Designing an interprofessional dementia specialty clinic: Conceptualization and evaluation of a patient-centered model

Unraveling the Complexity of Alzheimer's Disease: Insights into Etiology and Advancements in Treatment Strategies

Alzheimer's disease, a complex and progressive neurological disorder, is the leading cause of late-life dementia. Pathologically, it is marked by the presence of amyloid plaques and neurofibrillary tangles in the brain. Over the past two decades, advancements in understanding the disease's pathogenesis have spurred research into new pharmacological treatments that target its underlying mechanisms. Currently available drugs, such as acetylcholinesterase inhibitors (rivastigmine, galantamine, donepezil) and the NMDA receptor antagonist memantine, primarily address symptoms and are effective only in the later stages of the disease. While these medications can slow disease progression and provide symptomatic relief, they do not offer a cure. Despite having a clear understanding of Alzheimer's neuropathology, the precise mechanisms driving the disease remain elusive. The lack of effective treatments that can stop the start and progression of the disease may be caused by our incomplete understanding of the pathogenic process. New therapeutic targets are now available due to the significant advancements made in pathophysiology over the past few years, which should allow for a direct attack on the underlying illness process. The various pathophysiological pathways that underlie Alzheimer's disease and how it is managed by conventional medication therapy, including current exploratory therapeutic options, are covered in this review article. Innovative, beneficial policies are essential to determine and progress therapeutic molecules to defend against AD.

Scoping review of outpatient dementia care programs in the U.S. from 2011-2023

OBJECTIVE

Mainstream primary care settings are suboptimal for providing high quality, accessible outpatient care for persons living with dementia (PLWD). To enhance dementia care quality and access, interprofessional dementia care programs have been implemented. We sought to review the characteristics of these programs.

METHODS

Guideline-directed (Arksey & O'Malley, 2005) scoping review of the U.S. dementia care programs (2011-2023).

RESULTS

Twenty-three dementia care programs, described in 72 articles, were identified. All programs were focused on improving dementia care. The programs featured interprofessional approach, PLWD and caregiver involvement, and care access and continuity. Programs varied in scope, specifics of the populations served, duration and types of services, affiliation, linkage with primary care, staff' credentials, delivery mode, assessments, outcomes, and challenges. Financial and implementation barriers were commonly reported.

CONCLUSION

Dementia care programs remain few and highly variable. Addressing financial and implementation barriers is essential for the viability and wider adoption of these programs.

Mapping the evidence on dementia care pathways - A scoping review

BACKGROUND

One way of standardizing practice and improving patient safety is by introducing clinical care pathways; however, such pathways are typically geared towards assisting clinicians and healthcare organizations with evidence-based practice. Many dementia care pathways exist with no agreed-upon version of a care pathway and with little data on experiences about their use or outcomes. The objectives of the review were: (1) to identify the dementia care pathway's purpose, methods used to deploy the pathway, and expected user types; (2) to identify the care pathway's core components, expected outcomes, and implications for persons with dementia and their care partners; and (3) determine the extent of involvement by persons with dementia and/or their care partners in developing, implementing, and evaluating the care pathways.

METHODS

We systematically searched six literature databases for published literature in the English language in September 2023 utilizing Arskey and O'Malley's scoping review framework.

RESULTS

The findings from the dementia care pathways (n = 13) demonstrated assistance in dementia diagnostic and management practices for clinicians and offered structured care processes in clinical settings. For this reason, these pathways emphasized assessment and interventional post-diagnostic support, with less emphasis on community-based integrated dementia care.

CONCLUSION

Future dementia care pathway development can seek the involvement of persons with dementia and care partners in designing, implementing and evaluating such pathways, ensuring that outcome measures properly reflect the impact on persons with lived dementia experience and their care partners.

Integrated Care in Neurology: The Current Landscape and Future Directions

The rising burden of neurological disorders poses significant challenges to healthcare systems worldwide. There has been an increasing momentum to apply integrated approaches to the management of several chronic illnesses in order to address systemic healthcare challenges and improve the quality of care for patients. The aim of this paper is to provide a narrative review of the current landscape of integrated care in neurology. We identified a growing body of research from countries around the world applying a variety of integrated care models to the treatment of common neurological conditions. Based on our findings, we discuss opportunities for further study in this area. Finally, we discuss the future of integrated care in Canada, including unique geographic, historical, and economic considerations, and the role that integrated care may play in addressing challenges we face in our current healthcare system.