P4‐049: Development, implementation, and initial patient characteristics of an Alzheimer's risk assessment and intervention clinic

Background: Alzheimer’s dementia is the most feared illness among older adults in the United States. We identified an unmet need for clinical dementia risk assessment services in our community. Review of the literature identified a model program from Canada. We determined that available risk calculator models were potentially adaptable to the US clinical environment. Methods: We evaluated cost and practical aspects of what might be included in an Alzheimer’s Risk Assessment and Intervention Clinic (ARAIC) service. Because most US payers do not cover dementia preventative services, a cash-basis fee-for-service model was developed in cooperation with medical center financial and compliance officials. Components of the assessment include telephone screening for eligibility, including Cognitive Change Index 12-item score <25 and magnetic resonance imaging (MRI) compatibility. In-person activities encompass history and physical examination, brief neurobehavioral testing [including the Modified Mini-Mental State Examination (3MS) and a digit symbol substitution task, plus other common bedside cognitive tests selected ad hoc by the examiner], and brain MRI to qualitatively assess white matter change, ventricular size, and hippocampal atrophy. A second visit entails a personalized review of a written report of the results with the patient, providing risk estimates and recommended targets for intervention. Results:From July 2014 through January 2015, 12 patients attended ARAIC visits. Mean age was 67.866.7 years (median 1⁄4 68; range 56-83). Eight participants were women (67%). All participants identified at least one first-degree relative diagnosed with Alzheimer’s or unspecified dementia. Among quantified observations associated with increased dementia risk, systolic blood pressure >140 was identified in four patients, and low exercise frequency in two. Body mass index >30, alcohol abstention, and low psychomotor speed were recorded in one patient each. Mean 3MS score was 97.362.7 (median 99, range 92-100). One patient, with known prior stroke, had MRI findings suggestive of increased risk. Knowledge of APOE gene status would have altered baseline risk stratification in only two patients. Conclusions: Although administrative hurdles in the US health economic environment were substantial, a clinical Alzheimer’s risk assessment clinic focusing on treatable issues was successfully implemented. As predicted, most participants exhibited a favorable profile of modifiable risk factors.