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Introduction: US veterans have a unique dementia risk profile that may be evolving over time. Methods: Age‐standardized incidence and prevalence of Alzheimer's disease (AD), AD and related dementias (ADRD), and mild cognitive impairment (MCI) was estimated from electronic health records (EHR) data for all veterans aged 50 years and older receiving Veterans Health Administration (VHA) care from 2000 to 2019. Results: The annual prevalence and incidence of AD declined, as did ADRD incidence. ADRD prevalence increased from 1.07% in 2000 to 1.50% in 2019, primarily due to an increase in the prevalence of dementia not otherwise specified. The prevalence and incidence of MCI increased sharply, especially after 2010. The prevalence and incidence of AD, ADRD, and MCI were highest in the oldest veterans, in female veterans, and in African American and Hispanic veterans. Discussion: We observed 20‐year trends of declining prevalence and incidence of AD, increasing prevalence of ADRD, and sharply increasing prevalence and incidence of MCI. [ABSTRACT FROM AUTHOR]

Background: Negative outcomes associated with caring for a loved one with ADRD include increases in caregiver depression, anxiety, and burden often due to managing neuropsychiatric symptoms (NPS). CARE is an in‐person, group‐based behavioral intervention that teaches caregivers specific skills to manage the NPS that are common in ADRD. Prior to the COVID‐19 pandemic, we were funded to adapt the CARE program to a virtual format (TeleCARE) in order to improve access to specialized services for caregivers with barriers to in‐person care. The impact of COVID‐19 further underscored the importance of telehealth interventions for caregivers. Method: Twenty caregivers participated in TeleCARE using the Cisco Webex platform. Caregivers were predominately female (80%), spouses (80%), ranging in age from 35‐88 (M = 70.8). The CDR‐Sum of Boxes was administered to measure dementia severity of the care recipients with a mean of 11.1 (moderate dementia). Data were collected at baseline and immediately following completion of the 8‐week group intervention. Result: Eighty‐five percent of caregivers had a better understanding of NPS, and 90% of caregivers felt TeleCARE helped them take better care of the person with dementia and improved their ability to manage caregiving. Caregivers reported reduced depression and anxiety following the intervention (BDI: M = 9.6 vs M = 7.8; BAI: M = 8.7 vs. M = 6.8). They also reported increases in Positive Aspects of Caregiving (M = 33.2 vs. M = 35.3) and Meaning and Purpose in Life (M = 53.7 vs. M = 55.3). They reported little reduction in distress related specifically to NPS (M = 20.3 vs. M = 19.7). Conclusion: The TeleCARE adaptation was successful, with caregivers reporting improvements in understanding of NPS, caregiver depression and anxiety, ability to care for their loved one, and management of caregiving tasks. Even with the return to in‐person care options after the peak of the COVID‐19 pandemic, the nature of dementia caregiving often does not allow caregivers to easily leave home to join in‐person programs. Geographical distance, time, and money spent finding care for loved ones can be barriers to participation. Our results suggest TeleCARE may serve as an effective option to increase access to group caregiver education and support. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic and consequent protective measures, including quarantines reduced or eliminated access to supports for dementia CGs. Dementia CGs have also reported increases in behavioral problems and decreases in cognition for the person with dementia (PWD) during the pandemic. We collected data on the impact of COVID‐19 on dementia CGs. Method: CGs of PWD enrolled in a telehealth intervention were interviewed via video. At baseline, CGs completed The Caregiver COVID‐19 Limitations Scale. During interviews, CGs responses to questions about COVID‐19 related concerns and spontaneous discussion of concerns were recorded in field notes. Result: Most CGs had a low level of concern that they would contract COVID‐19, but a slightly higher level of concern about the PWD. Several CGs reported at least a moderate impact of COVID‐19 related limitations on getting respite care (37.5%), leaving the house (50%), having outside visitors (25%), and gaining access to healthcare (25%). A quarter of CGs noticed at least a moderate change in the PWDs behavior. CGs also noticed cognitive decline. CGs felt changes were due to isolation, boredom, and depressive‐like symptoms. Caregivers also noted the loss of pleasurable activities they could engage in both alone and together with the PWD. A quarter of CGs also reported a great deal of difficulty explaining COVID‐19 related restrictions to the PWD. Specifically, memory loss experienced by the PWD necessitated frequent reminders about COVID‐19 and related limitation Conclusion: Our results are consistent with literature demonstrating reduction in CG access to respite care and other supportive services during the pandemic. CGs noted declines in cognition and increases in neuropsychiatric symptoms in the PWD perceived to be due to isolation and lack of stimulation. CGs lacked access to previously enjoyable activities outside the home. CG noted the additional burden of lack of a shared pandemic experience due to memory loss that necessitated reminders about the pandemic and associated safety measures. In conclusion, dementia caregivers grapple with lost supports that increase burden, with simultaneously increases in perceived cognitive and behavioral problems in the PWD along with new pandemic‐specific burdens. Our findings underscore the necessity for increased dementia CG programming. