Haines says. "Based on those screening tools, people might need an early intervention or a referral to a higher level of care."

The most impactful part of the toolkit, Haines says, is giving her patients the opportunities to make specific changes that can potentially delay progression of dementia.

"For my practice, that means that I have a consistent conversation with people at their annual preventative visit and absolutely when they get to their Medicare visit."

But those conversations are also happening for patients that voice concerns about their memory.

Haines also says that other medical conditions could be hidden that mimic dementia or cognitive decline.

"Normalizing the conversation allows me to identify depression more readily, or thyroid conditions," Haines says. "Those things can often manifest that way," in the form of cognitive decline.

Haines also points to sleep patterns, diet and exercise as key factors in prevention and maintenance of memory loss.

But while the opportunity to engage in these discussions is encouraged by Haines, they are in no way mandatory when seeking care.

"People always can say, 'I don't want to do your screening, I don't want to know' and that's okay," Haines says.

But for those that are open to having a cognitive assessment, there are often valuable insights that are waiting to be uncovered.

One patient that Haines has been seeing for two years recently told her that she was having memory problems. Looking back, Haines says that if she had the toolkit and done assessments at their first appointments, she would have done things differently.

Haines also says that even when the boxes are checked on the toolkit's assessment, there could still be additional follow-up questions to better address cognitive health.

"We're treating an individual," Haines says. "I can see her pattern, I can see where she's at, and I can say - I think I have something I can do for you."