Disclosure of Alzheimer's Disease and Dementia: Patient- and Care Partner-Centric Decision-Making and Communication

Disclosing the diagnosis of cognitive impairment or dementia due to Alzheimer’s disease (AD) and related dementias can be one of the most challenging aspects of dementia care for clinicians, compounded by the fact that AD is one of the most feared diagnoses by patients and families.^1–5 However difficult the diagnosis is to give or receive, evidence supports that disclosing a timely dementia diagnosis, accompanied by psychoeducation and care planning, is beneficial to patient–care partner dyads.^5–7 Timely diagnosis, provided as early as possible, increases the likelihood that patients can be involved in decision making and planning for the future and allows care options to be implemented sooner to provide greater clinical and quality–of-life benefits, reduce potential for harm, and mitigate symptoms and course of decline.^6,8,9 One patient commented on the importance of receiving the diagnosis so that the family could address it together:

 Patient Perspectives

“It was hard for everyone to accept the diagnosis. While my family had to come to terms with this new situation, so did I. I needed to put it out there so that we could begin dealing with the new me.”⁴

When a dementia diagnosis is disclosed, persons with dementia and their caregivers have reported dissatisfaction with the following areas: clinicians’ reluctance to make a precise diagnosis and/or explain the diagnosis and prognosis, insensitive or abrupt manner of disclosure, unaddressed emotional needs, inadequate discussion of management options, and suboptimal post-disclosure follow up.¹ A successful disclosure process is predicated on a collaborative triadic relationship among the patient, the informant care partner, and the clinician that begins in the evaluation process, is iterative, and is patient-centered.

Although the tasks of AD diagnosis, disclosure, and management may appear complex, in typical cases, primary care clinicians who acquire knowledge and skills, adopt a proactive attitude, and who use patient-centered communication and a structured process can manage these important responsibilities and meaningfully support patients and their families throughout the process. Whether the process is embarked upon or completed within the primary or specialty care setting, it necessitates an active and expanding role from primary care providers (PCPs).

Role of Primary Care Providers

Primary care providers play a frontline role in detecting cognitive impairment and dementia. They often initiate the evaluation process and, for the majority of inidividuals with typical and uncomplicated syndromes, can have sufficient knowledge and skills to complete the evaluation process, including diagnosis, and to provide necessary management. The role of the PCP is expected to become even more crucial as the number of dementia cases is predicted to rise in the coming decades.^5,10 The 2016 World Alzheimer’s Report reviewed evidence on health care coverage, quality, and costs in dementia with a goal of identifying areas needing improvement. The report stated that dementia care is over-specialized and that the current model, in which all persons with dementia are being referred to specialists, is not scalable to provide sufficient coverage for the growing number of people affected.¹¹ A solution to this dilemma is to expand primary care services, which will increase the health care system’s capacity for diagnosis and continuing care and will also result in cost savings.¹¹

Globally, the current state of providing timely and appropriate dementia diagnosis and management is poor.^2,5,10 A review of 23 international studies reported a pooled rate of undetected dementia of 61.7%, and, even in high-income countries, only about 50% of persons with dementia receive a diagnosis; the rates are as low as 10% in low-income countries.^2,12 Dementia is underdiagnosed in primary care settings, with an estimated 50% of patients over age 65 years not diagnosed by their PCPs.¹² For many patients who do receive a dementia diagnosis, little or no objective workup is completed, and resource utilization is delayed, fragmented, and often redundant.

An accurate and timely diagnosis can serve to educate, support, and empower the patient and family when they are most capable of participating in treatment decisions, enabling them to make more informed choices and better use of community resources—including education support and advance planning—and to consider engaging in research.^5,6,8 Providing a timely dementia diagnosis can also reduce costs and improve the health and well-being of the patient and caregiver by decreasing patient hospitalizations, disability, and psychiatric emergencies as well as caregiver stress and depression.^1,5,6,8,13

