News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences
For early Alzheimer’s, staying home could be a matter of the right fertilizer.
Constantine “Kostas” Lyketsos was born in Greece. Deirdre Johnston drew her first breath in Ireland. It’s no coincidence that two psychiatrists born to cultures steeped in social service, ones that hold old people in high regard, find themselves together on a project that aims to rattle the status quo of the at-risk elderly in this country.
Specifically, Lyketsos, Johnston and other dementia experts are in the midst of MIND—for maximizing independence—at Home. The much-needed study, which makes partners of Hopkins and the Baltimore Jewish community, taps 30 years of research that Lyketsos and Hopkins colleague Peter Rabins conducted on identifying and treating patients with early Alzheimer’s or other dementias. The project holds to the mission of the Copper Ridge Institute, a research body Lyketsos helped create, to spread its model of care worldwide.
In MIND’s first phase, staff phone-surveyed Northwest Baltimore’s older, Jewish population. Phase II is now casting the nets wider to find elders more severely at risk. The study’s trained gatekeepers flag potential memory disorders for the project’s geriatric psychiatrists. Soon, 300 people with clear, early-stage dementia will enter a controlled trial, to see how care as usual compares with living under the Cadillac of “best practices.” At its finish, MIND at Home should stand as a prototype for communities, letting them find and nurture the elderly in early dementia, without plucking them from their homes.
Johnston, the lead investigator, directed geriatric psychiatry at Canada’s University of Alberta in Edmonton. There, she helped town leaders create an unusual citywide program for the aged at risk. More recently, she set up a highly effective project of at-your-door medical outreach to homebound elders in neighborhoods around Wake Forest University.
Lyketsos now heads Psychiatry and Behavioral Sciences at Hopkins Bayview.
We shudder at the figure: By 2050, Alzheimer’s disease will quadruple worldwide. That’s what prompted this project, yes?
(Kostas) That drives it, of course. But specifically, we’re doing MIND because of scale. We already know how to give patients with early dementia good care. We just don’t know how to make it available to large groups. (Deirdre) Services are available, but often, because dementia comes slowly, people don’t realize they need them. And even if they do, driving into Baltimore doesn’t work with dementia.
So the idea is that early dementia patients can do better at home?
(Kostas) The theory is: Meet patients’ needs and you reduce symptoms. Reduce symptoms and they function better. Then everyone’s happier. Patients can stay longer at home. Cost is less.
So you structure their day and fine-tune medicines—at home. Not shuttling them around, we think, will make a difference. Just the stress of a cold, for example, can push dementia patients into a really bad patch.
Why have you singled out Baltimore’s elderly Jewish?
(Deirdre) Basically because there’s wonderful infrastructure. The Associated Jewish Charities, which funded this study, also kindly offered us their telephone lists, demographics and more. We’ve already cold-called everyone over 70 in three target ZIP codes, given 283 cognitive status interviews by phone, then followed up with 43 in-home visits: Are you on medication? Is the dose right? Are caregivers coping? Sleep OK? The survey we gave was broad and accurate and, fortunately, it led to a simple instrument that others can use to guide at-home care for people with dementia.
Any surprises so far?
(Deirdre) Yes—how frequently family members are overwhelmed. Also, calls aren’t enough. We suspect there’s a huge vulnerable population out there not picking up the phone. MIND’s biggest impact could be on them.