COMMENTARY

Brain Health: The Role of Nurse Practitioners

Jill Lesser, JD

Disclosures

July 06, 2017

The Alzheimer's Outlook

The fight against Alzheimer disease—a game-changing national public health threat—needs nurse practitioners (NPs) on the front line. The nation is witnessing alarming trends in Alzheimer disease incidence,[1] mortality rates,[2] caregiver burden, and cost, all of which will continue to rise precipitously. Alzheimer disease death rates increased by 55% from 1999 to 2014.[3] Without a breakthrough, the incidence of Alzheimer's is projected to triple in the coming decades.

It's no secret that NPs will be needed to meet the ballooning primary care needs of an aging population. By 2020, NPs may be conducting nearly one third of all primary care visits.[4] As people live longer, despite having many preventable and treatable chronic conditions (such as heart disease), they face an increased risk of developing Alzheimer disease—indeed, by age 85, 1 in 3 Americans will develop the disease.[4]

Gaps in Dementia Knowledge

To lead the battle against this insidious disease, NPs need education about its signs and symptoms, techniques to engage patients in their own brain health, and tips on how to conduct proper screening.

In these areas, we've fallen short, as proved by new evidence. A recent survey[5] of NPs conducted by WomenAgainstAlzheimer's and the National Association of Nurse Practitioners in Women's Health found that approximately 30% of NPs in women's health do not raise brain health issues with patients. Only 18% of NPs occasionally broach this issue during office visits, and nearly 70% of the time, the discussion is initiated by patients.

The survey exposed other alarming gaps in care:

  • More than one fourth of NPs surveyed said that they do not know when to start asking patients about brain health, even though changes in the brain can develop more than a decade before the onset of symptoms.

  • Only 15% of NPs conduct a diagnostic test of brain health, and more than one half of NPs refer patients who are experiencing memory problems to a neurologist.

  • 86% of NPs reported not having access to a standard diagnostic tool for brain health.

  • 84% of NPs agreed or strongly agreed that they would benefit from additional resources and training on brain health.

  • 45% of NPs reported a lack of familiarity with the signs and symptoms of dementia.

These survey findings illuminate a general lack of understanding about dementia, and a reluctance to speak directly about this issue with patients who exhibit signs of memory loss, agitation, or confusion.

Improved Cognizant Approach

NPs can play a key role in improving the diagnosis and care of dementia. They can also contribute to the growing need in clinical research for participants and their care partners.

An improved cognizant approach allows NPs to refer patients to specialists who can order diagnostic procedures and direct patients to clinical trial opportunities. NPs also can address the reluctance of family members who may not be asking about the patient's brain health because they fear the answer. Fortunately, according to the survey, 54% of NPs said they want more knowledge in this area.

One route forward is to ensure that a standard method of assessing brain health is integrated into routine office visits.

One route forward is to ensure that standard methods of assessing brain health are integrated into routine office visits. Effective tools or protocols may ultimately inform a diagnosis; help families plan for the care of family members earlier; and afford patients the opportunity to enroll in potentially life-changing medical research, such as a clinical trial.

In the midst of the ominous dementia outlook, it's critical for NPs, who are already on the front lines and working directly with families and caregivers, to prioritize brain health as a central component of wellness exams and check-ups.

Make no mistake: NPs are the lifeline of care delivery, and they can help transform how our nation takes on the emerging epidemic of dementia.

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