Alzheimer’s Disease Legislation And Policy—Now And In The Future

Hoffman, David P.

doi:10.1377/hlthaff.2013.1223

Cited by 12 publications

(16 citation statements)

References 3 publications

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“…Finally, the advent of a predictive LOAD diagnostic is likely to advance researchers’ ability to develop and test novel AD therapeutics. Responding to the projected future financial burden imposed by LOAD, and the potential sources of value from predictive testing, many states have prioritized early detection in their future preparations for AD ( 63 ).…”

Section: Discussionmentioning

confidence: 99%

Plasma 24-metabolite Panel Predicts Preclinical Transition to Clinical Stages of Alzheimer’s Disease

et al. 2015

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We recently documented plasma lipid dysregulation in preclinical late-onset Alzheimer's disease (LOAD). A 10 plasma lipid panel, predicted phenoconversion and provided 90% sensitivity and 85% specificity in differentiating an at-risk group from those that would remain cognitively intact. Despite these encouraging results, low positive predictive values limit the clinical usefulness of this panel as a screening tool in subjects aged 70-80 years or younger. In this report, we re-examine our metabolomic data, analyzing baseline plasma specimens from our group of phenoconverters (n = 28) and a matched set of cognitively normal subjects (n = 73), and discover and internally validate a panel of 24 plasma metabolites. The new panel provides a classifier with receiver operating characteristic area under the curve for the discovery and internal validation cohort of 1.0 and 0.995 (95% confidence intervals of 1.0-1.0, and 0.981-1.0), respectively. Twenty-two of the 24 metabolites were significantly dysregulated lipids. While positive and negative predictive values were improved compared to our 10-lipid panel, low positive predictive values provide a reality check on the utility of such biomarkers in this age group (or younger). Through inclusion of additional significantly dysregulated analyte species, our new biomarker panel provides greater accuracy in our cohort but remains limited by predictive power. Unfortunately, the novel metabolite panel alone may not provide improvement in counseling and management of at-risk individuals but may further improve selection of subjects for LOAD secondary prevention trials. We expect that external validation will remain challenging due to our stringent study design, especially compared with more diverse subject cohorts. We do anticipate, however, external validation of reduced plasma lipid species as a predictor of phenoconversion to either prodromal or manifest LOAD.

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Section: Discussionmentioning

confidence: 99%

Plasma 24-metabolite Panel Predicts Preclinical Transition to Clinical Stages of Alzheimer’s Disease

et al. 2015

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“…Discussions could include a check for risk of falls, adherence with prescribed medications, review of exercise, smoking, dietary habits, level of social support, and consideration of future health care plans. Cognitive assessment tools have been developed ( 6 ) that could help in stimulating such discussions, and efforts are being made to raise awareness of the need for these activities ( 18 ). Because of the Affordable Care Act, those efforts currently focus on the Medicare population, estimated to include 93% of noninstitutionalized adults aged 65 or older ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Routine Check-Ups and Other Factors Affecting Discussions With a Health Care Provider About Subjective Memory Complaints, Behavioral Risk Factor Surveillance System, 21 States, 2011

Adams

2016

Prev. Chronic Dis.

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IntroductionMost adults reporting subjective memory complaints (SMCs) do not discuss them with a health care provider and miss an opportunity to learn about treatment options or receive a diagnosis. The objective of this study was to describe correlates of discussing memory problems with a health care professional among adults reporting SMCs.MethodsData were from 10,276 respondents aged 45 years or older in 21 states reporting SMCs on the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Odds ratios (ORs) adjusted for demographic and health-related measures were computed for discussing SMCs with a health care professional.ResultsAmong all respondents aged 45 or older reporting SMCs, 22.9% reported discussing them with a health care professional; among those reporting a recent routine check-up, this rate was 25.2%. The largest adjusted OR for discussing SMCs with a health care professional was for respondents reporting that SMCs always (vs never) caused them to give up household chores (OR, 3.02) or always (vs never) interfered with work (OR, 2.98). Increasing age reduced the likelihood of discussing SMCs. Among respondents who discussed SMCs, 41.8% received treatment.ConclusionRoutine check-ups may be a missed opportunity for discussions of SMCs that might lead to diagnosis or treatment. The Affordable Care Act requires a cognitive assessment for Medicare recipients during their annual wellness visit, but these results suggest that adults younger than 65 might also benefit from such an assessment.

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“…Coupled with an inadequate number of geriatric-based professional healthcare providers (LaMascus et al, 2005;IOM, 2008), the deficit of para-professionals to meet the growing demand for care is problematic (HRSA, 2004;Harahan and Stone, 2007). In the USA, the National Alzheimer's Project Act and the Health Brain Initiative were established to create and implement plans to overcome Alzheimer's disease and 33 states, including Oregon, developed plans to address Alzheimer's disease and support caregivers (NAPA, 2012;CDC, 2013;Hoffman, 2014). As part of Oregon's 2014 State Plan, free educational programs were offered to all caregivers as part of a multi-component strategy to deliver high-quality and safe dementia-care (SPADO Task Force, 2012).…”

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confidence: 99%