Identifying Treatment, Support Pathways After Cognitive Screening: Ken Cohen, MD, FACP

When patients screen positive for cognitive decline, taking the right next steps is crucial, explains Ken Cohen, MD, FACP, executive director of translational research, Optum Health. After Alzheimer disease screening, patients benefit from informed treatment options and comprehensive support.

This transcript has been lightly edited; captions were auto-generated.

Transcript

How can clinicians and health plans ensure that screening leads to meaningful next steps to support patients?

It's a great question, and it falls into 2 broad categories. One is pharmacologic treatment, and the other is nonpharmacologic treatment. I'll answer the pharmacologic treatment first, since it's gotten a lot of attention.

We now have 2 monoclonal antibodies, donanemab and lecanemab, that can be used in patients with established Alzheimer disease. Therefore, in the past, there has been a sense of, "Well, now we've made a diagnosis, what do we do about it?" And that has changed, although a lot of our efforts are around informing patients what the true value of these drugs is. We make certain patients understand that they don't reverse any existing cognitive loss, and they don't prevent future cognitive loss. They only slow the progression of cognitive loss.

Data suggests that these drugs, if you look at outcomes that matter to patients, one of the most important is the ability to live independently in their home, and these drugs seem to add perhaps another year of independent living. That's meaningful, but patients need to understand that at this point, there appear to be the limits of those therapies and the fact that they can be associated with significant harm in terms of cerebral edema and hemorrhage, so we have an informed discussion with patients about pros and cons and help them determine whether they should be treated or not with respect to nonpharmacologic care.

This, I think, is more compelling, and this is an area that we currently don't fund through most of our health plans, including traditional Medicare, and that's really comprehensive, wraparound services. Those wraparound services include medication assessments to make certain patients aren't on drugs that can worsen cognitive decline, education around their diagnosis, a tremendous amount of interaction with the caregivers, hooking them up with local community resources, and counseling and coping skills for both the patient and the family.

[For] behavior management education for patients, we have programs where we have 24/7 dementia specialists on call that very often can intervene and prevent a hospitalization. We have transportation assistance and safety assessments for the home respite care options—a tremendous amount of wrap-around services. There are several companies now that provide these as packages. We have built many of these internally, but the point is that these are services that really do impact management to a great extent, and if we can assure funding for these programs, then I think we can do a lot to improve patient outcomes.