Dorothy Visit 1: A 78-year-old woman who presents with complaints of memory problems

Title:	Dorothy Visit 1: A 78-year-old woman who presents with complaints of memory problems
Topic:	Geriatrics
Relevant Terms:	Alzheimer's Disease
Primary Audience:	Primary Care Physicians
Launch Date:	12-Oct-10
Credits:	0.5 AMA PRA Category 1 Credit™
Expiration Date:	The accreditation for this activity has expired.
Curriculum Name:	Best Practices in Identifying, Assessing, and Treating Alzheimer’s Disease

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Learning Objectives

Upon completion of the activity, participants should be able to:

Identify the continuum and progressive disease burden associated with Alzheimer's disease (AD)
Use methods to assess cognitive function that are appropriate in primary care practice and can aid in a timely and accurate diagnosis of AD
Define the potential benefits of initiating pharmacotherapy as early as possible in patients with AD
Apply various pharmacologic treatment options and implement management strategies for patients with moderate to severe AD

Faculty

Diana Kerwin, MD
Assistant Professor
Department of Medicine
Division of Geriatrics
Cognitive Neurology and Alzheimer's Disease Center
Northwestern University
Chicago, IL

Charles P. Vega, Jr., MD
Associate Clinical Professor
Residency Program Director
Department of Family Medicine
Director
UC Irvine Program in Medical Education for the Latino Community (PRIME-LC)
University of California, Irvine
Santa Ana, CA

Gary Small, MD
Parlow-Solomon Professor on Aging
Professor of Psychiatry & Biobehavioral Sciences
Director, UCLA Center on Aging
Director, Memory & Aging Research Center
Director, Geriatric Psychiatry Division
Semel Institute for Neuroscience & Human Behavior
David Geffen School of Medicine at UCLA
Los Angeles, CA

Gary Kennedy, MD; Course Director/Reviewer
Guest Faculty
Professor, Department of Psychiatry and Behavioral Sciences
Director, Division of Geriatric Psychiatry
Montefiore Medical Center
Bronx, NY

Gary Kennedy, MD

Dr. Kennedy is Professor of Psychiatry and Behavioral Science and Director, Division of Geriatric Psychiatry and Fellowship Training Program, Montefiore Medical Center, Albert Einstein College of Medicine. More than fifty psychiatrists with subspecialty training in geriatrics have graduated from the program. The training program is closely allied with Montefiore's Geriatric Medicine Fellowship Training Program with shared responsibilities in clinical services, case conferences, journal clubs and research. Since 1998 he has served in a variety of teaching and advisory positions for the John A, Hartford Foundation Institute for Geriatric Nursing, New York University School of Nursing. He has authored numerous publications on late life mental health and has given a number of invited presentations to educational, scientific and public policy organizations in the United States and abroad.

His research has focused on cardiac arrhythmias, the epidemiology of depression and dementia, mental health care in nursing homes, primary care sites and in the community, and novel communications approaches between health care providers. The National Heart, Lung and Blood Institute, the National Institute on Aging, the Forchheimer Foundation, the Resnick Gerontology Center, the New York State Department of Health, United Jewish Appeal-Federation, the JE & ZB Butler Foundation, The University Place Foundation, the Irving Weinstein Foundation, The Goldstein Foundation, The United Hospital Fund, and The New York Community Trust have supported his work. He has also received unrestricted educational grants from Janssen Pharmaceutica, Pfizer Incorporated, Forest Laboratories as well as clinical research grants from Janssen Pharmaceutica, AstraZeneca, and Forest Laboratories. From 2005-2007 he was the principal investigator of a project sponsored by the Robert Wood Johnson Foundation to study telephone facilitation of depression treatment among primary care patients.

He has served as a consultant to the New York State Commission on Life and the Law regarding physician-assisted suicide and to the Law Revision Commission regarding guardianship procedures in New York State's mental health law. He was also a member of the New York State Department of Health Advisory Work Group on Human Subject Research Involving Protected Classes. He has been a member of the American Psychiatric Association's Council on Aging, and was the 2002 President of the American Association for Geriatric Psychiatry. For the National Institute of Mental Health he was a member of the Mental Disorders of Aging Initial Review Group and Chairperson, Small Business Innovative Research Program Contract Reviews. In 2003 he was invited to testify before the President's New Freedom Commission on Mental Health. He is a Fellow of the Brookdale Center on Aging of Hunter College, The New York Academy of Medicine, The American Psychiatric Association, and a member of the Group for the Advancement of Psychiatry. He has received a New Investigator Award from the National Institute of Health, a travel study fellowship to Israel and the United Kingdom from the United States World Health Organization, an Archstone Award for Program Innovation from the American Public Health Association, Annual Exemplary Psychiatrists Award, National Alliance for the Mentally Ill. The American Journal of Nursing cited his Geriatric Mental Health Care published in 2000 as one of the best books of the year on gerontology.

