By Aaron Allen, The Seattle Medium
In a troubling scenario that a growing number of people can relate to, you might walk into your aging parent’s home, greeted by the familiar sight of them sitting comfortably in front of a television, only for your mother not to recognize you. As you approach and say hello, confusion marks her face; she does not recall your name or who you are. This heartrending moment underscores a pervasive issue facing our healthcare system—the need for effective and timely diagnosis and management of dementia.
At the forefront of addressing this challenge are Dr. Barak Gaster and Dr. Jackie Raetz of UW Medicine. These seasoned primary care physicians, with twenty years of experience, have spent the past several years learning all they can about dementia: red flags, diagnostics, treatment options, and how to talk with patients and families.
“Patients really want to talk about it with their trusted medical advisers,” says a clinician about the importance of dementia care. The urgency is echoed by healthcare providers nationwide who often feel underprepared to diagnose and discuss dementia.
The solution to this immersion is “Cognition in Primary Care,” which Gaster describes as a “simple, easy-lift intervention” that first-line clinicians critically need. This program is specifically designed to equip primary care practitioners with the skills and tools necessary to manage dementia confidently and compassionately in their everyday practice.
As it relates to dementia, the challenge is daunting. In the United States, experts predict the incidence rates of dementia will more than double by 2050. Such a case volume is far beyond what could be managed by specialists in this area, typically neurologists and geriatricians. This overwhelming increase is attributed not just to an aging population but to demographic bulges specific to the baby boomer generation.
The need for such specialized care in primary settings is becoming increasingly urgent as the U.S. population ages. Dr. Gaster recounts a defining moment that spurred the creation of the “Cognition in Primary Care” program, which highlighted a widespread lack of preparedness among primary care doctors when faced with this complex condition.
“I really had kind of a moment when I was supervising the resident doctors at our clinic and just saw how they were really struggling and not sure what to do with a patient who had Alzheimer’s disease,” said Gaster.
“There was a time when dementia or Alzheimer’s as it relates to memory loss and aging was a misconception even in healthcare,” explains Dr. Gaster, who notes that up to 70% of people in their 80s and 90s do not experience significant cognitive impairment, dispelling the myth that dementia is an inevitable part of aging.
The program developed by Drs. Gaster and Raetz provides a practical, efficient approach to dementia care that can be seamlessly integrated into the fast-paced environment of primary care. It includes a comprehensive checklist for maintaining brain health even in the early stages of Alzheimer’s disease.
Dr. Jackie Raetz emphasizes the centrality of patient-centered care.
“There are medications for Alzheimer’s, there have been medications that have been around for a long time, that help improve some of the symptoms, but they don’t work in everyone and sometimes the effects are small,” she explains. A major component of the “Cognition in Primary Care” program is to develop tools that doctors can use to optimize the brain health of those in the early stages of Alzheimer’s disease.
However, introducing such an innovative program has not been without its challenges, especially given its inception coincided with the onset of the COVID-19 pandemic. “Our grant was granted in 2020 when the pandemic started and we thought that no primary care doctors were going to even feel that they had the bandwidth to look into what we were trying to teach regarding dementia,” Dr. Gaster recalled. Despite these initial concerns, the response from the medical community was overwhelmingly positive, demonstrating a strong demand for specialized knowledge in dementia care.
“One thing that is important in primary care is patient-centered care,” Dr. Raetz adds, underscoring the program’s focus on what is essential for the patient and their families. This patient-first approach is a cornerstone of the “Cognition in Primary Care” program, which aims not just to treat symptoms but to enhance the overall quality of life for patients and their families.
Another major challenge the program addresses is the constraint of time in primary care settings.
“Time is the biggest obstacle,” Dr. Gaster points out. “Primary care is a stressful endeavor. We never feel like we have quite enough time with our patients, and evaluating cognition and managing dementia are activities that take up a fair amount of time.”
The program also confronts the psychological barriers associated with dementia.
“This is a psychologically hard area for both patients to talk about, for families to talk about, and for clinicians to talk about as well,” Dr. Gaster says. “Dementia is scary. People worry about it a lot; they are scared of it; there is a bit of shame to it. It is better for everyone to bring this issue out of the shadows and to engage with it and to help make care better rather than to pretend that it is not happening.”
As the demographics of the United States continue to evolve, with more people living longer lives, the demand for effective dementia care in primary settings will only grow. The “Cognition in Primary Care” program by Drs. Gaster and Raetz not only addresses a critical gap in our healthcare system but also paves the way for a future where primary care providers are fully equipped to handle the complexities of dementia, offering hope and improved care for millions of families affected by this condition.
Dementia is a very complex disease and, as of now, there is no cure. It can be caused by a number of ways: diet, alcohol, diabetes, the effects of too many medicines, etc. But this program is designed to make treatment more effective and seamless.
“The heart of Cognition in Primary Care is really to improve care for people who are living with cognitive impairment, which could be dementia or milder forms,” says Gaster. “We are aiming to help primary care doctors to get the knowledge and confidence they need to detect that disease in its earlier stages because that earlier detection does lead to better care.”