Cognitive Impairment: Dementia and Alzheimer’s

Dementia is a term for a collection of symptoms including decreased intellectual functioning that interferes with normal life functions and is usually used to describe people who have two or more major life functions impaired or lost such as memory, language, perception, judgment or reasoning. Members diagnosed with Dementia may lose emotional and behavioral control, develop personality changes, and have problem-solving abilities reduced or lost. Dementia may lead to depression, aggression, confusion, frustration, anxiety, a lack of inhibition and disorientation.

Symptoms of Dementia

Symptoms vary depending on the cause, but common signs and symptoms include:

• Cognitive Symptoms: Memory loss
• Difficulty communicating or finding words
• Difficulty with complex tasks
• Difficulty with planning and organizing
• Difficulty with coordination and motor functions
• Problems with disorientation, such as getting lost

Psychological Symptoms

• Personality changes
• Inability to reason
• Inappropriate behavior
• Paranoia
• Agitation
• Hallucinations

Emotional Changes

• Depression
• Aggression
• Confusion
• Frustration
• Anxiety
• Lack of inhibition
• Disorientation

Other Warning Signs

• Patient is a “poor historian”
• Inappropriately dressed for the weather
• Disheveled, dirty, inattentive to appearance
• “Failure to thrive,” unexplained weight loss
• Defers to caregiver– family member answers questions

Screening and Assessment

Molina Healthcare aligns with the National Institute of Health and Alzheimer’s Association recommended screening and assessment tools for Alzheimer’s, Dementia, and other cognitive impairments. Some recommended screeners and assessments include:

Mini Mental Status Exam _MMSE- A widely used test of cognitive function among elderly, including tests of orientation, attention, memory, language and visual-spatial skills.

Mini-Cog- A 3-minute screening tool that can increase the detection of cognitive impairment in older adults.

Memory Impairment Screen _MIS- Brief screening tool that assesses for patient’s ability to recall.

General Practitioner Assessment of Cognition _GPCOG- A screening tool developed by general practitioners, primary care physicians, and family doctors. This tool can be utilized with both patient and/or caregiver/family member.

For more information…

Please see the Alzheimer’s Association’s COGNITIVE ASSESSMENT TOOLKIT for additional recommendations and clinical guidelines on detecting cognitive impairment quickly and efficiently during the Medicare Annual Wellness Visit. This guide includes screening and assessment tools that can be utilized with both patient and informant, as well as recommendations for detecting cognitive impairment in the primary care setting.

Provider Interventions and Goals

Discuss prevention and early identification with members and caregivers

Increase member Quality of Life

Decrease caregiver burnout

Develop an integrated, collaborative care plan with PCP, Behavioral Health providers, and Molina Case Management

Caregiver Resources and Support

The caregiver is a vital role to an individual experiencing cognitive impairment, Dementia, or Alzheimer’s. Caregivers require support and appropriate resources to be able to provide care and safety to this vulnerable population. Providers can offer the following to caregivers or family members to partner in providing care to these individuals:

Alzheimer’s Association Local Resource Finder- For patients and support system.

10 Signs and Symptoms of Alzheimer’s- The Alzheimer’s Association’s list of 10 warning signs for patient’s and/or their support system.

A Caregiver’s Guide to Understanding Dementia Behaviors- The National Center on Caregiving’s guide provides education and support to caregivers related to communication, warning signs, managing related behaviors, and other challenges.

Molina Healthcare Case Management- Molina’s Case Management team offers support to members and caregivers. A dedicated Case Manager takes an integrated, collaborative approach to assisting with care coordination of both mental and physical health needs, health education, and connecting members and their caregivers to appropriate resources.