He was also the 2005-2007 chair of the Geriatric Mental Health Foundation, a Washington based 501c3 group advocating for the mental health and well being of senior Americans. In 2005 he was a Visiting Professor for the Geriatric Fellowship Training Program of the National Health Research Institute of Taiwan. In 2006 he was sponsored by The Atlantic Philanthropies to design a Bermuda specific geriatric mental health training program. In 2009 he was part of a seven person Professional Exchange Program sponsored by the Caring Commission of the United Jewish Appeal-Federation of New York and JDC-ESHEL, The Association for the Planning and Development of Services for the Aged in Israel. Since 1992 he has been listed as one of "The Best Doctors in America". He has appeared on National Public Radio, the Today Show with Katie Couric, and ABC's World News Tonight.

Born in Dallas, Dr. Kennedy is an alumnus of the University of Texas in Austin and the University of Texas Health Science Center in San Antonio.

David M. Kaufman, MD; Peer Reviewer
Professor, Department of Neurology
Professor, Department of Psychiatry and Behavioral Sciences
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, NY

COURSE VIEWING REQUIREMENTS

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ESTIMATED TIME TO COMPLETE THIS ACTIVITY: 0.5 hour

SPONSOR
This activity is jointly sponsored by Albert Einstein College of Medicine, SciMed and RealCME.

INTENDED AUDIENCE: Primary care physicians and other health care professionals involved in the management of patients with Alzheimer's Disease.

STATEMENT OF NEED

Poor identification and recognition of AD can have profound consequences for both the patient and their caregiver. A delay in diagnosis postpones patient care and treatment allowing for disease progression, putting the patient at risk, and increasing caregiver burden:

Primary care physicians (PCP) are insufficiently educated on geriatric neurological disorders (eg Alzheimer's disease) and as such inherently fail to appreciate the burden of AD, leading to the mistaken belief that there is little value in the diagnosis of AD. This ultimately results in a significant delay in diagnosis and treatment, diminished patient quality of life, and increased risk of caregiver burden, health crisis, and institutionalization.

Furthermore, PCPs may inadequately identify early signs of AD from other types of dementia syndromes, as they may be unaware of distinguishing clinical characteristics and innovative neuroimaging tools. This may lead to misdiagnosis, suboptimal patient care, and potentially incorrect treatment plans.

In addition, PCPs may be inadequately educated on the most recent AD clinical trial results, and may lack the knowledge and confidence in applying these findings to their patients with AD. Therefore, early-stage AD patients may not receive the highest standard of care, putting them at risk for health crises including falls, use of physical or chemical restraints, and institutionalization.

ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine of Yeshiva University, SciMed and RealCME. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

CREDIT DESIGNATION
Albert Einstein College of Medicine designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

DISCLOSURE STATEMENT

The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical or equipment company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity, or who refuses to provide all their conflict of interest information, will not be permitted to present.

Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States.

Albert Einstein College of Medicine CCME Staff, and the staff of RealCME have no conflicts of interest with commercial interest related directly or indirectly to this educational activity. Shari Fallet, D.O., employed by SciMed and a member of the planning committee, has disclosed that she owns stock with Pfizer.

FACULTY DISCLOSURES

David M. Kaufman, MD has no conflicts of interest to disclose.
Diana R. Kerwin, MD: Novartis (Speakers Bureau)
Gary Kennedy, MD: Forest Laboratories (Grants/Research); Wyeth (Speaker's Bureau).
Gary Small, MD: Dakim, Eisai, Forest Laboratories, Medivation, Novartis, Pfizer (Consultant); Dakim, Eisai, Forest Laboratories, Medivation, Novartis, Pfizer (Speakers Bureau); Dakim (Stockholder)
Charles P. Vega, MD has no conflicts of interest to disclose.

OFF-LABEL PRODUCT DISCUSSION
Faculty have indicated that this activity does not include off-label information.

METHOD OF PARTICIPATION AND RECEIVING CME/CE CREDIT
There are no fees for participating in and receiving credit for this activity. The participant must read the objectives and enduring material and must answer the multiple-choice online post-test. Please complete the evaluation form, which provides each participant with the opportunity to comment on the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his/her views on future educational needs. A score of at least 70% is required to successfully complete this activity. The participant may take the test until successfully passed. Credit is available through October, 2011.

DISCLAIMER
The opinions and recommendations expressed by faculty in this activity are their own and do not necessarily represent the views of Albert Einstein College of Medicine, Montefiore Medical Center, SciMed and RealCME. Please review complete prescribing information for specific drugs or combination of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

COPYRIGHT INFORMATION
Copyright © 2010 Albert Einstein College of Medicine. All rights reserved. No part of this material may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations.

PRIVACY POLICY
Albert Einstein College of Medicine, Center for Continuing Medical Education (Einstein) protects the privacy of personal and other information regarding participants and educational collaborators. Einstein will not release personally identifiable information to a third party without the individual's consent, except such information as is required for reporting purposes to the ACCME.

Einstein maintains physical, electronic, and procedural safeguards that comply with federal regulations to protect against the loss, misuse or alteration of information that we have collected from you.

Additional information regarding Albert Einstein College of Medicine's Privacy Policy can be viewed at http://www.mecme.org/site/privacy.php.

If you have questions about this CME activity, please contact Albert Einstein College of Medicine at 1-718-920-6674 or cme@montefiore.org.

RELEASE DATE: October 12, 2010
TERMINATION DATE: October 11, 2011

ACKNOWLEDGEMENT
This activity is supported by an educational grant from Forest Laboratories.

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