The Davos Alzheimer’s Collaborative Healthcare System Preparedness
(DAC-SP) Early Detection Blueprint
This blueprint provides practical recommendations for planning, implementing, and monitoring and evaluating an early detection program for cognitive impairment.
The blueprint contains three modules: Plan, Implement, Monitor & Evaluate. Each module contains Goals and Actions to support you in developing an early detection program for cognitive impairment.
This blueprint offers a modular approach to developing an early detection program for cognitive impairment. This structure allows you to select the Goals and Actions in each module that are relevant to your context and omit those that are not applicable.
You are the expert of your healthcare system. We encourage you to use the recommendations and resources in this blueprint that suit your specific circumstances.
E.g., Primary care physicians including family medicine doctors, internists, and general practitioners; memory and Alzheimer’s disease specialists; gerontologists; psychiatrists; advanced care providers; clinical researchers; brain health experts, operations leaders, project managers, and others.
E.g., Primary care clinics, community hospitals, academic hospitals, brain health clinics, research centers, and others.
E.g., Local, regional, or national healthcare systems.
Important reminder as you start the blueprint.
Every healthcare system is different, and there is no “one-size-fits-all” method for detecting early cognitive impairment in clinical practice.
As you begin to think about your own early detection program for cognitive impairment, it is important to note that different healthcare settings will have program objectives and aims reflecting the different policy environments, capabilities, and resource settings within which they are located.
Based on learned experience with global flagship sites, we have created a broad spectrum of possible policy environments. Use the spectrum below to help you to determine the right goals and objectives that reflect your local environment.
A key objective of early detection programs seeking ‘Big P’ policy change is to help establish, test, or otherwise influence a national or regional policy framework on cognitive impairment. An indicator of success might look like influencing governments to provide support and incentives that enable the sustainment and scalability of programs like this one.
A key focus of programs seeking ‘little p’ policy change is to influence a healthcare setting at the local level without explicit concern towards ‘Big P’ policy change. Success might look like implementing a pilot program, creating buy-in for sustainability at the local level, and using learnings to scale the program at the regional level.
‘Big P’ Policy Change – see more information on this type of policy change below.
It is the role of the government to create a policy environment that supports the implementation, sustainment, and scalability of early detection programs for cognitive impairment.
To create evidence related to key policy questions or debates to improve the policy landscape to better serve patients and families.
No specific geography and tends to be single-payer public systems in which a national government plays a significant role in determining healthcare practice across different levels of government.
DAC-SP Flagship Site Example
The Brain Health Scotland site designed its program as a quality improvement initiative so they could evaluate early detection as a key component of the Scottish Brain Health Service model. Local leaders considered implementation a success if a key component of the national strategy was leveraged to build a sustainable infrastructure within the National Health Service.
Both system or national-level and local/organizational policy changes might be needed to develop an early detection program. See more information on this type of policy change below.
The role of government is important in shaping the conditions that are supportive of the implementation and sustainment of programs. However, it is possible to make significant progress by focusing on a local system and building momentum around program findings and scaling successful implementation strategies
To demonstrate success and challenges at the local level, achieve program sustainability, and translate evidence into scalability efforts at the local or regional level. Advocate for change with national or regional policy leaders using evidence-based findings on barriers.
No specific geography, a mix of private healthcare and single-payer systems where significant decision-making for healthcare operations has been devolved to a local level.
DAC-SP Flagship Site Example
The IU/IU Health program focused on implementation at seven family medicine practices in Indianapolis. By convening stakeholders across multiple departments including primary care, neurology, and research, they were able to identify significant operational bottlenecks, some of which were driven by reimbursement policy. This study produced tangible evidence that is very useful in understanding implementation barriers related to policy.
More than 55 million people worldwide are currently living with Alzheimer’s or other related dementias. As the global population continues to age, the number of cases is expected to rise to over 152 million by 2050.1 Healthcare systems worldwide are not prepared to care for today’s population of people living with Alzheimer’s disease or other related dementias, much less the growing number of patients to come.
Mild cognitive impairment may indicate early signs of Alzheimer’s disease or other related dementias. However, these signs frequently go undetected or undiagnosed, and symptoms of cognitive impairment do not always lead to a diagnosis of dementia. Primary care providers can play an important role in detecting the signs and symptoms that suggest early cognitive impairment, conducting routine tests to rule out reversible causes, and then referring patients to formal diagnostic testing as necessary.2
Current evidence shows a number of benefits of the early detection of cognitive impairment. With early detection, patients may be able to implement positive lifestyle changes and address risk factors that can slow the progression of Alzheimer’s disease or related dementias.2 Twelve modifiable risk factors include: less education, hypertension, hearing loss, smoking, obesity, depression, physical inactivity, diabetes, social isolation, excessive alcohol consumption, head injury, and air pollution.4
Early detection also has the potential to improve the quality of life for patients and their families. It may allow them to prepare for the future by making necessary caregiving, financial, and/or legal arrangements. They may also anticipate possible mood and behavior changes due to cognitive decline or following a diagnosis. Early detection of cognitive impairment may also impact the management of a patient’s other medical conditions2, and may support pursuing additional treatment options, and/or enrolling in a clinical trial.
Establishing an early detection program for cognitive impairment, particularly in primary care settings, is a valuable step in supporting healthcare system readiness while providing much needed screening and care for patients and their families. By engaging primary care settings, healthcare systems can capitalize on existing infrastructure and expand access to screening, detection, and earlier diagnosis; and provide patients with actionable health information and options
1. GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105-e125. doi: 10.1016/S2468-2667(21)00249-8.
2. Mattke, S., Batie, D., Chodosh, J., Felten, K., Flaherty, E., Fowler, N. R., Kobylarz, F. A., O’Brien, K., Paulsen, R., Pohnert, A., Possin, K. L., Sadak, T., Ty, D., Walsh, A., & Zissimopoulos, J. M. (2023). Expanding the use of brief cognitive assessments to detect suspected early‐stage cognitive impairment in primary care. Alzheimer’s & Dementia, The Journal of the Alzheimer’s Association, 19(9), 4252–4259. https://doi.org/10.1002/alz.13051
4. Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., Orgeta, V., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet (London, England), 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
Cognitive impairment is when a person has difficulty remembering, learning new things, concentrating, or making decisions.6 Symptoms of cognitive impairment can be an early indication of Mild Cognitive Impairment (MCI); Alzheimer’s disease; and other related dementias, such as vascular dementia, Lewy body dementia, and frontotemporal dementia.
Dementia is not a specific disease but is rather a general term for the impaired ability to remember, think, or make decisions that interfere with everyday activities. Alzheimer’s disease is the most common type of dementia.7
Alzheimer's disease and related dementias usually start slowly and progressively worsen, leading to symptoms like difficulty remembering events, decline in cognitive abilities, and a loss of functioning and eventually independence.8
6. Centers for Disease Control and Prevention. (2011, February). Cognitive Impairment: A Call for Action, Now!. Centers for Disease Control and Prevention. https://www.cdc.gov
7. Centers for Disease Control and Prevention. (2019, April 5). What is dementia?. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/dementia/
8. The progression, signs and stages of dementia. Alzheimer’s Society. (n.d.). https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/progression-stages-dementia