Pilot study of an Alzheimer's disease risk assessment program in a primary care setting

Abstract

Introduction The goal of this study was to pilot a referral‐based cognitive screening and genetic testing program for Alzheimer's disease (AD) risk assessment in a primary care setting. Methods Primary care providers (PCPs; N = 6) referred patients ( N = 94; M = 63 years) to the Rhode Island Alzheimer's Disease Prevention Registry for apolipoprotein E (APOE) genotyping and cognitive screening. PCPs disclosed test results to patients and counseled them about risk factor modification. Results Compared to the Registry as a whole, participants were younger, more likely to be non‐White, and had lower cognitive screening scores. Mild cognitive impairment participants correctly reported a higher perceived risk of developing AD. Patients who recalled being counseled about modifiable risk factors were more likely to report positive health behavior changes. Discussion A referral‐based program for cognitive and genetic AD risk assessment in a primary care setting is feasible, acceptable to patients, and yielded a more demographically diverse sample than an AD prevention registry.

US Adults’ Likelihood to Participate in Dementia Prevention Drug Trials: Results from the National Poll on Healthy Aging

“…Given that Black and Hispanic adults are at increased risk for dementia, improving access to risk information for these groups may facilitate greater interest in prevention research. For example, a recent pilot study of an AD risk assessment program in a primary care setting found the intervention yielded a more demographically diverse sample than an AD prevention registry ( 34 ), suggesting this approach may be a potential method to improve recruitment.…”

Dementia prevention and the GP’s role: a qualitative interview study

“… 40 One study has noted the feasibility of such screening interventions. 30 However, in UK-based population studies, the most common recommendation was to embed proactive approaches in routine health check-ups, for example, the annual health review of older adults. 27 GPs in this study mirrored this suggestion and would require further investigation.…”

“…Alzheimer's Disease International (ADI) (39) recommends introducing annual brain health check-ups to those aged 50 and over, providing focused opportunities to promote dementia risk reduction (39). Some initial studies have noted the feasibility of such screening interventions (30). However, in UK-based population studies, the most common recommendation was to embed proactive approaches in routine health check-ups, e.g., the annual health review of older adults (27).…”

“…Furthermore, the study showed that while awareness of dementia risk factors was good, primary care professionals lacked confidence in their knowledge, leading to uncertainties in risk reduction advice (29). Research in the US has identified the feasibility and acceptability of dementia screening programmes within primary care, noting that patients who recalled being counselled about modifiable risk factors were more likely to report positive health behaviour changes (30). Despite such findings, there remains little research in the UK exploring GPs' views regarding their knowledge of modifiable dementia risk factors, the extent to which they discuss this with patients across the life course and those barriers that may limit their engagement in dementia risk communication (31).…”

Healthy Lifestyle Behaviors and Viewpoints Among Members of an Alzheimer Prevention Registry

“…We found that participants were willing to increase healthy lifestyle behaviors if they could achieve “moderate” risk reduction for dementia (between 21% and 23%). The fact that adults may be willing to engage in healthy lifestyle behaviors with the potential for even moderate risk reduction has implications for counseling at-risk individuals28 and potentially reducing dementia prevalence, given that up to one third of AD cases could be attributed to modifiable causes such as smoking, poor diet, and lack of exercise 5. Clinicians may consider exploring perceptions of dementia risk reduction with their patients in order to identify individualized factors that could enhance engagement in healthy lifestyle behaviors, as there was variability in our sample, with some participants willing to change behavior to achieve only mild risk reduction, while others reported a more substantial risk reduction would motivate them to shift behavior.…”