Dementia 2.0: Updates in Classification, Evaluation, and Treatment with Dr. Anna Chodos

Understanding Cognitive Decline

• 🧠 The conversation introduces new terminology: minor neurocognitive disorder and major neurocognitive disorder, which aim to better link mild cognitive impairment (MCI) to dementia and emphasize progression.
• 💡 Dementia is defined as cognitive decline from a prior baseline affecting day-to-day function, distinct from MCI which does not significantly impair function.
• 🎯 The Mini-Cog is highlighted as a practical and sensitive screening tool for primary care, useful for identifying individuals who require further evaluation.

Comprehensive Dementia Evaluation

• 📝 A thorough dementia evaluation involves assessing cognitive domains (memory, language, executive function, social cognition, visual-spatial, motor, attention), functional decline (ADLs and IADLs), and a medical workup.
• 🗣️ Gathering a detailed cognitive history is crucial, often requiring collateral information from caregivers to understand changes in memory, language, executive functions, behavior, visual-spatial abilities, motor skills, and attention.
• 🩺 The medical workup typically includes labs (B12, thyroid, HIV, RPR) and imaging (MRI or CT) to rule out reversible causes and identify structural changes like atrophy or small vessel ischemic disease.

Staging and Diagnosis

• 📊 Dementia is staged as mild, moderate, or severe based on the degree of functional impairment, with mild dementia characterized by IADL difficulties but preserved ADLs.
• ⚠️ Safety concerns such as leaving the stove on or driving impairment require immediate intervention and knowledge of state-specific reporting laws.
• 🗓️ Early detection and diagnosis are crucial for advanced care planning, allowing patients to maintain autonomy and participate in decisions about their future.

Brain Health and Management

• 🌱 Brain health plans focus on modifiable risk factors: encouraging physical and social activity, managing vascular risks (blood pressure, diabetes, LDL), correcting hearing and vision, and reducing medications with anticholinergic burden or sedative effects.
• 💊 Symptomatic medications like acetylcholinesterase inhibitors (e.g., donepezil) and NMDA antagonists (memantine) can help manage symptoms and improve quality of life, though they are not curative.
• 🔬 Biomarker testing (CSF or blood tests for amyloid and tau proteins) and disease-modifying therapies like monoclonal antibodies are currently primarily in the specialist domain due to intensive monitoring, potential side effects, and high costs.

Resources and Support

• 🤝 Connecting patients and caregivers to dementia organizations (e.g., Alzheimer's Association, Dementia Minds) provides valuable resources, support groups, and practical tips for managing symptoms.
• 🌟 Incorporating the voice of people living with dementia is essential, advocating for their autonomy and ensuring their needs are centered throughout the care process.
• 🏥 Primary care physicians play a vital role in early detection, initiating brain health plans, and facilitating connections to specialists when needed, emphasizing that caring for dementia extends beyond medication.