While following the cases of hundreds of patients with dementia for the last 15 years, George Wilson, M.D., has identified many unanswered questions about the disease.
Now he can answer one of them.
Thanks to an $86,500 grant from Pfizer, Wilson will be the first to study the incidence of undiagnosed dementia in long-term care.
Treatment of dementia as a disease has evolved slowly and with few breakthroughs, said Wilson, associate chair of community health/family medicine at UF HSC Jacksonville.
“Even as long as 20 years ago, there were really no therapies for dementias.Some could be prevented, but there was no treatment for the disease,” he said. “We, being physicians in primary care, used various anecdotal treatments but none showed true effi cacy. Then, about 10 years ago, several drugs were developed that seemed to have a positive effect on dementia and physicians started using them to treat moderate-to-severe dementia.”
Over the next several years the data showed two things, Wilson said. First, the drugs seemed to slow down dementia but did not arrest it. Second, they were most effective in early dementia and had almost no effect in moderate-to-severe dementia.
“So the problem now becomes who should get the drug,” Wilson said. “Most of us intuitively or from observation know who has moderate-to-severe dementia, but how do we know who has early dementia?”
That question prompted Wilson to find out how many people admitted to nursing homes for reasons other than dementia actually had early dementia.
“The obvious benefit of knowing this is that those people might benefit most from the new drugs, but if you don’t know if someone has dementia until they’re moderate to severe, then it’s too late to treat them,” Wilson explained.
He also was led to believe that because of a difference in patients’ daily routines, most people don’t recognize dementia progression in nursing home residents as quickly as in those living at home.
“The dementia can be fairly far advanced before somebody one day says, ‘You know, I think Granny is demented,'” he said.
The UF study, which will evaluate 80 to 100 residents and track them over time, involves two questions: What is the incidence of unrecognized early dementia in individuals who are admitted to nursing homes regardless of why they’re admitted and what is the progression rate of dementia in nursing homes that is unrecognized?
The first part of the study looks at how many already living in a nursing home are unrecognized.
“I’m working with River Garden Hebrew Home in Jacksonville and identifying all current residents who do not have a diagnosis of either dementia or minimum cognitive impairment and screening them to see how many actually screen positive,” Wilson explained. “I’m not going to screen those already on treatment for dementia because I don’t know what that would mean relative to the question.
“The second part of the study involves screening all new admissions – again, those without a diagnosis for dementia – over the next three years who enter River Garden to fi nd out how many have early dementia that’s unrecognized,” he said. “Then over those same three years I’ll re-screen to see what the progression rate is and how that correlates with the staff’s appreciation of progression.”
Wilson’s premise is that there will be more people who enter the nursing home who have dementia that nobody’s recognized, that there will be more individuals already living in the nursing home who have unappreciated early dementia and that the progression rate will be more signifi cant than the clinical staff has recognized.
“If these theories prove out,” Wilson said, “then the research becomes extremely important because it would suggest screening all nursing home residents and admissions for early dementia because those individuals would benefi t most from starting drug therapy.”
Wilson is principal investigator of the three-year study. Co-investigators are Fern Webb, Ph.D., a UF epidemiologist and assistant professor, and Sue Leger-Krall, Ph.D., River Garden research director. The study is being conducted at River Garden Hebrew Home and is under the umbrella of UF’s Center for Geriatric Medicine at River Garden.