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WAI 2003-2008 Summary

 

Introduction

The Wisconsin Idea, a principle stating that university education should influence and improve people's lives beyond the classroom, was first attributed to UW President Charles Van Hise in 1904. For more than 100 years this idea has guided the university's work and since 1998 has guided the mission of the Wisconsin Alzheimer's Institute (WAI). The WAI's mission is to create a public health environment in which Alzheimer's disease and related dementias are widely recognized, well understood, aggressively and appropriately treated, and in which those who are afflicted and those who care for them receive the education, services and support they need to effectively cope with this devastating chronic disease. The following summary identifies WAI activities from 2003-2008 which includes pioneering research, local community service development, collaborative partnership building and the education of compassionate, knowledgeable health-care professionals.

 

 

Statement from the Director

The WAI was founded in 1998 as a public-private partnership between the State of Wisconsin, the UW School of Medicine and Public Health (UWSMPH) and the Helen Bader Foundation in Milwaukee. In 1998, the Medical School had few resources dedicated to Alzheimer's disease education and research. The WAI was created to fill that void. The Institute has developed a large successful research program in Alzheimer's disease; implemented educational opportunities for physicians, medical students and other health professional students; partnered with healthcare organizations to develop memory assessment clinics and developed a satellite office in Milwaukee. We have conducted educational programs directed at the public in almost every county in Wisconsin. Our Dementia Diagnostic Clinic Network has benefited the lives of thousands of Wisconsin families and serves as a model of care in communities throughout the Midwest. We are very proud of our work with the State of Wisconsin, and continue to collaborate in educational and cognitive screening projects that assist the state in providing the highest quality long-term care and support programs possible. We are as proud of our partnerships as we are of our programs and want to thank all of those people throughout Wisconsin who have helped make the WAI a success.

 

Mark A. Sager, M.D.

Director, Wisconsin Alzheimer's Institute

 

 

Professional Education: Changing Clinical Practice

 

Needs Assessment on the Assessment, Treatment and Management of Alzheimer's Disease

Over one-half of persons with dementia are undiagnosed and therefore not treated. In partnership with the UW Office of Continuing Professional Development (UWOCPD) and AXDEV Global, the WAI conducted a needs assessment on the diagnosis, treatment and management of Alzheimer's disease among primary care physicians, specialists and allied health care professionals. Four focus groups met in rural and urban areas of Wisconsin in September through November, 2003. The goals of the focus groups were to understand current clinical practice and the needs for and barriers to Alzheimer's disease diagnosis and management.

 

Lessons learned included an understanding that physicians lack the tools to screen and diagnose Alzheimer's disease; have limited time to adequately assess the patient or interview the family and lack confidence in their knowledge about the treatment of the disease and the availability of community resources for the patient and family. Because of this, physicians often delay addressing concerns about cognition until a crisis occurs. Subsequent medical education efforts of the WAI have been designed to meet these needs and to overcome the knowledge and practice obstacles to diagnosis and treatment of dementing disorders in primary care practice in Wisconsin.

 

Medical Student Education

The WAI maintains a web-based module for first year medical students enrolled in the UW School of Medicine and Public Health course, Patient, Doctor and Society II. This web-based module is paired with an in-class presentation by caregivers who speak about the emotional, physical and financial challenges of caring for spouses and parents with Alzheimer's disease. The presentation is enhanced by a person with Alzheimer's disease who relates common concerns and fears about the disease and the expectations people with the disease have of their physicians.

 

A summer externship has been developed to introduce second year medical students to the complexities associated with diagnosing and treating Alzheimer's disease as well as the need to provide adequate support and education to family members. Each summer two students spend 8 weeks with WAI affiliated memory clinic physicians in both rural and urban areas. They are exposed to a variety of experiences working in primary care clinics and community agencies. The medical students accompany physicians and nurse practitioners on nursing home rounds, visit adult day and senior centers, observe home visits with care managers and attend support groups. These experiences provide the medical students with an example of a physician's day-to-day responsibilities and emphasize the importance of building relationships with patients, their families and other health care professionals. Learn more

 

Undergraduate and Graduate Education

In order to understand the needs of persons with Alzheimer's disease and those who care for them, an overview of Alzheimer's disease is offered to students in the School of Nursing, Pharmacy, Social Work and the Department of Communicative Disorders. An on-line module of continuing education is also available for practicing nurses. Working with WAI faculty and staff, students in the Lafollette School of Social Policy learn about Alzheimer's disease and the public policy implications of Alzheimer's disease and its impact on the economics of long term care.

