Dementia: A Comprehensive Update

Dementia, a devastating condition that affects millions worldwide, is a complex and multifaceted issue that requires a comprehensive understanding. The spectrum of neurodegenerative diseases spans from asymptomatic preclinical disease to very mild cognitive impairment to frank dementia. Alzheimer’s disease (AD), the most common cause of dementia, is a condition that affects not only the patient but also their entire family and caregivers at tremendous emotional and financial cost.

Course Overview

Dementia: A Comprehensive Update is a three-and-a-half day, annual, review course designed by clinicians for clinicians. The course is organized by Neurology faculty members of Harvard Medical School who specialize in the care of patients with cognitive and behavioral disorders at Brigham and Women’s Hospital, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, McLean Hospital, and Banner Sun Health Research Institute/Banner Health. The course takes a practical and multidisciplinary approach to understanding and treating dementia and is designed for healthcare professionals involved in the diagnosis, management, and investigation of disease states causing dementia. This cutting-edge course is in its 26th year, includes locally, nationally, and internationally renowned faculty and attracts 300-400 participants from throughout the U.S. and the world.

Course Objectives

Upon completion of this activity, participants will be able to:

1. Describe current understanding of epidemiology, risk factors, pathobiology, societal costs, clinical differences, gaps in knowledge, and challenges in distinguishing and managing the spectra of normal cognitive aging, mild cognitive impairment (MCI), Alzheimer’s disease (AD), and other neurodegenerative dementias.
2. Distinguish pre-clinical AD, MCI due to AD/prodromal AD, and AD dementia phases.
3. Summarize tiered diagnostic and management approaches, and future experimental therapeutics strategies under consideration for risk reduction, prevention, diagnosis, and treatment of the AD spectrum.
4. Differentiate, based on neuropathology, affected neural systems, clinical criteria, and biomarkers, AD and its atypical variants from other common dementias including Dementia with Lewy Bodies (DLB), Vascular Cognitive Impairment (VCI)/Vascular-Ischemic Dementia, Frontotemporal Degeneration (FTD), Parkinson’s disease with Dementia (PDD), Parkinson’s-Plus Syndromes, and less common dementias.
5. Identify and explain the importance of evidence-based and coordinated individualized approaches to the evaluation and management of MCI, AD, and neurodegenerative dementias that stress combining: (i) early and accurate detection, assessment, and monitoring; (ii) psycho-education and non-pharmacological interventions; (iii) pharmacological strategies; and (iv) caregiver, psychosocial/environmental, quality of life, ethical, medico-legal, and end-of-life considerations.
6. Apply data-supported diagnostic, behavioral, pharmacological, and environmental strategies, including appropriate and tiered use of cognitive tests/measures, labs, and imaging studies/biomarkers; and delineation of expectations, roles (i.e., indications and benefits), cautions (i.e., risks, side-effects, warnings), and treatment nuances in the interdisciplinary management of CI, AD, and neurodegenerative dementias.
7. Demonstrate neural processes and functional networks that support perception and cognitive systems including memory, language, attentional, frontal/executive, visuospatial, and motor systems.
8. Explain the roles of office-based screening instruments, mental status exam (MSE), and neuropsychological evaluation in the diagnosis and management of dementia; develop efficient approaches to MSE and use of screening instruments (e.g., MoCA); and interpret and compare cognitive testing/neuropsychological performance patterns for different conditions and clinical syndromes (e.g., MCI, AD, FTD, primary progressive aphasias, posterior cortical atrophy, DLB).
9. Utilize appropriate laboratory tests, imaging studies, and neuropsychological testing for the diagnosis of dementia in clinical practice; incorporate appropriate use of clinical biomarkers (e.g., CSF a-beta/tau, MRI, FDG- and Amyloid-PET) in evaluation of neurodegenerative dementias to differentiate AD and non-AD processes; and explain clinical versus research use and apply appropriate use criteria/guidelines to the clinical use of amyloid PET imaging in the diagnosis of AD-like syndromes.
10. Apply data-supported pharmacologic management strategies including the roles (i.e., indications and benefits), cautions (i.e., risks, side-effects, warnings), and potential alternatives to using cholinesterase inhibitors, memantine, antipsychotics, and antidepressants in dementia and AD.
11. Integrate a holistic approach to management of problem behaviors and neuropsychiatric symptoms (e.g., aggression, apathy, anxiety, depression, psychosis) in individuals with dementia that stresses education and behavioral and non-pharmacological interventions as first-line approaches.
12. Discuss the important role, and the challenges and risks caregivers face; describe strategies to help dementia caregivers cope and better care for themselves and for patients with dementia including psychosocial counseling, community support resources, and respite care.
13. Identify delirium/encephalopathy and Chronic Traumatic Encephalopathy (CTE) as a dementia risk or entity.
14. Develop appropriate practices concerning medico-legal and safety issues surrounding patients with dementia, including capacity with regards to medical care, finances, contracts, independent living, and driving; and integrate medico-legal and safety practices to support and safeguard patients and families, and the public-at-large.
15. Describe issues related to dementia neuroethics, and implement effective practices in the long-term care/nursing-home environment and in end-stage dementia regarding medical, legal, and ethical issues including recognition and treatment of delirium/encephalopathy and pain, providing palliation and hospice care, and managing end-of-life issues related to dementia.

