Resources for Providers
As one of only 33 NIH-designated Alzheimer’s Disease Research Centers, the KU ADRC provides the resources doctors and other healthcare providers need to improve screening, treatment, and prevention.
Explore the KU ADRC resources for providers
Working together, the healthcare community is moving toward the day when we can postpone, or prevent, the changes created by Alzheimer’s disease. The KU Alzheimer’s Disease Research Center is pleased to offer the resources you need to stay updated on research and treatments, improve screening, and refer patients as needed. We encourage you to learn more about all the resources available, including the Cognitive Care Network, created with your practice and patients in mind.
To refer patients to MyAlliance for Brain Health, download this PDF for easy signup.
Refer Your Patients to the ADRC for Research Participation
The single largest barrier to finding a cure is not having enough research participants.
Do You Have Patients With:
- Mild Cognitive Impairment
- Alzheimer’s Disease
- Frontotemporal Dementia
- Lewy Body Dementia
- Family history or increased risk
- Interest in dementia prevention
Refer your patients to us for research participation and other Brain Health Resources such as:
- The opportunities are vast: Groundbreaking research is underway in our observational discovery and innovation studies, investigational medicine trials and exercise and lifestyle intervention trials.
MyAlliance for Brain Health
- Provides patients and caregivers with weekly communications about brain health information on nutrition, exercise, and lifestyle; advice and support; invitations webinars and other events; and research study opportunities.
LEAP! Lifestyle Empowerment for Alzheimer’s Prevention
- The LEAP! program translates the latest Alzheimer's disease prevention research into actionable recommendations for everyday life.
For Questions about research, programs, or resources contact
Amy Wilson, MS, LPN | Brain Health Navigator | firstname.lastname@example.org | 913-574-2046
Information on Leqembi (lecanemab) for the treatment of Mild Cognitive Impairment and mild Alzheimer’s disease
About Leqembi (lecanemab)
Leqembi, also known as lecanemab, is a drug given to patients with mild cognitive impairment (MCI) or mild Alzheimer's disease to slow the rate of decline in memory and thinking. The drug reduces clumps of proteins (made up of amyloid) that play a key role in the brain changes of Alzheimer's disease. Reducing these amyloid proteins is not a cure but does slow memory and thinking decline for those in the earliest stages of Alzheimer's disease. Leqembi is given to patients through an IV every two weeks for 18 months or longer.
Who is it for?
Leqembi is for people who have had clear decline in their memory and thinking and who have confirmed elevated levels of amyloid in their brain. This includes individuals who are diagnosed with mild cognitive impairment (MCI) or mild Alzheimer's disease. The drug is unlikely to help those with more advanced cognitive decline and it is not yet known if the drug helps individuals who have no memory loss but who have increased brain amyloid (we are studying this approach now in clinical trials).
Potential Side Effects
Like all medications, Leqembi can have side effects. These can include:
- Visual changes
- Worsening confusion
- Brain swelling or bleeding
- In rare cases, death
Healthcare teams closely monitor patients receiving Leqembi to manage side effects and assess the body's reaction to the drug. Regular brain scans are mandatory, as up to 30% of patients can exhibit brain swelling and microhemorrhages, usually without symptoms. If severe side effects occur, further treatment, potentially including hospital care or anti-seizure drugs, may be required.
Patient Selection Criteria
If you have cognitive issues that have been documented by your physician and you are interested in determining if you are a candidate for Leqembi, you will need to complete the following tests through your physician:
- Cognitive testing
- You will need to complete formal cognitive testing (often called neuropsychological testing) to demonstrate measurable impairment that is in the mild range
- Lumbar Puncture (spinal tap)
- A spinal tap will need to be completed to test for the presence of amyloid
- Brain MRI (within the last year)
- You will need to complete an MRI as a safety check to assess for changes that could put an individual at high risk from the drug
- ApoE4 gene testing
- We recommend all individuals considering Leqembi therapy have an ApoE4 gene test to help assess the likelihood of side effects. Individuals who carry a copy of the APOE E4 gene (up to 60% of individuals with Alzheimer's disease) are at a higher risk of the side effects of the drug
A Checklist for Physicians
Documented cognitive changes
- Document a history of mild and progressive cognitive changes. This should include the age of onset of cognitive decline, predominant symptoms, and examples of their impact on day-to-day affairs
- Cognitive testing
- Neuropsychological testing to 1) document measurable impairments that are 2) in the mild range (for example, an MMSE score of around 20 or above out of 30 total points)
- Lumbar Puncture (spinal tap)
- A spinal tap will need to be completed to confirm the presence of amyloid in the brain. Spinal fluid should be tested for CSF biomarkers of Alzheimer’s disease (amyloid measures such as AB42 and tau measures of total tau and ptau181)
- Brain MRI (within the last year)
- The MRI needs to include a GRE or SWI sequence to detect microhemorrhages
- Individuals with any of the following on MRI are not a good candidate for the drug: microhemorrhages (5 or more), macrohemorrhage (>10mm), superficial siderosis, multiple lacunar infarcts, or severe white matter hyperintensities
- Given the need for safety monitoring, individuals who are unable to obtain an MRI are not candidates for Leqembi
- ApoE4 gene testing
- Individuals who carry the APOE E4 gene (up to 60% of individuals with Alzheimer's disease) are at a higher risk of the side effects of the drug. Carrying the gene does not exclude someone from receiving the drug but this information is useful in considering risks vs benefits and in monitoring for side effects
- Health screen
- Individuals with a history of brain bleeding, stroke, seizures, or who are using anticoagulants are unlikely to be a candidate for Leqembi
Consider the following cognitive screening algorithm:
- AD-8 used as cognitive screening tool in all Medicare Wellness Visits
- AD-8 used when either individuals or families report subjective cognitive concerns
- If AD-8 score >2, incorporate MoCa (Montreal Cognitive Assessment), STMS (Short Test of Mental Status) or SLUMS (St. Louis University Mental Status Exam).