Barriers. Barriers to dementia diagnosis in primary care settings must be overcome for providers to fulfill the responsibility of providing timely, accurate, and compassionate disclosure. Barriers that PCPs face include significant time constraints; low reimbursement; lack of confidence, knowledge, communication abilities, and skill with the diagnostic and disclosure process; and ambivalence about the value of the diagnosis (AV 1).^1,3,12 Additional challenges are finding (or convincing patients to bring) a knowledgeable informant care partner to a visit and a lack  of resources (eg, limited availability of specialists) and access to case management and/or social workservices. Furthermore, reasons that clinicians provide for delaying or witholding full diagnostic disclosure include a sense of futility because the patient may no longer have the ability to understand or make use of the information, patients’ desire not to know, and a wish to protect the patient from undue distress.^3,14 However, the vast majority of patients and care partners express that they want to be told the diagnosis, and full diagnostic disclosure, under the vast majority of circumstances, is supported by data and consensus.^4,6,15 Some provider-related barriers to diagnosing dementia can be addressed by improving PCP knowledge, skills, communication abilities, and attitudes toward making and disclosing a dementia diagnosis.

When educated and supported, PCPs are uniquely positioned to appropriately detect, evaluate, and disclose dementia diagnoses. The PCP is more likely to have greater familiarity with the patient and his or her life circumstances than a specialist is, often having established trust and rapport, and caregivers place critical value on their relationship with the patient’s PCP for recommendations and guidance.¹⁶ These factors support the role of PCPs in diagnosing and managing typical cases of dementia.

Evaluation. The evaluation process can be initiated and completed in one or more clinical settings.

Core elements of the evaluation include the following:

• A focused history of present illness obtained from the patient and an informant care partner
• A multidomain structured review of systems (eg, cognition, daily function, behavior/neuropsychiatric symptoms, sensorimotor function)
• A relevant biopsychosocial history and risk factors
• Mental status (using a validated brief cognitive instrument such as the Montreal Cognitive Assessment)
• Medical, neurologic, and psychiatric examinations
• Cognitive laboratory panel (eg, complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, Vitamin B₁₂)
• Structural brain scan (eg, noncontrast brain MRI).^8,17

In some cases, depending on the nature of the patient’s illness, the complexity of biopsychosocial factors, or the clinician’s comfort level and proficiency, the PCP may refer the patient for neuropsychological evaluation (such as when a patient’s clinical characteristics or comorbidities may confound an office-based examination) or to a specialist. However, patients with typical dementia syndromes and a typical AD presentation can be appropriately evaluated in the primary care setting.^17,18

Once the evaluation process is complete and the primary or consulting clinician has sufficiently high confidence in the nature of illness (ie, level of impairment and type of syndrome) and the etiological cause(s), the stage can be set for the disclosure. Disclosure can be appropriately achieved in any clinical setting, whether primary care, specialty care (eg, general psychiatry, general neurology, geriatrics, neuropsychology), or dementia subspecialty care (eg, geriatric psychiatry, cognitive neurology, geriatric dementia specialty).

Patient-Centered Communication

A patient-centered communication approach is beneficial in the dementia disclosure process.¹⁹ Communication about the diagnosis must be tailored to the individual and the family and should create a partnership between the patient, the caregiver, and the provider.^1,6,8 Clinicians should balance sensitivity with honesty and preserve the dignity of the person with dementia by acknowledging their important central role in guiding their care.⁶

The conceptual framework of patient-centered communication comprises the following 6 core functions:

• Exchanging information
• Fostering healing relationships
• Recognizing and responding to emotions
• Managing uncertainty
• Making decisions
• Enabling patient self-management (or management by the patient and his or her care partner).²⁰

Patient-centered communication uses the following strategies:

• Eliciting, understanding, and validating the patient’s perspective (eg, concerns, ideas, expectations, feelings)
• Understanding the patient’s unique psychosocial and cultural contexts
• Reaching a shared understanding of the patient’s problem and its treatment
• Offering the patient meaningful involvement in medical decisions.^19–21

Patient-centered communication has been shown to be beneficial in areas of medicine such as cancer^19–21 and is well suited for complex, multifaceted illnesses such as dementia.

A patient–care partner dyad-centric approach is an important component of assessment and disclosure, according to recent preliminary recommendations from the multidisciplinary Alzheimer’s Association Clinical Practice Guidelines for the evaluation of cognitive-behavioral syndromes, AD, and other dementias.¹⁷ Early in the process, it is important to identify a close family member or friend as a care partner(s) who will participate in the diagnostic process, as noted below by a practitioner.