Program Schedule

Wednesday, May 31, 2023

1. 8:10-8:20 AM: Introduction to the Course – Alireza Atri, MD, PhD, Brad Dickerson, MD, MMSc, Lynn Shaughnessy, PsyD, ABPP/CN
2. 8:20-9:20 AM: Human Cognition: An Overview – Brad Dickerson, MD, MMSc
3. 9:20-9:55 AM: Memory Systems & Amnesia – Andrew Budson, MD
4. 9:55-10:30 AM: Neuropathology of AD/ADRD: A Guide for Practicing Clinicians – Matthew P. Frosch, MD, PhD
5. 10:30-11:15 AM: From Proteinopathies to Neuroimaging & Biomarkers in AD/ADRD: Primer on Practice and Advances – David Wolk, MD
6. 11:15-11:30 AM: Morning Coffee Break
7. 11:30 AM-12:00 PM: Alzheimer’s Disease & Related Dementias: Global Perspectives and Opportunities – Maria Carrillo, MD
8. 12:00-12:30 PM: Alzheimer’s Disease Pathobiological Definitions & Prevention Strategies – Randall Bateman, MD
9. 12:30-1:10 PM: Panel Discussion and Q&A – Course Directors and Faculty
10. 1:10-2:10 PM: Lunch Break
11. 2:10-2:15 PM: Afternoon Introductions – Alireza Atri, MD, PhD
12. 2:15-3:20 PM: AD Dementia: Practical Evaluation & Management in Clinical Practice – Alireza Atri, MD, PhD
13. 3:20-4:00 PM: Mild Cognitive Impairment: Prodromal AD and Beyond – Ronald Petersen, MD, PhD
14. 4:00-4:15 PM: Afternoon Coffee Break
15. 4:15-4:55 PM: Advances in AD Experimental Therapeutics – Alireza Atri, MD, PhD
16. 4:55-5:30 PM: Panel Discussion and Q&A – Course Directors and Faculty
17. 5:30-6:15 PM: Cocktail Reception with Course Faculty

