Highlights from the 2013 Trends Report - Central Nervous System Diseases

In December 2013, Annals of Long-Term Care and Clinical Geriatrics released the Trends Report, examining the latest trends in long-term care (LTC) and geriatric medicine. The survey results were provided by a variety of key thought leaders within the field of LTC and geriatric medicine. The following provides information regarding the participants and the organizations they are associated with, as well as their facilities’ guidelines and resident demographics. While 27.9% of the survey participants said they worked in a skilled nursing facility, 23% answered “other” when describing their practice setting. When asked to clarify “other,” the survey participants provided the following responses: LTC, pharmacy benefit manager, and Program of All-Inclusive Care for the Elderly. The remaining survey participants cited private practice (19.7%), academic institution (14.8%), hospital/hospital-based practice (11.5%), and assisted living facility (3.3%) as their primary practice setting. Of the survey respondents whose primary facility is a LTC setting, 24.6% said their facility houses between 100 and 249 beds. Below are some of the highlights on Alzheimer's Disease from the Central Nervous System Disease section.
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Central nervous system diseases encompass a range of psychiatric or neurological disorders that affect the brain or spinal cord. Alzheimer’s disease (AD), a progressive degeneration of memory and behavior, is the most common form of dementia and is highly prevalent in the geriatric population, affecting 5 million people >65 years of age. Other common movement disorders that affect the geriatric population are Huntington’s disease and Parkinson’s disease. Long-term care (LTC) providers face difficulties with depression, which is frequently underdiagnosed in the older population. Depression is often a comorbidity of other illnesses and occurs in approximately 15% of the geriatric population. Clinicians have a variety of diagnostic measures they can use to screen for and monitor change in level of cognitive impairment, such as dementia. When asked what measure(s) they typically use—with the option to choose all that apply—65.6% of the survey respondents chose Mini-Mental State Examination (MMSE), while 60.7% chose Clock Drawing Test. Both the Minimum Data Set 3.0 Brief Interview for Mental Status and the Mini-Cognitive Assessment were selected by 39.3% of survey participants. See Figure 1 for all answer options and percentages. This number is similar to but up slightly from the 2012 Trends Report, where 64.7% said MMSE was most often used to screen for cognitive impairment in dementia.

According to the survey, when asked which treatment they are most likely to prescribe or observe being prescribed to an older patient with AD, 73.8% of participants said donepezil (Aricept®). Another 11.5% said memantine HCl (Namenda®), and 6.6% said rivastigmine transdermal system (Exelon® Patch). See Figure 2. 

To prevent elopement in AD patients prone to wandering, survey participants were asked about what steps they take. They were asked to choose all that apply. The most common steps noted were educating new staff about at-risk patients and safety measures in place to prevent elopement (62.3%), using door alarms requiring activation to gain access to or leave the facility (54.1%), using wireless technology (eg, wristwatch transmitters) to monitor patients at high risk for elopement (42.6%), and conducting regular inspections of the patient’s room to help track the patient’s whereabouts (41%). See Figure 3.

The FDA recently approved florbetapir F18 injection (Amyvid®), which is a radioactive diagnostic agent used during positron emission tomography to estimate betaamyloid neuritic plaque density in cognitively impairedadults who are being evaluated for AD. A majority of the survey participants (67.2%) said they were not familiar with this diagnostic agent. See Figure 4.