 Clinician Perspectives

“I think it’s very important that you spend some time… with the carers [so]… the family is aware of what’s going on… and they get involved.”⁴

The care partner can help with providing the patient’s history, facilitating and enabling the treatment plan, and providing emotional support.^1,6,8,17

The recommendations from the workgroup include establishing a dialogue with the patient and care partner to assess their understanding and appreciation of the presence and severity of the cognitive-behavioral syndrome, which encompasses all levels and forms of cognitive and behavioral impairment and dementia.¹⁷ The workgroup recommended that the patients’ and care partners’ level of understanding guide clinicians’ communication of diagnostic findings (disclosure).

A Conceptual Model for Structured Diagnostic Disclosure

The guidelines provide a structured process to personalize and communicate the diagnostic findings and strongly recommend that it be done honestly and compassionately and involve both the patient and care partner.¹⁷ A structured approach to disclosing a serious diagnosis has been shown to not only alleviate clinician concerns and anxiety about the experience but also improve the experience for patients and their families.^1,6,22

The workgroup recommends that the disclosure include the name, characteristics, and severity of the syndrome; the disease likely causing the syndrome; the stage of the disease; what can be expected in the future; treatment options; potential safety concerns; and medical, psychosocial, and community resources for education, care planning and coordination, and support services.¹⁷

Because of the amount of information, appropriate disclosure of the diagnosis usually requires multiple visits.^1,6,17

Planning and preparation. The pre-disclosure planning should focus on building rapport with patients and their caregivers; exploring their knowledge of dementia, beliefs, values, and preferences; and addressing knowledge gaps. Diagnostic procedures should be discussed so that patients and caregivers understand the testing being done and its purposes. While the diagnostic testing process is being undertaken, clinicians should evaluate how to personalize the disclosure with the individual and the care partner.

Under the vast majority of circumstances, a full disclosure of the diagnosis is warranted.^6,17 If a family member or caregiver expresses a desire that the patient not know the diagnosis, the clinician should explore the caregiver’s reasons. The caregiver may be trying to protect the patient or may be experiencing grief, stress, or difficulty processing the situation.¹ While some studies have reported different attitudes between caregivers and persons with dementia regarding disclosure, the vast majority of individuals with mild dementia(92%) wanted to be fully informed of their diagnosis, and 98% of caregivers wanted the same were they to be the subject of a dementia diagnosis.^4,6,15 Clinicians must understand the patient-caregiver dyad’s values, beliefs, and concerns about dementia; educate them on the benefits of diagnostic disclosure; and uncover what the patient really would want.

The following comments illustrate caregiver qualms about whether to disclose the diagnosis versus the patient’s need for knowledge:

  Family Perspectives

“My wife, a retired RN, has had the tests, and we have a meeting with the neurologist coming up within the next two weeks. We have a good relationship with him, and I’m struggling with whether or not I should get the diagnosis (if he has one) without her knowing because I’m not sure how she will handle it. The needed papers have been signed to allow this. If you have been diagnosed, what emotions did you experience, and how long did they last before you became accepting to the point where you could focus more on what you could do to improve your life, instead of having those emotions consume your every minute? I know there are pros and cons for her knowing the diagnosis.”²³

“I’m all for telling. If she is in Early Stage and knows something is wrong, many of us found the actual words a relief: ‘yes, I’m not crazy, there is something wrong with me.’ After the diagnosis, when I’d forget or goof, I merely shrugged and thought, ‘that’s the AD.’”²³

“I think she has the right to know. so hopefully you will hear the diagnosis together…and then when it is said…you can then support her in how she will be the best she can be…I would say an absolute wrong thing to do would be to say stuff like ‘a lot of people have this diagnosis’….’You are young, you will beat it.’ I think she needs validation first…like ‘Wow, I’m sorry honey this is the diagnosis. What can we do to take your mind off this and let you absorb it? A massage at the local spa? A pedicure … a nail job? Dinner? Anything but focus on it …until she wants to focus on it.”²³ 

In the uncommon instance when the clinician decides it is ethically appropriate to delay or to make a limited disclosure of diagnosis to the patient or caregiver, the provider can use broad terms, such as, “You have memory loss that is impacting your daily function,” rather than explicitly naming the condition as dementia or AD. The patient can then receive the same care without the provider naming the disease. The patient’s right to not be informed should be honored if this is their decision and the patient has capacity in this regard; the reasons for not being informed should help guide the provider in terms of how to approach and help them. Limited disclosure may also be appropriate when a patient has reduced capacity or appreciation, has agitation when cognitive problems are discussed, or has a mood disorder that is focused on their cognitive problems. When limited disclosure to the patient is deemed ethically appropriate, the caregiver can be separated from the patient to be provided the full diagnosis and counseling and to engage in care planning. This can be done by having the patient go to another area for vital signs or other testing or can be scheduled separately.

