Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017;4(3):157-164.
doi: 10.14283/jpad.2017.3.

From Brain Disease to Brain Health: Primary Prevention of Alzheimer's Disease and Related Disorders in a Health System Using an Electronic Medical Record-Based Approach

A M Fosnacht  1 , S Patel  1 , C Yucus  1 , A Pham  1 , E Rasmussen  1 , R Frigerio  1 , S Walters  2 , D Maraganore  1
Affiliations

From Brain Disease to Brain Health: Primary Prevention of Alzheimer's Disease and Related Disorders in a Health System Using an Electronic Medical Record-Based Approach

A M Fosnacht et al. J Prev Alzheimers Dis. 2017.

Abstract

Background: Alzheimer's disease and aging brain disorders are progressive, often fatal neurodegenerative diseases. Successful aging, modern lifestyles and behaviors have combined to result in an expected epidemic. Risks for these diseases include genetic, medical, and lifestyle factors; over 20 modifiable risks have been reported.

Objectives: We aim to primarily prevent Alzheimer's disease and related disorders through electronic medical record (EMR)-based screening, risk assessments, interventions, and surveillance.

Design: We identified modifiable risks; developed human, systems and infrastructural resources; developed interventions; and targeted at-risk groups for the intervention.

Setting: A Community Based Health System.

Participants: In year one (June 2015 to May 2016), 133 at-risk patients received brain health services with the goal of delaying or preventing Alzheimer's disease and related disorders.

Measurements: We created mechanisms to identify patients at high risk of neurodegenerative disease; EMR-based structured clinical documentation support tools to evaluate risk factors and history; evidence-based interventions to modify risk; and the capacity for annual surveillance, pragmatic trials, and practice-based and genomic research using the EMR.

Results: This paper describes our Center for Brain Health, our EMR tools, and our first year of healthy but at-risk patients.

Conclusion: We are translating research into primary prevention of Alzheimer's disease and related disorders in our health system and aim to shift the paradigm in Neurology from brain disease to brain health.

Keywords: Neurodegeneration; brain health; electronic medical record; primary prevention; risk assessments; surveillance.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Screenshots of structured clinical documentation support tools that we have built into the electronic medical record (EPIC) that assess known risks to Alzheimer’s and related disorders. These tools electronically capture large amounts of clinical and diagnostic data. Data capture includes: Mediterranean diet and Readiness Assessment (both shown below). Additional screenshots are shown in Appendix A. © 2015 EPIC Systems, used with permission
Figure 2
Figure 2. Principal component analyses for score test measures at initial visits for 118 patients in the cohort
A) Cascade figure, demonstrating the proportion of the variance between the measures explained stepwise by each of the principal components. B) Illustrates the principal component mappings of first principal component (PC1) versus second principle component (PC2) loadings for each of the score tests and their spatial relationships. C) Illustrates the principal component mappings of PC1 and PC2 loadings for each of the score tests, after Varimax rotation (to maximize the distance between measures). PREDIMED (Mediterranean diet questionnaire); CES-D (Center for Epidemiological Studies-Depression); GAD-7 (Generalized Anxiety Disorder 7-item scale); ISI (Insomnia Severity Index); 9-hole dom (9-hole peg test, dominant hand); 9-hole non-dom (9-hole peg test, non-dominant hand); 25ft walk (25-foot walking test); STMS (Short Test of Mental Status); UPDRS (Unified Parkinson’s Disease Rating Scale-Motor); AD8 (The Eight-Item Informant Interview to Differentiate Aging and Dementia); PARK (Parkinsonism screening questionnaire); BMI (Body-mass index); Readiness (Brain Health Readiness Assessment)
See this image and copyright information in PMC

References

    1. Alzheimer’s Association. 2016 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia. 2016;12(4) https://www.alz.org/documents_custom/2016-facts-and-figures.pdf. [Accessed September 1, 2016] - PubMed
    1. Schneider LS, Mangialasche F, Andreasen N, et al. Clinical trials and late-stage drug development for Alzheimer’s disease: an appraisal from 1984 to 2014. J Intern Med. 2014;275(3):251–83. - PMC - PubMed
    1. Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers Dement. 2015;11(6):718–26. - PubMed
    1. Genworth Financial, Inc. Cost of Care Survey. Home Care Providers, Adult Day Health Care Facilities, Assisted Living Facilities and Nursing Homes. 2016 https://www.genworth.com/about-us/industry-expertise/cost-of-care.html. [Accessed September 1, 2016]
    1. Roses AD. On the discovery of the genetic association of Apolipoprotein E genotypes and common late-onset Alzheimer disease. J Alzheimers Dis. 2006;9(3 Suppl):361–6. - PubMed

LinkOut - more resources