CCBH Brain Health & Dementia Preceptorship

Background

The population of the US is aging with the largest proportion of this population represented by the 85y and older cohort. This will place great demands on healthcare systems particularly in the dealing with disorders of brain aging and neurodegenerative disease. Alzheimer disease (AD) alone affects more than 6.2 million Americans in 2021 with total costs estimated to exceed $355 Billion. Within a generation, the number of Americans with AD will more than double. Lewy Body Dementia (LBD) is the second most common cause of dementia affecting more than 1.4 million Americans. Additional causes of dementia such as Vascular Contributions to Cognitive Impairment and Dementia (VCID), Frontotemporal Degeneration (FTD), and Chronic Traumatic Encephalopathy (CTE) increase these numbers further and add to societal burden. For nearly all brain aging disorders, there are equally large numbers of very mild or prodromal stages such as Mild Cognitive Impairment (MCI) due to AD as well as many individuals in pre-symptomatic states such as Subjective Cognitive Impairment (SCI). A large proportion of these individuals have abnormalities on imaging and fluid biomarkers. Hence there is a critical need to educate MD and PhD researchers, scientists and developmental personnel from pharmaceutical and biotechnology company, investors, and public policy stakeholders regarding causes of disorders of brain aging and cognitive health, development of new therapeutics and interventions, and translation of these findings from bench to bedside, and from bedside to practice and policy.

Objective

The goals of the CCBH Brain Health and Dementia Preceptorship is to provide educational opportunities to researchers and professionals in the pharmaceutical and biotechnology industry to: 1) review concepts of healthy brain aging and the spectrum of dementia that impact cognitive, motor and behavioral function; 2) develop a differential diagnosis; and 3) become familiar with how patients present to clinical practice; research and clinical evaluation of patients; pharmacological and non-pharmacological approaches to treatment; the role of biomarkers now and in the future; and with challenges and opportunities for diagnosis and management of AD and related disorders.

At the end of the Preceptorship, the attendees should be able to:

1. Differentiate healthy brain aging from Pre-symptomatic, Prodromal, and Clinically apparent dementia that affect cognition, function, and behavior.
2. Understand the differences between screening for dementia and diagnostic evaluations.
3. Describe the components of a comprehensive clinical and cognitive evaluation of older adults to establish a diagnosis and stage disease.
4. Characterize the role of biomarkers, genomics, precision medicine in the research evaluation of dementia and how these findings can be translated into clinical practice.
5. Recognize and value the role of caregiver support and non-pharmacological approaches in improving patient outcomes and how these approaches complement pharmacological interventions.
6. Develop an understanding of the threats, challenges and opportunities facing clinicians in the diagnosis and management of dementia.
7. Define the challenges to AD clinical trial recruitment and new opportunities to increase research recruitment and retention in older adults from diverse populations. Differentiate healthy brain aging from Pre-symptomatic, Prodromal, and Clinically apparent dementia that affect cognition, function, and behavior.
8. Understand the differences between screening for dementia and diagnostic evaluations.
9. Describe the components of a comprehensive clinical and cognitive evaluation of older adults to establish a diagnosis and stage disease.
10. Characterize the role of biomarkers, genomics, precision medicine in the research evaluation of dementia and how these findings can be translated into clinical practice.
11. Recognize and value the role of caregiver support and non-pharmacological approaches in improving patient outcomes and how these approaches complement pharmacological interventions.
12. Develop an understanding of the threats, challenges and opportunities facing clinicians in the diagnosis and management of dementia.
13. Define the challenges to AD clinical trial recruitment and new opportunities to increase research recruitment and retention in older adults from diverse populations.

The Preceptorship is delivered into 2 sessions:

Session One

1. Review of the spectrum of clinical, cognitive, and behavioral findings in healthy brain aging, subjective cognitive complaints, and mild cognitive impairment.
2. Comprehensive review of Alzheimer disease and related disorders.
   • Epidemiology, pathophysiology, genetic and risk factors, current and future targets of therapy.
   • Differential diagnosis of dementia.
   • Application of the Amyloid, Tau, Neurodegeneration (ATN) Framework in research and clinical practice.
3. How patients and research participants enter the healthcare portal.
4. Evaluation of the older adult in a research setting.
5. Evaluation of the older adult in a busy office setting.
6. The role of the caregiver.

Session Two

1. Impact of new diagnostic criteria on current clinical practice.
2. The role of biomarkers (MRI, PET, CSF)
   • Predicting disease in asymptomatic patients
   • Diagnosis
   • Monitoring progression and response to therapy
3. Current approaches to the treatment of the patient
• Non-pharmacologic
• Pharmacologic
• Caregiver interventions
4. Current and future challenges in care and management of AD.
5. How new participants are recruited for research studies.

The Preceptorship program is a mix of didactic and case-based applications with lecture, video, patient-interviews, neuropathology, and imaging. Pre-tests will be required with each session, followed by a post-test and practice change questions for outcomes. Pricing includes all educational materials, handouts, curriculum, and catering for breaks and meals. Travel and lodging is not included.

Questions related to the CCBH Brain Health and Dementia Preceptorship should be directed to healthybrain@miami.edu.