JAMA Neurology editorial calls for interdisciplinary team-based care during new therapeutic era for dementia

A new era has begun for the care of people with dementia. Since 2023, two drugs have been approved by the FDA that can slow the progression of Alzheimer’s disease in its early stages by removing the build-up of an associated protein, amyloid, in the brain. These are the first drugs that address the disease’s underlying biology, though they are not likely to be the last. Meanwhile, new blood tests are in development that promise to detect the disease earlier, while also being less costly and more accessible than brain scans and spinal taps.

All of this is good news in a field where good news has been hard to come by. But with it comes a need to integrate these new diagnostics and treatments into the health care system in a way that delivers the greatest good for the greatest number of people without overwhelming an already stressed system. And the way to do that is by establishing collaborative care models that include care navigation, according to a JAMA Neurology Viewpoint article published online in October that was co-authored by Jeffrey Burns, M.D., co-director of the University of Kansas Alzheimer’s Disease Research Center.

“Collaborative dementia care models … address dementia-related medical and psychosocial needs via interdisciplinary teams that extend the reach of the limited dementia specialty workforce, coordinate care and improve quality of life for both patients with dementia and their caregivers,” wrote Burns along with Katherine Possin, Ph.D., Global Brain Health Institute, University of California, San Francisco; and Brent Forester, M.D., Tufts University School of Medicine. “The teams are led by a dementia specialist and often use care navigators as the primary point of contact for families.”

The article cited the GUIDE (Guiding an Improved Dementia Experience) Model, a federal eight-year pilot collaborative care program announced by Medicare in July 2024. GUIDE is designed to help people with dementia and their caregivers better navigate health care and social support systems to improve dementia care. Moreover, collaborative models are believed to be more cost-effective, saving patients an estimated $500 per month while also increasing revenue for health systems through more accurate documentation of dementia.

Collaborative care benefits not only people eligible for the new therapeutics, but also those who are ineligible for it, the authors state, by providing and coordinating medical and social support and services as the disease progresses. And they can address gaps in Alzheimer’s care, including more timely diagnosis by primary care providers. The treatment of Alzheimer’s and dementia is also multidimensional, noted Burns.

“Alzheimer's is a complex disease. The brain is complex. It requires understanding what types of things are causing someone's dementia. It’s not as simple as amyloid,” said Burns. “We know when we see somebody with Alzheimer's disease, if we see the changes of Alzheimer's in the brain, more often than not, we see vascular issues, we see inflammatory issues, we see metabolic issues. And so it requires a personalized approach, but also a multidisciplinary approach.”

The authors also stressed that new care models are critical to ensure that new diagnostics and therapeutics are accessible to everyone, not just the most financially or socially advantaged patients. “If we divert limited resources to the concierge treatment of patients receiving DMTs (disease-modifying treatments) without simultaneously addressing care reform, we will exacerbate well-established health disparities in access to dementia services,” they wrote.

The need for a interdisciplinary approach is only going to grow as the field moves more into the realm of prevention, noted Burns, who also cited a JAMA editorial published in July 2024 that he co-authored about advances in blood tests that improve diagnostic accuracy for Alzheimer’s disease.

“We’ll be looking at the risk factors and detecting risk from new blood tests and then doing something about it to reduce risk or indefinitely delay the onset of memory problems,” he said. “That's the new era we're entering, and we need to be thinking about, how do we do this? How do we move as quickly as we can into this new era, and scale these new interventions to the population? It's going to require a lot of new thinking, new models and teamwork.”