Wellness
Better communication needed in Alzheimer’s care, says new report
A new report from the Alzheimer’s Association highlights the need for better patient-doctor communication as new treatments for the disease become available.
While recent advancements in treatment of early-stage Alzheimer’s are providing hope to millions living with memory loss and early cognitive decline, a new report finds too often individuals with memory concerns and their doctors are not discussing the issue, missing a critical first step toward diagnosis and potential treatment.
The Alzheimer’s Association 2023 Alzheimer’s Disease Facts and Figures report estimates that 6.7 million people 65 and older are living with Alzheimer’s dementia, one of the costliest conditions to society.
This year, the national cost of caring for individuals living with Alzheimer’s or other dementias in the US is projected to reach $345 billion — a $24 billion increase from a year ago.
An accompanying special report, The Patient Journey In an Era of New Treatments, offers new insights from patients and primary care physicians (PCPs) on current barriers that impede earlier discussion of cognitive concerns.
Focus groups reveal many people with subjective cognitive decline (self-reported memory concerns) do not discuss cognitive symptoms with their health care providers. Previous special reports have indicated many people believe their experiences are related to normal ageing, rather than a potential diagnosable medical condition.
Maria C Carrillo, PhD, chief science officer, Alzheimer’s Association, commented: “Providing the best possible care for Alzheimer’s disease requires conversations about memory at the earliest point of concern and a knowledgeable, accessible care team that includes physician specialists to diagnose, monitor disease progression and treat when appropriate.
“For the first time in nearly two decades, there is a class of treatments emerging to treat early-stage Alzheimer’s disease. It’s more important than ever for individuals to act quickly if they have memory concerns or experience symptoms.”
The annual report provides an in-depth look at the latest national and state-by-state statistics on Alzheimer’s disease prevalence, mortality, caregiving, dementia care workforce and costs of care.
This year it also examines the capacity of the medical specialty workforce essential for diagnosis, treatment and ongoing care for people living with Alzheimer’s and all other dementia.
The shortage of dementia care specialists could soon become a crisis for Alzheimer’s disease care, especially with the recent FDA accelerated approval of new treatments targeting the underlying biology of Alzheimer’s disease, which is reframing the health care landscape for people with early-stage Alzheimer’s or mild cognitive impairment due to Alzheimer’s disease.
Risks outweigh benefits of speaking about memory issues
Many Americans could potentially be eligible for new and emerging treatments, assuming they receive a timely diagnosis and want medical intervention.
Yet most focus group participants said their memory and thinking problems would need to have a significant negative impact on their quality of life or the lives of their family members in order for it to warrant a discussion with their physician.
Concerns about receiving an incorrect diagnosis, learning of a serious health problem, receiving unnecessary treatment and believing symptoms might go away on their own also make people reluctant to broach the topic of cognitive impairment.
Furthermore, most participants said they would be more comfortable talking to a friend about memory and thinking problems than a medical professional.
Different racial and ethnic groups express concerns about care delivery and specific barriers to care, which influences their interactions with healthcare providers. For example, Black Americans, American Indians, Alaska Natives and Hispanic Spanish-speaking Americans strongly preferred holistic approaches to treatment that minimise the use of biomedical interventions or prescription medication.
Black Americans, American Indians and Alaska Natives indicated the presence of historical racism in the medical field, which makes many individuals feel that they do not receive adequate, culturally competent care.
Some participants also indicated that their community’s mistrust of doctors and/or Western medicine prevents them from talking to a doctor.
In addition to reluctance from individuals, the focus groups revealed that PCPs are not proactively asking their patients about cognitive issues either.
PCPs shared that they hesitate to initiate conversations about cognitive decline and will wait until family members bring it to their attention.
PCPs expressed concern about how people will be cared for if an assessment uncovers Alzheimer’s disease or other dementia in light of specialist shortages and few referral options.
Importantly, PCPs view family members as influential and critical partners in care, often relying on them to initiate conversations about memory and thinking problems they observe in their loved ones, making the role of caregivers ever more significant.
“Both physicians and patients need to make discussions about cognition a routine part of interactions,” said Nicole Purcell, D.O., M.S., a neurologist and senior director, clinical practice, Alzheimer’s Association.
“These new treatments treat mild cognitive impairment or early-stage Alzheimer’s disease with confirmation of amyloid, so it’s really important that conversations between patients and doctors happen early or as soon as symptoms occur, while treatment is still possible and offers the greatest benefit.”
Taking action: Navigating early intervention
PCPs shared starting a clinical visit with an informal conversation may provide important cues to help inform a formal cognitive assessment. Short appointment times can make it difficult to notice subtle changes in a patient’s thinking over time, so many PCPs suggested a consistent, standardised process to begin visits would help overcome barriers to initiating conversations independently.
Family members are crucial in facilitating conversations and follow up care for loved one’s memory and thinking issues. In fact, almost all PCPs interviewed learned of their patients’ memory problems when a family member communicated concerns rather than hearing directly from the patients themselves. Many felt the issues were more serious when a relative provided an outside perspective. PCPs noted patients were generally more accepting of their issues and the need to address them when a family member or caregiver attended their visit.
Challenges across the specialist physician workforce
As the prevalence of Alzheimer’s disease and other dementias increases from 6.7 million today to nearly 13 million by 2050, so does the need for a larger paid workforce involved in diagnosing, treating and caring for those living with these diseases.
The special report examined the current specialist physician workforce capacity for Alzheimer’s care in the US.
Emergency medicine specialists see the most patients age 60 or older, as compared to geriatricians, neurologists and neuropsychologists, yet specialists said their neurology and geriatrician colleagues could most effectively diagnose Alzheimer’s disease.
Neurologists and geriatricians are also viewed by other specialists as best able to recommend treatments for Alzheimer’s disease. Geriatricians are viewed as the best able to provide ongoing care for people living with Alzheimer’s.
New treatment advances have generated excitement and hope — as well as many questions — for people living with early-stage Alzheimer’s and MCI due to Alzheimer’s. Whether the approval of treatment options will stimulate more conversations between people experiencing cognitive decline and their health care providers remains to be seen.
However, shortages of geriatricians and neurologists necessary to care for the aging U.S. population — which is expected to grow from 58 million people 65 and older in 2021 to 88 million by 2050 — remains a major challenge.
“If specialists receive an influx of referrals to evaluate new patients for cognitive impairment, the specialist shortage is likely to have the most immediate and obvious impact on people at the early phase of Alzheimer’s disease — those who may be eligible for newly approved treatments,” Purcell said.
Currently, there are more than 140 unique therapies that are being tested in clinical trials that target multiple aspects of Alzheimer’s biology. As the world’s largest non-profit funder of Alzheimer’s research, the Alzheimer’s Association is currently investing more than $320 million in over 1,000 active best-of-field projects in 54 countries, spanning six continents.
Full text of the 2023 Alzheimer’s Disease Facts and Figures report, including the accompanying special report, “The Patient Journey In an Era of New Treatments” is available here .
Gut-friendly foods such as kimchi and kombucha may carry hidden risks for heart health when eaten in excess, the British Heart Foundation (BHF) has warned.
The charity said foods marketed as prebiotic, probiotic or otherwise good for the gut can support the microbiome, but some may also be high in salt or sugar, which can raise the risk of cardiovascular disease.
Products highlighted by the British Heart Foundation included kimchi, kombucha, fruit yoghurts, smoothies and sauerkraut. It said there is no harm in including them as part of a healthy diet, but advised people to check labels for added salt and sugar and eat them in moderation.
Tracy Parker, the charity’s nutrition lead, said: “We encourage everyone to choose foods that can keep their gut microbiome healthy. The benefits are clear, and we are continuing to improve our understanding of how a gut-friendly diet may help our hearts.
