Collaborative Management of Neurocognitive Disorders in Primary Care: Explorations of an Attempt at Culture Change.
BACKGROUND
Minor neurocognitive disorder (MiND; previously mild cognitive impairment) is a transitional zone between normal cognitive function and early stages of major neurocognitive disorder (previously called dementia). Of people with MiND, 5% to 10% progress to major neurocognitive disorder. Simple interventions such as memory activities, balance exercises, and anti-inflammatory diets have been shown to improve cognitive ability. Also, education and support in group settings have proved beneficial for patients with MiND.


METHODS
Survey evaluation of outcomes of geriatric consultation and prospective educational study.


METHODS
We collaborated with an academic training program to introduce into primary care the ideas of educational activities and participation in group medical care for people with MiND. Educational programs were developed and presented to family medicine residents and practicing physicians, and their knowledge was assessed before and after education.


RESULTS
Two group programs were implemented: one at our hospital and one at a local skilled nursing facility. These were initially envisioned as time-limited, but participants insisted on their continuance. Thirty-two different patients attended the groups for at least six sessions. Participants enthusiastically reported positive change on qualitative interviews and showed improvement in cognition, balance, and self-esteem. Family medicine residents and practicing physicians both shifted toward lifestyle medicine and significantly changed their views on the efficacy of treatments. Despite these activities, community physicians making referrals for geriatric consultations did not change their discussions with patients and families about exercise, diet, cognitive enhancement, and socialization for MiND.


CONCLUSIONS
Group visits that emphasized support for increased exercise, improved diet, more movement and balance, and cognitive enhancement appear to please and benefit patients with MiND. Physicians are more open to these approaches with training after initial skepticism. A struggle exists to convince the profession that lifestyle change may be beneficial in MiND.
Faculty Physician at the Eastern Maine Medical Center Family Medicine Residency in Bangor and Associate Professor of Family Medicine at the Univerity of New England in Augusta, ME. He is also affiliated with the Coyote Institute in Orono, ME. mehlmadrona@gmail.com.
Lewis
L
Mehl-Madrona
Psychotherapist and Reiki practitioner. She is the Education Director at the Coyote Institute in Orono, ME. artbarb@gmail.com.
Barbara
B
Mainguy
D000368:Aged; D001291:Attitude of Health Personnel; D003071:Cognition; D003299:Cooperative Behavior; D003469:Culture; D004032:Diet; D019468:Disease Management; D004493:Education; D015444:Exercise; D005260:Female; D006801:Humans; D007318:Inservice Training; D008019:Life Style; D008297:Male; D008568:Memory; D019965:Neurocognitive Disorders / Q000628:therapy*; D010820:Physicians; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires