National Plan to Address Alzheimer’s Disease Includes
Some Key APA Recommendations
The National Plan to Address Alzheimer’s Disease represents a significant expenditure of effort and resources, which will continue to be directed toward expanding research and services to prevent and treat Alzheimer’s disease.
About the Plan
The National Plan to Address Alzheimer’s Disease was released in May 2012. The plan has been in development since the National Alzheimer’s Project Act was signed into law in early 2011. This law established a public-private Advisory Council on Alzheimer's Research, Care and Services. The Advisory Council was charged with making recommendations to the Department of Health and Human Services (DHHS) for priority actions to expand, coordinate, and condense federal programs in order to improve the health outcomes of people with Alzheimer’s disease and related dementias and reduce the financial burden of these conditions on patients, their families, and society.
The recommendations (PDF, 161KB) of the Advisory Council on Alzheimer's Research, Care and Services were released on the same day as the National Plan to Address Alzheimer’s Disease.
APA Recommendations for the National Plan
The comments submitted by the American Psychological Association (APA) were informed by members of the APA Committee on Aging and members of Division 20 (Adult Development and Aging), Division 40 (Clinical Neuropsychology), and Division 12 Section 2 (Society for Clinical Geropsychology). Thanks to all who generously reviewed the several drafts of the Plan and made suggestions for APA’s responses:
January 26: The January 26 plan comments addressed the inclusion of psychology, expanding research beyond biomarkers, the importance and sensitivity of neuropsychological measures, and the need for risk factor prevention education.
March 28: The March 28 plan comments included a call for research that links identification of biomarkers with cognitive and behavioral markers.
The final version of the National Plan was responsive to some of the concerns APA raised in its four sets of comments (two written and two oral) offered since the Draft Framework for the National Plan to Address Alzheimer’s Disease was released this past January.
Need for Clinical Trials Included
The National Plan includes a strengthened statement on the need for clinical trials on pharmacologic and non-pharmacologic ways to prevent Alzheimer’s disease and to manage and treat its symptoms. Particularly noteworthy is the specific objective to continue clinical trials on the most promising lifestyle interventions. APA’s recommendation that the term “behavioral” be used rather than “non-pharmacological” was not accepted in the National Plan.
Explicit Inclusion of Psychologists
We are pleased that the National Plan now explicitly mentions psychologists as a member of the skilled workforce needed for the future and states that DHHS will disseminate, evidence-based dementia-specific guidelines including those generated by psychologists. (The first draft of the plan did not mention psychologists with other disciplines in the strategy to build a workforce with the skills necessary to provide high-quality care to individuals with dementia and their families.)
In addition, the text was broadened in a number of sections, as APA suggested, to acknowledge that a variety of health care providers, including psychologists, are involved in assessment and planning of advance care counseling for individuals with Alzheimer’s disease, in addition to physicians. For example, in one instance, the phrase “physician who has identified cognitive impairment” was expanded to “a physician or another health care provider who has identified cognitive impairment…”
Importance of Neuropsychological Evaluation Not Adequately Portrayed
APA comments on both draft documents noted that neuropsychological evaluation remains a critical component of differential diagnostic methods in discriminating neurodegenerative changes from normal age-related cognitive decline, cognitive difficulties that are related to psychiatric conditions or medical morbidities, and other related disorders.
APA cited evidence that neuropsychological measures are accurate, early predictors of progression to Alzheimer’s disease (Gomar, et al, 2011; Heister, et al, 2011; Landau, et al, 2010) and provide useful information to individuals with dementia and their families regarding the functional capacities of the individual and potential impact of interventions on disease progression. Unfortunately, the National Plan was not revised to incorporate these findings.
However, one of the National Plan’s specified actions is to identify and disseminate appropriate assessment tools. This statement has been expanded so that it currently states “once cognitive impairment has been detected, practitioners will be able to consider potential causes of cognitive impairment and determine the need for a comprehensive diagnostic evaluation for AD.” Previous drafts of the Plan did not have this last (italicized) clause.
Summary of Advisory Council Recommendations
The recommendations of the Advisory Council on Alzheimer's Research, Care and Services highlight the importance of biological and behavioral markers, as well as behavioral and pharmacologic interventions, throughout.The council notes that, to address disparities, clinical research studies and activities aimed at translation of research findings into medical practice and for the public should include specific targets for outreach to specific high-risk populations. Another recommendation is to expand funding and incentives for health care providers to pursue careers in geriatric specialties.
The importance of addressing the current needs of individuals and their caregivers is infused throughout the Advisory Council’s recommendations. This can be seen in the strategic research plan and in the request that DHHS and state lead entities assure that caregiver physical health/behavioral health risk is assessed and addressed regularly.
Another favorable recommendation is to redesign Medicare coverage and provider reimbursement to encourage appropriate diagnosis and care planning to diagnosed individuals and their caregivers, including coverage for care planning with a family caregiver even if the individual is not present. This barrier to care was one cited by APA in its initial remarks: “For patients with cognitive impairment, there must be options for reimbursement when working with families and caregivers without the patient present.”
Looking to the Future
One of the first action steps recommended in the National Plan has already been completed. A summit meeting to set a research agenda for Alzheimer’s disease was held on May 14 and 15, 2012, on the campus of the National Institutes of Health.