Thursday, June 1, 2023

1. 8:35-9:15 AM: Attentional and Executive Systems – Don’t Leave Home without Them – Kirk Daffner, MD, FAAN
2. 9:15-9:55 AM: Neuropsychology of Aging – Sandra Weintraub, PhD, ABPP/CN
3. 9:55-10:35 AM: Frontotemporal Dementias: Focus on Behavioral/Executive Variants – Bruce Miller, MD
4. 10:35-10:50 AM: Morning Coffee Break
5. 10:50-11:30 AM: Language Systems & Aphasia-predominant Dementia Syndromes – M. Marsel Mesulam, MD
6. 11:30 AM-12:10 PM: Updates on Vascular Cognitive Impairment & Dementia – Charles DeCarli, MD, FAAN, FAHA
7. 12:10-12:40 PM: Panel Discussion and Q&A – Course Directors and Faculty
8. 12:40 PM-1:40 PM: Lunch Break
9. 1:40-1:45 PM: Afternoon Introductions – Alireza Atri, MD, PhD
10. 1:45-2:35 PM: Lewy Body Disease, and Parkinsonian & Sensorimotor-predominant Dementias – James Galvin, MD, MPH
11. 2:35-2:55 PM: Assessment of Cognition in Clinical Practice – Alireza Atri, MD, PhD
12. 2:55-3:15 PM: Practical Compensatory Strategies for Cognitive Decline – Lynn Shaughnessy, PsyD, ABPP/CN
13. 3:15-3:40 PM: Assessment of Daily Function and Neuropsychiatric Symptoms/Behavior and Staging of Dementia in Practice – Brad Dickerson, MD, MMSc
14. 3:40-3:55 PM: Afternoon Coffee Break
15. 3:55-4:10 PM: Telehealth Neuropsychological Evaluations for Patients with Possible Neurocognitive Disorders: Lessons from COVID – Janet Sherman, PhD
16. 4:10-5:05 PM: Cased-based Assessment and Application of Biomarkers in Dementia Clinical Practice – Alireza Atri, MD, PhD, Brad Dickerson, MD, MMSc, Janet C. Sherman, PhD, David Wolk, MD
17. 5:05-5:35 PM: Panel Discussion and Q&A – Course Directors and Faculty

Friday, June 2, 2023

1. 8:30-8:35 AM: Morning Introductions – Alireza Atri, MD, PhD
2. 8:35-9:30 AM: Non-Pharmacological Approaches to Neuropsychiatric Symptoms and Problem Behaviors in Dementia – Helen Kales, MD
3. 9:30-10:25 AM: Pharmacological Management of Behavioral Problems in Dementia – Clive Ballard, MB ChB, MRC Psych, MD
4. 10:25-10:40 AM: Morning Coffee Break
5. 10:40-11:25 AM: Practical & Ethical Considerations for Disclosure of Dementia-Related Diagnosis and Risk – Jason Karlawish, MD
6. 11:25 AM-12:05 PM: Caregiving in Dementia: Impact, Consequences & Opportunities – Mary Mittelman, DrPH
7. 12:05-12:40 PM: Panel Discussion and Q&A – Course Directors and Faculty
8. 12:40-1:40 PM: Lunch Break
9. 1:40-1:45 PM: Afternoon Introductions – Brad Dickerson, MD, MMSc
10. 1:45-2:00 PM: Community Advocacy and Activism For Dementias – Katie Brandt, MM
11. 2:00-2:45 PM: Chronic Traumatic Encephalopathy (CTE) & Dementia – Robert Stern, PhD
12. 2:45-3:00 PM: Afternoon Coffee Break
13. 3:00-4:00 PM: Delirium, Encephalopathies and Uncommon Dementias – Jeremy Schmahmann, MD
14. 4:00-4:45 PM: Panel Discussion, Q&A and Conclusions – Course Directors and Faculty

Saturday, June 3, 2023

1. 8:30-8:40 AM: Introduction to Symposium – Alireza Atri, MD, PhD
2. 8:40-9:15 AM: Dementia & The Law: Clinical Pearls on Testamentary Capacity and Undue Influence – Judith G. Edersheim, JD, MD, Bruce H. Price, MD
3. 9:15-10:15 AM: Principles & Practice of Mental Capacity and Competence in Dementia: From Finances to Firearms – Barry S. Fogel, MD
4. 10:15-10:50 AM: Driving, Home & Community Safety and Dementia – Margaret O’Connor, PhD, ABPP/CN
5. 10:50-11:05 AM: Morning Coffee Break
6. 11:05-11:55 AM: Advanced Care Planning & Management of End-stage Dementia, Pain, Palliation & Hospice in Long-Term Care – Mary Norman, MD
7. 11:55 AM-12:45 PM: Panel Discussion, Q&A and Conclusions – Course Directors and Faculty