An estimated 4 million Americans suffer from dementia of the Alzheimer's type and the prevalence of the disorder increases dramatically as a function of age. Research efforts over the last two decades have carefully characterized the clinical syndrome and the disorders that mimic this process so that an evaluation following National Institute of Neurological and Communicable Disease criteria results in clinical diagnoses which will be 80-90% accurate at autopsy. Research has also produced insights into the genetics, potentially important epidemiologic factors, neurochemistry and neuropathology. Treatment modalities on promising agents that either halt progression or reverse deficits are in clinical trials. Research has also addressed the effect of the disease on caregivers, their risk for depression and the burden of providing care to Alzheimer's Disease (AD) victims. In spite of major advances in knowledge on the disease and its effects on caregivers, the standard of community care for AD lags far behind current knowledge. The purpose of this proposal is to develop a model community outreach program which could be broadly disseminated to other rural and frontier states. In this project the University of Nebraska Medical Center (UNMC) will disseminate state-of-the-art knowledge on detection, diagnosis, treatment, management, and family care of AD to community professionals and organizations in conjunction with the Nebraska Chapters of the Alzheimer's Association. Nebraskans over the age of 65 comprise 14.1% of the state's population and the proportion of those also over the age of 85 is among the highest in the United States. It is the group over 85 years of age that is at highest risk for AD. Problems of both diagnosis and family care are complicated by geographic distance from knowledgeable health providers and family members. The present proposal will address these issues through: (1) improving physician knowledge of detection and appropriate evaluation; (2) development of 8 regional Dementia Assessment and Treatment Sites (DATS) to assist health professionals and families with diagnosis and planning; (3) education of health professionals in care of dementia patients and support of their families; and (4) public education on dementing disorders. The project is designed to establish systems for education and support that will persist beyond the project period.