Another situation that may arise is that a patient, even after substantial counseling, refuses inclusion of any family, friends, or informants during disclosure. Although this should be a rare occurrence, if the patient is assessed to be capable of making that decision, then clinicians should respect their wishes and autonomy but maintain an ongoing dialogue regarding the need for and benefits to the patient of involving a fully informed partner in her/his current and future care.

Case Practice Question

Case 1. Helen is a 73-year-old woman who presents with her family to discuss the findings of her comprehensive dementia workup. First, her family tells you privately that you should not disclose Helen’s  diagnosis to her if it is Alzheimer disease because she would be devastated. You have determined that Helen has mild dementia due to Alzheimer disease. What would be the best step to take now?

1. a) Comply with the family’s wishes and withhold Helen’s Alzheimer diagnosis.
2. b) Go ahead and disclose to Helen that she has mild dementia due to Alzheimer’s disease; she has the right to know her diagnosis.
3. c) Explore the family’s beliefs, values, and concerns about Alzheimer disease and what they believe it means to Helen.
4. d) Advise Helen of her family’s concerns.

Discussion of Case Practice Question

Preferred response is c. Explore the family’s beliefs, values, and concerns about Alzheimer disease and what they believe it means to Helen

Explanation: Your initial response should be to explore the reasoning behind the family’s concern about Helen knowing her diagnosis and also what Helen has expressed to her family regarding an Alzheimer diagnosis. Helen’s diagnosis of mild dementia does not preclude having capacity to understand her diagnosis and to be an active participant in her treatment and future planning.

Diagnostic disclosure. The goals of the diagnostic disclosure visit are to honestly and sensitively convey the diagnosis, including nuances and likelihoods regarding etiology, differential diagnosis, treatment options, realistic expectations of medications/therapies, prognosis, future planning, and support services. This is a lot of information to convey and to be absorbed in a single visit, so multiple visits may be needed to provide a complete disclosure and appropriate personalized education and care planning.^1,6

If the caregiver cannot be in the office for the disclosure, they may participate by phone. If a large family is present, clinicians should identify a spokesperson and get consent from the patient (if capable of making their own decisions) to discuss their diagnosis in the presence of all the family members.

Clinicians should use eye contact and other cues and strategies to engage the person with dementia and the care partner; adjust the level of the information to fit the degree of cognitive impairment, knowledge, and appreciation; avoid using compound questions; and allow time to respond to questions, especially if the patient has language impairment.^1,6,8

Clinicians should begin with one to two sentences that offer a personalized clinical summary, confirm the goal of the meeting, and request to be invited to proceed with the disclosure. For example, the clinician might say, “You are a high-functioning, retired architect who has noticed some trouble with your memory and thinking, along with some increased anxiety, over the past 2 years. We’re here today to go over the results of your tests from last month and the reasons you’ve been experiencing these symptoms. Is this okay?” This statement acknowledges the person’s identity, briefly points out the symptoms along with the timeframe, and permits the patient and care partner to elaborate and agree to proceed.

The next step is to provide the diagnostic information: to identify and explain the level of impairment (eg, mild cognitive impairment or dementia), the nature of the cognitive behavioral syndrome (eg, dementia that “affects your ability to learn and remember new information and recent life events and some aspects of your thinking such as planning, problem solving, and doing multiple tasks), and the causative disease and stage (eg, Alzheimer’s disease in the mild stage). This vital information should be, in almost all circumstances, explicitly disclosed. The sentences should be kept short and to the point, adjusted to the patient’s and care partner’s capacity, and followed by pauses of 3 to 5 seconds to allow processing and any requests for clarification. For example, clinicians could say, “You have mild dementia. Dementia is a broad term that describes trouble with thinking that impacts your daily function. There are many causes of dementia. The description of your symptoms, the results of your examinations, and your brain scan fit best with Alzheimer’s disease as the cause of your dementia. Alzheimer’s disease is the most common cause of dementia. It is a gradually progressive, neurodegenerative disease. While we currently don’t have a cure for Alzheimer’s, there are important things that you can do to improve your symptoms and quality of life.”