- If MoCa score <25 or STMS score <30 or SLUMS score <27, proceed with full diagnostic workup.
Considerations before making a Memory Care Clinic referral:
- The patient or family reports subjective cognitive decline, and the explanation is not found on standard dementia evaluation
- The case is neurologically complicated
- Other treatable contributors of cognitive impairment to review:
- If snoring or daytime sleepiness is present: sleep study to rule out sleep apnea
- If hearing impairment is present: conduct an audiology evaluation
- If anticholinergic, benzodiazepine, or opioid medications are present
- A slow transition/weaning protocol is recommended
To refer a patient, fax the following records to the Memory Care Clinic at 913-945-7508:
- Referring provider’s clinic note detailing the nature of the cognitive concern prompting referral
- Abnormal cognitive testing documenting objective cognitive impairment, within the last 12 months
- Abnormal bedside screening tests: AD8, Mini-Cog, MMSE, MoCA, SLUMS, STMS, or other valid cognitive screening tools
- If bedside testing is borderline or normal but concern remains, we recommend you order detailed neuropsychological testing
- Reversible labs
- CBC/CMP/B12/TSH within the last 12 months
- B12 deficiency, we recommend supplementation for a level < 400 in patients with memory impairment
- MRI brain scan within the last 12 months ruling out structural etiology for cognitive complaint
- If a patient is unable to get an MRI brain scan for any reason, a CT head scan will be accepted
- Patient/family contact information/face sheet
Once required records are received, the Memory Care Clinic team will review for referral consideration.
If your patient is interested in learning more about research opportunities at our Alzheimer’s Disease Research Center, we recommend they contact our research coordinating team at 913-588-0555, option 1.
The Visual Guide: Mood and Behavioral Challenges in Dementia provides a way to think through mood and behavioral challenges and potential directions to respond to them for individuals who have moderate impairment.
The KU ADRC launched the Cognitive Care Network (CCN) in 2019 to increase access to care and support across Kansas, and help providers throughout the region incorporate early-stage-sensitive screening tools into their practice.
- Advance early detection of cognitive disorders.
- Provide a collaborative system that can advance education and support of individuals who are diagnosed with MCI, Alzheimer’s disease or another dementia.
- Move the current crisis-driven model of dementia care to an empowerment model, including advancing health literacy, personal control, wellness planning, and a collaborative approach to disease management
Partnership with Primary Care Providers
The Cognitive Care Network creates much-needed partnerships with primary care providers throughout the state, with a special focus on rural and other areas where there aren’t enough dementia-specialized neurologists to respond to the growing numbers of patients with cognitive concerns. In neurologically uncomplicated cases, the primary care provider is the best and most timely resource for diagnostic evaluation. The Cognitive Care Network supports providers through educational opportunities; recommended screening, diagnostic and disclosure protocols; and incorporation of co-management practitioners – dementia-specific “navigators” – when needed.
These navigators are a tremendously valuable resource for providers, patients, and caregivers. Experienced CCN navigators are incorporated into primary care practices and work with individuals and families following a new diagnosis of a dementia, rather than waiting for a crisis and integrating support services then. The CCN navigators can also be involved when patients with an existing diagnosis have needs.
With earlier detection and engagement, the person living with a dementia better understands how to address, adjust, compensate, and plan for challenges that can be experienced as part of this disease.
For more information about participating in the Cognitive Care Network, please contact Michelle Niedens at email@example.com or 913-945-7310.