On 25 June 2010, Ken Kosik, M.D., a neuroscientist at the University of California, Santa Barbara (UCSB), and the executive director of Cognitive Fitness and Innovative Therapies (CFIT), led a Webinar about CFIT, which he describes as "the first full-service, community-based ‘cognitive shop’ in the nation."
Anyone who cares for a person with Alzheimer disease quickly slams up against the frustratingly fragmented nature of medical care. Family members can spend exhausting weeks shepherding a confused loved one from the internist to a neurologist, then a psychiatrist, with perhaps a detour to an endocrinologist to discuss the patient's diabetes, a urologist to try to address incontinence issues, with stops along the way to consult a nutritionist, a social worker, perhaps a genetic counselor. All the while, the caregivers are wondering if they can find a physical therapist to help keep the patient mobile. How about a meal service that would have a nutritionally correct, delicious dinner waiting for them when they stagger in through the door after 12 hours of sitting in hospital waiting rooms?
Kosik spent many years caring for patients at Boston's Brigham and Women's Hospital, and thought there had to be a better way to serve the complex needs of patients. When he was recruited from Harvard University by the University of California, Santa Barbara to co-direct the Neuroscience Research Institute, he saw an opportunity to turn his ideas into reality, and founded CFIT, which opened its doors last year in Santa Barbara (see ARF related news story). The center's goal is to move Alzheimer’s care out of the hospital setting and instead combine all of a person’s cognitive needs—diagnostic, social, psychological, practical, treatment-related—under one roof in a homey, friendly setting. CFIT aims to serve its already impaired clients in a more holistic way and help younger clients delay the impairment that often comes with aging by taking proactive advantage of new research about mid-life risk factors for late-life dementia. Kosik has now written about this approach in a just-published book, The Alzheimer's Solution: How Today's Care Is Failing Millions and How We Can Do Better (by Kenneth Kosik and Ellen Clegg, Prometheus Books, 2010).
One year later, how is CFIT working? What lessons have been learned along the way? Can the CFIT model be emulated more broadly? What other ideas are people trying out? Joining Dr. Kosik for the discussion were Pierre Tariot (Banner Alzheimer's Institute), John Ringman (UCLA), and Suzee Lee (UCSF).
"A lot of the services that Alzheimer’s patients and their families really need are non-physician services. The physician is an important piece, but it’s not necessarily the main piece. In fact, after the diagnosis is made, what the physician can do becomes diminishingly small. If you want to go into other settings, you really have to put together your own package. Whom are you going to talk to about diet? Whom are you going to talk to about social work? There’s nothing where this all exists in one place.
Something else has happened that has made it even more important to do what we’re doing. That is the realization that if you intervene in mid-life, you can actually delay the onset of Alzheimer’s, or if you have it, you can slow its progression. The data for those interventions, most of which are lifestyle and medical optimization, are by now unequivocal. If we’re really going to have an impact on this disease, we have to be able to recognize it before it even happens. The best time to treat Alzheimer’s is before it strikes."
- Click on the four-arrow button at the bottom right of the screen for a full-screen view.
- Lu DC, Rabizadeh S, Chandra S, Shayya RF, Ellerby LM, Ye X, Salvesen GS, Koo EH, Bredesen DE. A second cytotoxic proteolytic peptide derived from amyloid beta-protein precursor. Nat Med. 2000 Apr;6(4):397-404. PubMed.
- Trojanowski JQ, Arnold SE, Karlawish JH, Brunden K, Cary M, Davatzikos C, Detre J, Gaulton G, Grossman M, Hurtig H, Jedrziewski K, McCluskey L, Naylor M, Polsky D, Schellenberg GD, Siderowf A, Shaw LM, Van Deerlin V, Wang LS, Werner R, Xie SX, Lee VM. Design of comprehensive Alzheimer's disease centers to address unmet national needs. Alzheimers Dement. 2010 Mar;6(2):150-5. PubMed.