Clinicians should explicitly check in to evaluate how everyone is processing the information and to address emotions (AV 2).¹ Then, the conversation can shift to the management process,^8,24,25 including patient- and caregiver-centric and holistic psychoeducation, treatment options (nonpharmacologic and pharmacologic), and care planning.

Management, monitoring, and support process. The clinician can meaningfully help the patient and caregiver feel empowered by engaging them in discussions regarding  management and care planning that are iterative, pragmatic, and focused on achieving important patient- and care partner–centered goals. These conversations and psychoeducation can focus on how they can maximize their potential to better live with dementia and optimize maintenance of function, quality of life, and physical and emotional well-being.¹

A preliminary multifactorial and multistepped management and care plan with regular monitoring visits should be devised and implemented in a collaborative way. Goals include addressing health, wellness, safety, the current psychosocial needs of the patient and caregiver, and expected care planning needs in the future.^1,8,25

Providing psychoeducation about the disease, prognosis, and management can be aided by handouts and resource materials (including ) that patients and caregivers can take or access at home. Patients may choose to seek help in online forums, like the individuals below:

  Patient Perspectives

“I was diagnosed by Neuropsychology today with early stages of Alzheimer’s. We knew due to my family history & me working closely with dementia patients that this was the likely outcome. I am reeling a bit. My wife is scared & I am just looking for information from sources that I trust.”²⁶

“This Monday I was told the diagnosis was real. I have been freaking out all week. I don’t know what to do. I was my mother’s caregiver when she had it. Now my husband will have to be my caregiver. I know he’s not emotionally ready for it. He keeps telling me I should be more Mohammed Ali and fight it. I just see what my mother turned into and I see me. How long before the freak out period stops? I’m scared.”²⁶

Contact information and referrals to community resources, such as the local , or local social work or social services, can help the patient and caregivers receive additional counseling and other support.³ This support is vitally important, especially for caregivers because their health and well-being are crucial to the safety, care, and well-being of the patient.¹³ Clinicians should acknowledge the important role of and demands on caregivers, ask and assess how they are coping, and direct them to appropriate support. This conversation with the caregiver is just the beginning of a therapeutic relationship to address how to best support them.

Caregivers, particularly spousal caregivers, often suffer from depression and other stress-related disorders, which can lead to reduced quality of life and contribute to illness.¹³ Caregivers have described the burden of looking after a loved one with dementia:

 Family Perspectives

“As a result of all the stress, pressure, I got burned out. I began to despise the situation and even developed ill feelings for my father. I would also get physically sick.”¹⁷

“I never seem to get the help I need: in-home help, tangible help so I can have a day to myself once a week. …I want off this merry-go-round… 7 years and counting.”²⁷

“Caretakers grieve dying loved ones while they are still breathing. …You need to deal with the reality that your partner with dementia will not be there for you. The odds are you will suffer in a way they never will. You are there for them BUT they are not going to be there for you. This is a very hard reality.”²⁸

“I don’t know how to keep the depression away when I feel like I’m hit with so much at once. I don’t know how to find time for myself, when I’m already feeling guilty about the time I spend at work.”²⁸

Although the disclosure process is a challenging and emotional task, the person with dementia and their caregiver should feel supported, empowered, and left with hope. It is important to provide an honest, compassionate, and balanced disclosure of the diagnosis that does not take hope away and is constructive and pragmatic.^4,6,8 Providing hope, meaning, and useful strategies, as well as dispelling misconceptions, explaining the variations of disease progression, and encouraging proactive interventions and timely planning, is empowering to patients and caregivers, as is focusing on how to live with dementia and how to improve the patient’s quality of life. The clinician must encourage them by making a commitment to advise them and provide ongoing care and support.

Conclusion

The disclosure of a dementia diagnosis can be successfully performed by knowledgeable clinicians in both primary and specialty care settings. Clinicians should provide diagnostic disclosure in a timely and appropriate manner. Preserving the dignity of the person with dementia by acknowledging their continued central role in their own care is paramount, as is establishing and maintaining a collaborative dialogue and triadic relationship between patient, care partner, and clinician. Communication with patients and caregivers should be personalized, sensitive, and honest and should leverage the triadic therapeutic partnership. Providing a timely, individualized, and structured disclosure not only represents best practices but is ethically essential, medically beneficial, and impactful for the quality of life and well-being of patients and their caregivers.