“A lot of these products can contain high levels of salt or sugar though, so it is important to be aware of the potential drawbacks.
“By ensuring you check package labels for added salt and sugars, and eat each in moderation, you can make sure the risks do not outweigh the benefits for your heart health.”
Fermented foods such as kimchi and sauerkraut are rich in probiotics, the healthy bacteria produced during fermentation that can help support a diverse and healthy gut microbiome.
However, both are traditionally made using a lot of salt, which can raise blood pressure if eaten frequently or in large quantities. High blood pressure is known to increase the risk of heart attack and stroke.
Kombucha, a fermented tea, also contains probiotics and can be a healthier alternative to fizzy drinks, but many commercial and shop-bought versions contain added sugar.
Eating too much sugar can lead to weight gain, which can increase the risk of heart attack, stroke and other cardiovascular disease.
Fruit yoghurts can contain probiotic live bacteria cultures, but may also be high in sugar and have fewer live cultures than plain versions.
The charity said plain yoghurt with live and active cultures on the label can be a lower-sugar option, with whole fruit added at home for sweetness.
Smoothies made with whole fruits provide prebiotic fibre, which feeds beneficial gut bacteria and supports digestive health.
They can also provide vitamins and antioxidants, especially when made with a variety of plant-based ingredients.
But blending breaks down the structure of fruit, releasing free sugars that behave like added sugars in the body and can cause faster rises in blood sugar levels.
Regularly consuming too much sugar can lead to weight gain, which can increase the risk of developing type 2 diabetes, heart disease and kidney disease.
The charity said only one 150ml serving of any smoothie counts towards five-a-day, and suggested adding nuts or seeds for extra protein and fibre to help keep blood sugar levels more stable.
The BHF also noted that some shop-bought sauerkraut is pasteurised, which removes most of the live bacteria.
It advised checking the label, eating small portions and choosing unpasteurised products for those seeking the probiotic benefits.
The charity said beneficial gut bacteria produce short-chain fatty acids during digestion, which are linked to reduced inflammation, better metabolism and better heart and circulatory health.
These good bacteria also help digest polyphenols, natural plant chemicals thought to have antioxidant properties and which may help lower blood pressure.
By contrast, harmful gut bacteria, which thrive on diets high in fat and red meat, produce chemicals that can cause problems in the heart and blood vessels by increasing inflammation and altering how cholesterol is processed in the body.
Beneficial bacteria thrive on varied diets high in prebiotics, non-digestible fibres found in foods such as wholegrains, oats, beans, lentils, bananas and onions.
People with diabetes may have undiagnosed heart failure that could be detected by a simple screening blood test, research suggests.
The TARTAN-HF trial found that one in four patients with diabetes who had at least one other risk factor for heart failure had undiagnosed heart failure detected through screening with a blood test and ultrasound scanning of the heart.
Experts said the findings show the extent of unrecognised heart failure in people with diabetes, and how the condition can be detected using a widely available blood test called NT-proBNP, which measures how much strain the heart is under.
They suggest a heart failure screening programme for diabetics could improve diagnosis rates, lead to earlier treatment and potentially reduce the risk of hospitalisation and death.
The study, involving 700 patients, was led by the University of Glasgow in collaboration with AstraZeneca, Roche Diagnostics, Us2.ai, NHS Greater Glasgow and Clyde and NHS Lanarkshire.
Dr Kieran Docherty, clinical senior lecturer at the University of Glasgow’s School of Cardiovascular and Metabolic Health, said: “Our results from the landmark TARTAN-HF trial identified heart failure in a large proportion of people living with diabetes, emphasising the need for a heart failure screening strategy in this group of patients.
“We know that many of the symptoms and signs of heart failure are non-specific, and may go unrecognised as potentially being due to heart failure for a long time.
