ABSTRACT: To describe structural barriers to mental health specialists and consequences of these barriers to care for patients with dementia and neuropsychological symptoms and their primary care physicians (PCPs).
Cross-sectional qualitative interview study of PCPs.
Physicians' offices, primarily managed care.
Forty PCPs in Northern California.
Open-ended interviews lasted 30-60 minutes. The interview guide covered clinician background, practice setting, clinical care of a particular patient, and general approach to managing patients with Alzheimer disease or related dementias.Interviews were transcribed and themes reflecting referrals identified.
Ninety-three percentage of the PCPs described problematic access to and communication with mental health specialists (in particular psychiatrists and neuropsychologists) as impediments to effective care for dementia patients. Thematic analysis identified structural barriers to mental health referrals ranging from problems with managed care and reimbursement policies to lack of trained providers and poor geographic distribution of specialists. Structural barriers compromised care for patients with dementia because the barriers limited PCP treatment options, and resources, impacted office staff and time with other patients, impeded and delayed care, and fostered poor communication and lack of coordinated care. Negative consequences for PCPs included increased frustration,conflict, and burnout.
PCPs viewed problems created by onerous referral systems, such as mental health carve outs, as particularly burdensome for elderly patients with comorbid dementia and neuropsychiatric problems. These problems were cited by PCPs across different types of practice settings. PCPs managed treatment of neurobehavioral symptoms as best they could despite lack of specialist support.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 07/2010; 18(7):576-85. · 3.35 Impact Factor
ABSTRACT: Although deterioration of higher-order visual information processing abilities occurs in Alzheimer's disease (AD), few cross-sectional or longitudinal studies have systematically examined this deficit. The performance of 135 patients with probable AD and 97 matched normal control (NC) participants were compared on a structured test of perceptual organization ability, the Hooper Visual Organization Test (VOT). Both the standard VOT score and a derived score that corrected for anomia were significantly lower for AD patients than for NC participants, but neither score was particularly effective at distinguishing between the groups. The derived VOT score proved to be a more effective measure of visuospatial functioning than the standard VOT score as it loaded with other visuospatial tests in a principal components analysis while the standard score loaded with language tests. The VOT was sensitive to severity of dementia in the AD patients. Longitudinal assessment of 37 of the AD patients and 46 NC participants revealed significant decline over one year in the VOT scores of AD patients, but not in those of NC participants. These results indicate that higher-order visual information processing is impaired in patients with AD and gradually deteriorates with disease progression. This deficit may not be a particularly salient early marker of the disease, but it may be useful in tracking disease course.
Cortex 11/2007; 43(7):967-75. · 6.08 Impact Factor
ABSTRACT: Functional magnetic resonance imaging plays a promising role in the preclinical characterization of Alzheimer disease (AD) for use in early diagnosis and in preventive drug trials.
To determine whether functional magnetic resonance imaging can reliably distinguish risk groups for AD among cognitively normal middle-aged adults.
Cross-sectional case-control study.
University of California, San Diego, Alzheimer Disease Research Center participants and San Diego community volunteers.
Twenty cognitively normal individuals (10 high risk and 10 low risk), aged 58 to 65 years, were divided into 2 groups based on the presence or absence of the apolipoprotein E epsilon4 allele and a positive family history of AD.
Word pairs were presented in a blocked design alternating between conditions of novel pairs, repeated pairs, and fixation. Whole-brain differences in blood oxygenation level-dependent brain responses between conditions were compared across risk groups.
Compared with the low-risk group, the high-risk group showed many areas of differential blood oxygenation level-dependent response in regions commonly associated with AD pathology (eg, the left medial temporal lobe). Furthermore, different patterns of association between left medial temporal lobe activity and memory performance were demonstrated.
Results support a theory of up-regulation in neuronal memory systems in people at risk for AD many years before the typical age at disease onset. They further demonstrate that functional magnetic resonance imaging is a viable technique to identify persons at risk for AD.
Archives of Neurology 01/2006; 62(12):1881-8. · 7.58 Impact Factor
ABSTRACT: Support groups can provide a forum for socialization and learning for people with mild to moderate Alzheimer's disease. The aim of this study was to evaluate the effectiveness of these groups based on participant feedback. A survey questionnaire was administered to 70 support group participants with Alzheimer's disease from 8 well-established groups across the United States. Participants reported on the educational value, positive socialization, and improved ability to cope with symptoms and to accept the diagnosis as a result of participating in a support group. These reported outcomes suggest the importance of creating more sensitive measures to better evaluate the effectiveness of support groups and other educational or social support programs for persons with dementia.
American Journal of Alzheimer s Disease and Other Dementias 22(1):14-9. · 1.45 Impact Factor