 

Family Practice Residency Training

Recognizing the failure of primary care physicians to diagnose and treat dementing illnesses, a Dementia Diagnosis in Primary Care practice module was introduced to the UWSMPH family practice residency programs in 2005. The intent of this module is to introduce family practice residents to a cognitive screening and diagnostic process that will promote early recognition, treatment and support of persons and their families who are affected by dementia. These programs are repeated every three years at each residency site. Learn more

 

Web series: Diagnosis and Management of Dementing Disorders

In partnership with the Greater Wisconsin Alzheimer's Association, the WAI developed a live four-part web-series targeted to primary care physicians and allied health professionals in the northern part of Wisconsin. This was funded by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) grant and attended by over 100 persons in the winter and spring of 2007. The web series remains on the WAI website and is available to new learners. web series

 

Topics in this series include:

  • Early Diagnosis and Treatment of Persons with Alzheimer's disease
  • Differential Diagnosis of Dementing Disorders
  • Treating the Behavioral and Psychological Symptoms of Dementia
  • The Caregiver is Also Your Patient

Alzheimer's Disease: Annual Update

Since 2000, the WAI has partnered with the UWSMPH Department of Medicine, the UWOCPD and the William S. Middleton Memorial Veterans Hospital to offer an annual continuing medical education conference. The goal of these conferences is to improve the diagnostic and therapeutic capability of health care providers who care for persons with Alzheimer's disease and related dementias. In recent years, close to 200 participants have attended this annual event. In 2008, participants were asked to develop personal learning objectives that they would implement in their practice after attending and learning at the conference. In a follow-up questionnaire many of those who responded reported that they were able to, or in the process of, changing their practice as an outcome of their learning at the conference.

 

Recent national speakers have included; Mary Mittleman, Dr PH, from New York University School of Medicine; William Dale, MD PhD, from The University of Chicago Medical Center; Malaz Bustani, MD, MPH, from the Indiana University for Aging Research and Martha Morris, ScD from Rush University Medical Center.

 

 

Outreach to the People of Wisconsin

 

Wisconsin Alzheimer's Institute Affiliated Dementia Diagnostic Clinic Network

To improve access to and quality of dementia diagnostic services, the WAI collaborates with health care providers throughout Wisconsin, Illinois and Michigan to develop a network of interdisciplinary dementia diagnostic clinics. These clinics include teams of physicians, nurses, social worker, psychologists, occupational therapists and Alzheimer's Association staff who meet with both the family and patient at the time of diagnosis and during follow-up visits. These teams come to the UWSMPH and its Memory Assessment Clinic for training in the diagnosis and treatment of dementia and return to their communities serving as models of dementia care.

 

After 10 years there are 33 clinics affiliated with the WAI diagnosing over 2,000 new patients annually. Long-term relationships with the WAI and other clinics are maintained through bi-annual meetings and an annual continuing medical education conference. These opportunities foster learning with updates on recent advances in diagnosis and disease management. Demographic and diagnostic data are collected from the clinics and summarized for their use and/or quality assurance purposes.