CLINICAL POINTS

• Informed PCPs are well-positioned to provide timely dementia diagnosis, education, and support.
• Disclosure is a process that involves a triadic relationship between patient, care partner, and clinician.
• Patient- and caregiver-centered communication is an important component of the disclosure process, which acknowledges the patient’s autonomy and their central role in decisions and offers individualized education and care planning.
• A well-planned, structured, personalized, and timely disclosure of the diagnosis is an ethical and medical imperative in the optimal care and well-being of the patient and caregivers.

Abbreviations

AD = Alzheimer’s disease

PCP = primary care provider

© Copyright 2019 Physicians Postgraduate Press, Inc.

Affiliations

Banner Alzheimer’s Institute, Phoenix, Arizona (Dr Goldfarb); Banner Health Center, Maricopa, Arizona (Dr Sheard); Ray Dolby Brain Health Center, California Pacific Medical Center, Sutter Health, San Francisco (Dr Shaughnessy); Banner Sun Health Research Institute, Sun City, Arizona (Dr Atri)

REFERENCES

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6. Grossberg GT, Christensen DD, Griffith PA, Kerwin DR, Hunt G, Hall EJ. The art of sharing the diagnosis and management of Alzheimer’s disease with patients and caregivers: recommendations of an expert consensus panel. Prim Care Companion CNS Disord. 2010;12(1):0-0.
7. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673-2734.
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17. Atri A, Norman M, Knopman D, et al. Alzheimer’s Association Best Clinical Practice Guidelines for the Evaluation of Neurodegenerative Cognitive Behavioral Syndromes, Alzheimer’s Disease and Dementias in the United States. In: Chicago, IL; 2018.
18. Gauthier S, Patterson C, Chertkow H, et al. Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4). Can Geriatr J. 2012;15(4):120-126.
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CME Background Information

Supported by educational grants from ACADIA Pharmaceuticals Inc.; Allergan; Avanir Pharmaceuticals, Inc.; and Biogen MA, Inc.

Participants may receive credit by reading the activity, correctly answering the posttest question, and completing the evaluation.

Objective

After completing this educational activity, you should be able to:

Knowledgably and compassionately disclose a dementia diagnosis to patients and their caregivers

Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosures are as follows:

Drs Goldfarb, Sheard, and Shaughnessy have no personal affiliations or financial relationships with any commercial interest to disclose relative to the activity. Dr Atri has no equity, shares, or salary from any pharmaceutical or biotechnology company and is not a member of any pharmaceutical company’s speakers’ bureau. Dr Atri has received honoraria for consulting, educational lectures/programs/materials, or medical/scientific advisory/data safety monitoring boards from AbbVie, Allergan, Alzheimer’s Association, Eisai, Harvard Medical School Graduate Continuing Education, Lundbeck, Merck, Roche/Genentech, Suven, and Synexus. Dr Atri’s institution (Banner Health) has received investigational observational study/clinical trial-related funding from Novartis. Dr Atri’s previous institution had contracts for or had received investigational clinical trial–related funding from The American College of Radiology, AbbVie, Avid, Biogen, Lilly, Lundbeck, Merck, and vTV. Dr Atri has received book royalties from Oxford University Press.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.0 hours of Category I credit for completing this program.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

Release, Review, and Expiration Dates

This brief report activity was published in January 2019 and is eligible for AMA PRA Category 1 Credit™ through January 31, 2021. The latest review of this material was December 2018.

Statement of Need and Purpose

Globally, more than half of patients with dementia due to Alzheimer’s disease (AD) and Related Dementias (ADRD) do not receive a timely and appropriate diagnosis. Several barriers including gaps in clinician knowledge, skills, communication strategies, perceptions, and attitudes towards the benefits of evaluation and the process of diagnostic disclosure contribute to a low rate of timely and appropriate diagnosis in AD/ADRD. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on AD.

Disclosure of Off-Label Usage

Dr Atri has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration–approved labeling has been presented in this activity.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.

Acknowledgment

This brief report is derived from the planning teleconference “Communication About Alzheimer’s Disease Diagnosis and Management,” which was held on October 3, 2018 and supported by educational grants from ACADIA Pharmaceuticals Inc.; Allergan; Avanir Pharmaceuticals, Inc.; and Biogen MA, Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporters.