And last year, the FDA approved the first blood tests that indicate the likelihood of a patient developing dementia.
“It’s a new day, a new era for brain health,” said Jeffrey Burns, M.D., co-director of the University of Kansas Alzheimer’s Disease Research Center.
The Brain Health Care Accelerator model, which Burns and his colleagues have begun implementing at KU, works differently.
Decision tools are built into the EHR (electronic health record) that help the primary care provider to complete an evidence-based workup.
In addition to shifting some of the memory clinic’s function to primary care, the model also calls for specialized subclinics, rather than a single clinic for anyone with dementia.
Much good news has been reported in the past few years in the field of Alzheimer’s disease. In 2021, the U.S. Food and Drug Administration (FDA) approved the first drug ever that can slow the progression of the disease, rather than merely manage symptoms. And last year, the FDA approved the first blood tests that indicate the likelihood of a patient developing dementia.
But it isn’t enough for these new treatments and tests simply to exist. Providers have to know when and how to use them, and patients need to be able to access them quickly. The new drugs, for example, help only those who are in Alzheimer’s early stages, making it critical to diagnose patients in time for them to be effective.
“It’s a new day, a new era for brain health,” said Jeffrey Burns, M.D., co-director of the University of Kansas Alzheimer’s Disease Research Center. “We have these new tools — blood measures and the new drugs — (but) we're not using them well. No one is. So we have to rethink how we do it.”
Burns and his colleagues have done exactly that: They have designed a new model for delivering dementia care that they have already begun implementing at The University of Kansas Health System. This model, dubbed the Brain Health Care Accelerator and published in detail this spring in Alzheimer’s & Dementia, the journal of the Alzheimer’s Association, places primary care at the forefront of dementia diagnoses and treatment in order to provide care for the growing number of people who need it.
In 2060, the number of Americans aged 65 and older with Alzheimer’s disease is projected to reach 13.8 million, according to a 2026 report by the Alzheimer’s Association. More than 55,000 Kansans are living with Alzheimer’s and related dementia, and that number is growing. Meanwhile, there are a limited number of neurologists trained in dementia, especially in rural and underserved areas.
Burns described the current typical process of receiving a dementia diagnosis as a series of visits to the patient’s primary care doctor, who eventually might order an MRI and some labs, and then refers the patient to neurology. It often then takes several more months for the patient to get in to see the neurologist, and then several months after that before a diagnosis is made. The result? “The average time for diagnosis is three and a half years, nationally,” said Burns, which means that some people who could benefit from the new medications miss the window for treatment.
The Brain Health Care Accelerator model, which Burns and his colleagues have begun implementing at KU, works differently. First, upon hearing the patient’s initial complaint about memory, the primary care doctor brings the patient back into the office within a month or two for a comprehensive cognitive assessment. This visit includes cognitive screening tools (e.g., questionnaires) and blood testing, if indicated. Decision tools are built into the EHR (electronic health record) that help the primary care provider to complete an evidence-based workup. Providers also can reach out to the KU memory clinic for a quick electronic consultation, Burns said.
“The new tools allow the primary care provider to confidently complete a cognitive assessment visit, which walks through all of the requirements to complete the evaluation, order appropriate tests, interpret those tests, diagnose the patient, start treatment and make appropriate referrals,” said Jennifer Woodward, M.D., MPH, a primary care physician and associate professor of family medicine and community health at KU Medical Center. “The results are that the patients receive a diagnosis much sooner and can start treatment earlier, if appropriate.”
The Brain Health Care Accelerator also redefines the role of the memory clinic. In addition to shifting some of the memory clinic’s function to primary care, the model also calls for specialized subclinics, rather than a single clinic for anyone with dementia. There are separate subclinics for patients who are eligible for the new medications, for people with atypical or complex cognitive syndromes and for people needing counseling and support. Burns said he eventually would like to have a subclinic for prevention and monitoring for people at an elevated risk for Alzheimer’s disease.
The model is also built on a team-based approach, utilizing nurse practitioners, physician assistants, registered nurses and social workers, rather than relying on cognitive neurologists alone. These clinicians can lead many aspects of the treatment delivery and monitoring once provided with training and structured protocols.
“It's been incredible to see the difference it's made in the speed of diagnosis and getting patients to appropriate treatment so much more efficiently than the old refer-and-wait process,” said Woodward, who also is one of the authors of the paper outlining this new approach. “Patients are able to get everything completed with their trusted primary care provider and then move along the pathway more quickly.”
The new approach has increased the number of visits at KU’s memory clinic by 60%. “We still have major growing pains, but we are serving far more (patients),” said Burns. “Because we’ve got all this change happening, we have to approach it with a whole new model of care, and we're trying to do that in a systemwide way.”