Memory Screening Initiatives

Funding provided by Centers for Medicare and Medicaid Service and the Administration on Aging to the Wisconsin Department of Human Services was made available to 11 Wisconsin counties to implement memory screening. The WAI trained staff at County Aging and Disability Resource Centers and Family Care organizations to cognitively screen people over the age of 65 who were demonstrating symptoms of dementia. The results of the cognitive screens were sent to the person's primary care physician and the persons who screened positive were encouraged to see their physician or a nearby dementia diagnostic clinic. Learn more

 

To ensure understanding of cognitive screening results, the WAI educated physicians about interpretation of the screens and differential diagnosis of dementing disorders. Continuing medical education was offered through local healthcare systems in each of those 11 counties. The learning modules included:

  • Early Diagnosis of Alzheimer's Disease
  • Differential Diagnosis of Dementing Disorders

In 2007, the content from the modules was combined to create the web course Early Recognition and Treatment of Dementing Disorders so physicians who could not attend the live programs had access to the information. Although no longer available for credit, the course content remains available today.

 

Wisconsin Alzheimer's Institute Milwaukee Project

In the spirit of the University of Wisconsin's Wisconsin Idea, the WAI partnered with the Center for Urban Population Health to develop the WAI Milwaukee Project that will contribute to and collaborate with the rich resources of the healthy aging community in Milwaukee, particularly its communities of color. The purpose of this Milwaukee initiative is to improve the knowledge and the understanding of Alzheimer's disease in these communities and to provide direct services to persons and families affected by it.

 

Gina Green-Harris, Senior Outreach Specialist, is leading the WAI Milwaukee Project. She is working to assess program needs and to develop additional services for persons with Alzheimer's disease and their caregivers particularly in the African American community. The project supports the WAI's efforts in the following areas:

  • Community education, Outreach and Public Awareness
  • Collaborative Relationships
  • Professional Education
  • Research (Wisconsin Registry for Alzheimer's Prevention)
  • In home memory and functional assessment

The initial goal is to make the WAI Milwaukee Project a valuable resource to Milwaukee's families who struggle with this disease. The WAI has developed and will continue to develop working relationships with community organizations including grassroots agencies, traditional community based organizations, hospitals, government agencies and universities. Supporting the culture and heritage of Milwaukee's minority communities, we are using proven community- based participatory research recruitment models that have proven to be effective in other projects across the country.

 

 

Research: Contributing to the Future

 

WRAP

The Wisconsin Registry for Alzheimer's Prevention (WRAP) is a longitudinal study of adult children of persons with Alzheimer's disease with over 1,300 participants from throughout Wisconsin and the United States. Research sites are in Milwaukee, Madison and La Crosse. The long-term goal of this project is to identify lifestyle and health variables associated with abnormal cognitive aging and the development of Alzheimer's disease and to use this information to develop interventions that may slow disease progression years before people become symptomatic. Knowledge of the factors that influence the development of Alzheimer's disease in asymptomatic persons is critical to developing strategies for early intervention and prevention of the disease. The WRAP study was recently recognized by the National Institute of Health with a $3.5 million 5-year grant and serves as the dominant research theme for Wisconsin's recently funded Alzheimer's Disease Research Center.

 

Take Charge: Pilot Program for Older Adults with Memory Problems

Take Charge was a year long pilot program focused on using education and psychosocial support to sustain or enhance everyday cognitive skills. Older adults with Mild Cognitive Impairment were invited to enroll at WAI-affiliated dementia diagnostic clinics in Beloit, LaCrosse, Madison, and Richland Center, WI. A "personal trainer" was assigned to each participant. Volunteers met twice per month (2007-2008) with a Take Charge staff member to develop and implement individualized activity care plans to encourage cognitive activity, management of everyday stress, physical exercise and a healthy diet.

 

A total of 38 volunteers participated in the study. At the end of the year-long project, all but one participant reported that they would recommend Take Charge to others. Eighty-seven percent stated that they had increased their engagement in mentally stimulating activities as a result of Take Charge, and 63% reported improvements in their ability to manage everyday stress.

 

An advisory board made up of program directors from other early memory loss programs was convened at the start of Take Charge to offer guidance to the project. This group continues to meet and has planned a Summit meeting in the Spring of 2009 to discuss early memory loss programming in Wisconsin.

 

For a historical overview of the WAI's first 5 years, please read The Wisconsin Alzheimer's Institute, 1998-2003.