IU Health: Advancing early AD detection as new treatments emerge

June 06 2023

Linus Health recently partnered with Indiana University Health to present a webinar on insights gained from an IU Health program to expand cognitive assessment care in primary care settings. The presentation also included key takeaways from the recent survey report, Patient Voices on Alzheimer’s and Other Dementias, exploring experiences and preferences among older adults related to dementia detection, prevention, and treatment.

The expert speakers were Dr. Deanna Willis, Endowed Professor of Primary Care and Population Health Research at IU; Dr. Jared Brosch, Associate Professor of Clinical Neurology at IU; and Dr. John Showalter, Chief Product Officer at Linus Health and a dual board certified primary care physician.

Survey of older adults shows a lack of cognitive health literacy combined with a strong desire for information and testing

Dr. Showalter reviewed the key findings from the recent survey of 1,000 older adults found in the Linus Health report, and their implications for PCPs.

  • Over 80% of the respondents have some concern that they may develop Alzheimer's or another form of dementia. PCPs should note that only 12% said that they had regular discussions about their cognitive healthcare with their PCP.
  • 95% of survey respondents indicated a willingness to make a positive change in lifestyle to reduce dementia risk; PCPs can use this as motivation for patients to alter their behaviors to protect brain health.
  • 92% said that they would prefer to know about Alzheimer's and other dementias early on, though only 23% reported they had ever had a cognitive assessment before.
  • 90% said that if they had a diagnosis, they'd be interested in taking a drug to slow the progression, and 60% said they will reach out to a provider to discuss  new drugs (e.g., Leqembi) once they become available.

A proactive approach to moving the diagnosis point upstream and optimizing the benefits of new therapies requires new tools for PCPs, tools that provide the fast and accurate detection needed to effectively connect eligible patients to early interventions – both lifestyle and pharmaceutical.

Implementing digital cognitive assessments in primary care: lessons from Indiana University Health

The team at IU Health – the largest network of physicians in Indiana, partnered with the Indiana University School of Medicine – recently participated in a Davos Alzheimer's Collaborative initiative, implementing digital cognitive assessments at six of their primary care sites with the goal of improving screening for cognitive impairment and advancing early detection.

Patients were identified as eligible to participate if they were older than 65 and did not have a diagnosis of dementia. The cognitive assessment tool included a digital clock drawing test (designed to enhance sensitivity by  bringing the power of AI to the widely-used paper and pencil analogue), an automated verbal recall exercise, and modifiable risk factor questionnaire.

During implementation, the IU Health team identified a number of barriers and learned lessons at the provider level. While PCPs want to do what's best for patients, the reality is that they must balance competing demands and cope with labor shortages, so practicality of any new assessments introduced is key. And because they perceived a lack of treatment efficacy for Alzheimer’s and other dementias, many of them deprioritized early detection.

The IU Health team also found a gap in the system between primary care and overburdened specialty care providers. To address this issue, they created the role of Brain Health Navigator, a registered nurse who serves a variety of functions including assessment, support and resources, and care management.

The digital cognitive assessment tool was so incredibly sensitive at picking up cognitive impairment, that some participating PCPs initially questioned the results for patients they perceived to be “clinically normal.” The IU Health team asked PCPs to automatically refer patients with borderline or clearly negative results to the Brain Health Navigator for further workup, regardless of their own clinical impression, unlocking powerful early detection opportunities as a result.

The results of the project showed that almost half of the participants had no signs of cognitive impairment. Nearly 40% showed borderline results for cognitive impairment, and 13% had results indicative of cognitive impairment. The high percentage with signs of impairment was surprising to some PCPs, but the neurology department found them to be accurate and timely, considering new medications coming to market are targeted exclusively at this group – those in the early stages of Alzheimer’s and therefore still within the Leqembi treatment window.

Dr. Jared Brosch summarized the importance of timing and early detection in relation to emerging pharmaceutical interventions saying, “...the earlier we act the better. In fact, over 60% of individuals in [Leqembi clinical trials] had mild cognitive impairment. These are folks who would look completely normal to most people, including their primary care doctors…those are the people who get the best performance from these drugs.”   In other words, if people are already struggling with noticeable symptoms at home, they may be too late to receive treatments that target early stage Alzheimer’s disease.

For more details, as well as the answers to questions posed by the audience, watch this recorded webinar. You’ll learn more about real patient perspectives on the current state of dementia prevention, detection, and treatment today, as well as the results of the IU Health project in expanding digital cognitive assessments in the primary care setting. If you’re ready to learn more about how to roll out a program like IU Health, you can also  download a practical guide to expanding cognitive assessment and screening in primary care.