Primary Care Roles in Alzheimer Diagnosis, with Theresa Sivers-Teixeira, MSPA, PA-C

As cases of Alzheimer disease and dementia climb among the aging US population, the health care system is burdened by a limit on prospects for disease-altering therapy and means to do little more than delay the onset of progressive cognitive decline.

Even worse—as previously discussed with HCPLive¹—is that the pipeline from primary and family care to specialists for a new dementia patient is long and arduous. It’s key that frontline clinicians know their role well in facilitating care at the first stages of dementia.

In an interview with HCPLive during the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston, TX, this week, Theresa Sivers-Teixeira, MSPA, PA-C, instructor of clinical medicine at Keck School of Medicine of University of Southern California, discussed the optimal role of primary care and physician associates specifically in managing new cases of dementia. As she explained, it’s not necessarily that the care team’s role changes with a potential diagnosis; PAs in particular have been trained holistically, and those skills come into immediate use.

“To me, when there's memory impairment, it's another chronic disease,” Sivers-Teixeira said. “It's a progressive chronic disease, and usually people who have cognitive impairment that evolves into Alzheimer's disease, at least 95% of them have at least 1 chronic disease, and then they gain more as the disease progresses. And that's not for the specialist so much.”

While specialists including neurologists, neurology-psychiatrists and other disease-specific caregivers focus on cognition-related health and prescribing strategies, primary caregivers should stay focused on supporting the needs of patients. But in their dynamic with specialists, Sivers-Teixeira said, the objective is to detect signs and symptoms and report them to specialists.

“We need to screen and we need to detect,” she explained. “And then we need to do the workup—we need to rule out the reversible causes. That's the very first thing that we need to do.”

They key to an effective referral is to fully ensure a complete workup on patients presenting with cognitive issues: other conditions, family history, attention to potential exacerbations or misdiagnoses, etc. As Sivers-Teixeira noted, patients with dementia risk face substantial wait time for not only treatment, but even just consultation, from a neurologist once a referral has been made.²

“You've told this families on pins and needles that, oh my gosh, this could be a progressive dementing illness. They can't pick up the phone and call the specialists,” Sivers-Teixeira said. “We're the ones that are there on the front line. And then we communicate and do a good job, so that by the time they get to the specialist, they don't have to do all that stuff.”

References

1. ^{Kunzmann K. How to Adequately Screen for and Treat Cognitive Decline in Primary Care. HCPLive. Published May 20, 2024. https://www.hcplive.com/view/how-to-adequately-screen-treat-cognitive-decline-primary-care}
2. ^{Mattke S, Hanson M. Expected wait times for access to a disease-modifying Alzheimer's treatment in the United States. Alzheimers Dement. 2022;18(5):1071-1074. doi:10.1002/alz.12470}