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is a debilitating, progressive brain disorder that diminishes quality of life and represents immense burden of public health. This study characterizes healthcare utilization related to clinical detection of AD and care for AD patients in the US Veterans Affairs (VA) Healthcare System. Methods: Using the VA Corporate Data Warehouse (2000‐2019), we studied Veterans aged ≥50 years who received ≥2 ICD‐10 codes (G30) for AD, with first code appearing in fiscal year 2018. We identified prior related ICD‐10 codes and summarized care processes during the years before and the year after the first AD code, including referrals to dementia‐related medical specialists (neurologists, geriatricians, geriatric psychiatrists), assessments by neuropsychological tests and radiological brain imaging, dementia medication prescriptions (donepezil, galantamine, memantine, rivastigmine), community‐based services (home health, adult day programs), and placements in institutional long‐term care in VA or community nursing homes. Results: The study cohort consisted of 6,046 Veterans (mean age of 80 years; 3% women; 22% non‐White race/ethnicity). Prior to the first ICD coding, 53.1% received codes for non‐specific dementia and 29.4% for mild cognitive impairment (MCI), with the first code appearing an average of 3 years before the first AD code. In the year before the first AD code, 51.1% visited specialists, 25.7% received neuropsychological assessments, 31.3% had brain imaging (but only 1.3% had a fluorodeoxyglucose‐PET scan), 30.2% received prescriptions for dementia medication, 45.8% received community‐based services, and 15.0% were admitted to institutional long‐term care. In the year following the initial AD code, 73.2% had specialty visits, 60.5% received dementia prescriptions, 63.6% received community‐based services, and 44.2% were admitted for institutional long‐term care. Conclusions: Medical and pharmacy utilization for non‐specific dementia or MCI begins years before AD detection, marked by the first AD‐specific clinical encounter in VA. Many AD patients do not receive specialty care and very few undergo a PET scan before AD detection. Community‐based home or day care and institutional nursing care increase with AD detection suggesting a substantial need for healthcare resources. [ABSTRACT FROM AUTHOR]

Background: The 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers identified the need for person‐centered dementia care throughout the care continuum. Challenges include adapting health care to meet the complex needs of persons with dementia and their caregivers across a variety of settings. Method: To understand dementia caregivers' experience of the health care system, we conducted qualitative interviews with twenty‐four middle‐to‐older age caregivers of community‐dwelling people with dementia. Data were analyzed using conventional content analysis whereby the coding team sought to identify barriers and facilitators to person‐centered dementia care. Result: We identified three categories and associated sub‐categories related to caregiver experience: 1) Preparing for the Visit, with sub‐categories Physical Challenges and Emotional Preparation; 2) Visit‐Related Time and Travel, with sub‐categories General Travel Challenges, Physical Limitations, Cognitive Limitations, and Benefits; and, 3) In‐visit Experience, with sub‐categories Physical Challenges and Emotional Preparation. Preparing for visit statements revealed barriers, such as patient resistance to attending visits due to not understanding the need. Visit‐related time and travel statements reflected a balance of challenges and facilitators, including general challenges such as traffic and dementia‐specific challenges such as patient agitation around visit wait times. Facilitators reflected the benefit of visits as opportunities for social participation. In‐visit experience statements reflected a mix of challenges and facilitators. Challenges included person with dementia difficulty participating in the health care visit due to poor insight and inability to answer questions, while facilitators included caregivers' positive engagement with the care team. Across categories, caregivers assumed high‐level responsibility to accommodate for person with dementia physical and cognitive challenges. Conclusion: Categories underscore the complexity of health care management for a person with dementia both in and around actual clinic appointments, highlighting both challenges related to person with dementia cognitive deficits and perceived benefits related to visits as opportunities for social participation and accessing resources. This study offers relevant insights about tailoring health care to accommodate for person with dementia deficits while supporting their caregivers. [ABSTRACT FROM AUTHOR]