“The strategy used in our trial is simple and easy to implement in clinical practice, and will aid in the early identification of heart failure in people with diabetes, and facilitate the initiation of medications that we know improve outcomes in patients with heart failure.”
The study, which began more than three years ago, involved more than 700 people with diabetes from the two health board areas who had at least one other risk factor for heart failure.
They were randomly assigned either to receive heart failure screening or to continue with their usual care.
Researchers found screening uncovered a large number of previously unrecognised cases of heart failure. Around one in four, or 24.9 per cent, of those screened were found to have the condition within six months, compared with 1 per cent in the group continuing their usual care.
The study, involving patients with type 1 and type 2 diabetes, found almost all of the participants found to have heart failure had preserved ejection fraction, which can be difficult to detect without dedicated testing.
The findings of the TARTAN-HF trial were presented at the American College of Cardiology conference taking place from 28 to 30 March in New Orleans in the US.
Dr Edward Piper, medical director at AstraZeneca UK, said: “Delayed diagnosis and treatment of heart failure in people with type 2 diabetes contributes to poor long-term outcomes. TARTAN-HF demonstrates that targeted, risk-based screening can identify previously undiagnosed heart failure in approximately one in four high-risk patients with diabetes, enabling earlier intervention with guideline-directed therapy.”
Dr Christian Simon, head of global medical affairs at Roche Diagnostics, said: “We are proud to have supported the landmark TARTAN-HF trial. These findings demonstrate the transformative power of early, accessible diagnostics like the NT-proBNP blood test.
“By identifying unrecognised heart failure in people with diabetes, we enable clinicians to initiate appropriate treatments sooner, ultimately improving patient outcomes and lives.”
The UK has launched a £6.3m men’s health fund to back local projects aimed at helping men and boys live longer, healthier lives.
The Men’s Health Community Fund is a partnership between the Department of Health and Social Care, Movember and People’s Health Trust.
The government is contributing £3m, while the two charities are more than doubling that to take the total to £6.3m.
Grants will support community projects reaching underserved men and boys aged 16 and over, particularly in the most disadvantaged areas and at key points in their lives such as becoming a father, losing a job or retiring.
Projects could include support for new fathers, activities for men facing loneliness and social isolation, services to help young men engage with the health system, and support for men in work, out of work and moving into retirement.
The programme will bring together voluntary, community and social enterprise organisations to test new ways of reaching men who are least likely to use traditional health services.
An evaluation funded through the National Institute for Health and Care Research will assess what works and help inform future policy and delivery.
Health and social care secretary Wes Streeting said: “Too many men across the country are living shorter, less healthy lives, particularly those in our most disadvantaged communities.
“This new partnership will help men get the support they need in the places they feel most comfortable, their communities, among people they trust.
“By working with expert charities and local organisations, we can reach the men who are too often missed by traditional services and help them take better care of their mental and physical health.”
“It is a key step in delivering our first ever Men’s Health Strategy and driving forward our ambition to halve the gap in healthy life expectancy between the richest and poorest areas.”
The Men’s Health Strategy sets out plans to tackle the physical and mental health challenges men and boys face.
Men can be less likely to seek help and more likely to suffer in silence, while higher rates of smoking, drinking, gambling and drug use are damaging men’s health and affecting families, workplaces and communities.
The government is also investing £3.6m over the next three years in suicide prevention projects for middle-aged men in local communities across areas of England where men are most at risk, many of which are also among the most deprived. Suicide is one of the biggest killers of men under 50, and three-quarters of all suicides are men.
The projects will aim to break down barriers middle-aged men face in seeking support, including stigma around asking for help and a lack of awareness of what is available and how to access it.
They will be co-designed with experts and men with lived experience of mental health crises and suicidal thoughts.
Gut-friendly foods may damage heart, charity warns
Diabetes patients face increased risk of undiagnosed heart failure
UK government announces £6.3m fund to boost men’s health
Brain health collaboratory launches in Gulf South
