DEMENTIA A Comprehensive Update
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- Derick Bruce
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1 DEMENTIA A Comprehensive Update May 27 30, 2015 The Fairmont Copley Plaza Hotel Boston, MA OFFERED BY Memory Disorders, and Frontotemporal Disorders Units/Divisions; MA Alzheimer s Disease Research Center; and The Center for Mind/Brain Medicine; Attending Staff, Harvard Partners Neurology Departments at Massachussetts General Hospital and Brigham & Women s Hospital Ray Dolby Brain Health Center Attending Staff, California Pacific Medical Center COURSE DIRECTORS Alireza Atri, MD, PhD Bradford Dickerson, MD, MMSc
2 COURSE DESCRIPTION The Alzheimer s disease (AD) and associated-disorders spectrum of neurodegenerative diseases clinically span from very mild cognitive impairments to frank dementia, and are increasingly recognized as a scourge of our time. Dementia: A Comprehensive Update is a three-and-a-half day annual review course designed by clinicians for clinicians. The course is organized by Neurology faculty members of Harvard Medical School who specialize in the care of patients with cognitive and behavioral disorders at Massachusetts General Hospital, Brigham and Women s Hospital, McLean Hospital. The course takes a practical and multidisciplinary approach to understanding and treating dementia and is designed for neurologists, psychiatrists, internists, primary care physicians, geriatricians, psychologists, nurse specialists, social workers, occupational therapists, clinical pharmacists, research scientists, and other health professionals involved in the diagnosis, management, and investigation of disease states causing dementia. This cutting-edge course is in its 19th year, includes local, national and international renowned faculty, and attracts over 300 participants from throughout the U.S. and the world. The organization of the course takes an integrative approach by interweaving lectures (1) establishing the neuroanatomical and cognitive framework underlying disorders of cognition, (2) addressing specific diseases (e.g. AD, vascular cognitive impairment/ dementia, Parkinsonian dementias, frontotemporal dementias), (3) discussing the latest clinical and research approaches to the diagnosis and treatment of dementing illnesses, and (4) providing, via the main program or optional fee-based programs, additional education on special topics in dementia (e.g. chronic traumatic encephalopathy; pain, palliation & hospice; medico-legal issues; capacity and competence; driving; nursing home care; delirium & dementia; neuroethics of dementia). FACULTY HARVARD MEDICAL SCHOOL COURSE DIRECTORS ALIREZA ATRI, MD, PHD Ray Dolby Endowed Chair in Brain Health Research, and Director, Research & Education, Ray Dolby Brain Health Center, California Pacific Medical Center (CPMC); Senior Scientist, CPMC Research Institute; Assistant in Neurology, Massachusetts General Hospital; Instructor in Neurology, Harvard Medical School BRADFORD DICKERSON, MD, MMSC Director, Frontotemporal Disorders Unit, MGH; Associate Neurologist and Co-investigator, MA ADRC; Associate Professor of Neurology, HMS MASSACHUSETTS GENERAL HOSPITAL Alireza Atri, MD, PhD David N. Caplan, MD, PhD Bradford C. Dickerson, MD, MMSc Matthew P. Frosch, MD, PhD Stephen N. Gomperts, MD, PhD Jeremy D. Schmahmann, MD Anand Viswanathan, MD, PhD Faculty profiles at BRIGHAM & WOMEN S HOSPITAL Andrew E. Budson, MD Kirk R. Daffner, MD Barry S. Fogel, MD Reisa A. Sperling, MD, MMSc MCLEAN HOSPITAL Bruce H. Price, MD James M. Ellison, MD, MPH BETH ISRAEL DEACONESS MEDICAL CENTER Sharon K. Inouye, MD, MPH Margaret O Connor, PhD
3 LEARNING OBJECTIVES Upon completion of this activity, participants will be able to apply the following: 1 Describe the clinical functional neuroanatomy underlying the cerebral hemispheres that support perception and cognitive systems including memory, language, frontal/executive, visuo-spatial, and motor systems 2 Compare differences due to normal cognitive aging and dementing processes; identify AD risk factors and epidemiology; and distinguish pre-clinical AD, MCI due to AD, and Alzheimer s dementia 3 Describe healthy cognitive aging, cognitive reserve and dementia protection strategies 4 Differentiate, based on neurobiology and clinical criteria, AD, and its atypical variants, from other common dementias including Dementia with Lewy Bodies (DLB), Vascular-Ischemic Dementias, Frontotemporal Degeneration (FTD), Parkinson s disease with Dementia (PDD), and Parkinson s-plus Syndromes 5 Identify Chronic Traumatic Encephalopathy (CTE) as a dementia risk/entity 6 Recognize and manage seizures in patients with dementia 7 Determine the role of office-based screening instruments, mental status exam and neuropsychology in the evaluation and management of dementia 8 Interpret and compare cognitive screening instruments and neuropsychological performance patterns for different dementias such as AD, FTD, and DLB 9 Develop efficient approaches to the mental status evaluation and the use of screening instruments (e.g. MoCA) in the evaluation of cognitive impairment and dementia 10 Utilize appropriate laboratory tests, imaging studies, and neuropsychological measures for the diagnosis of dementia in clinical practice 11 Incorporate appropriate use of clinical biomarkers (e.g. CSF a-beta/tau, MRI, PET) in the evaluation of neurodegenerative dementias to differentiate AD and non-ad processes 12 Explain the clinical versus research use of AD biomarkers; identify individuals with cerebral amyloidosis and risk of future AD dementia, and evaluate the scientific basis of current and future therapies in clinical trials and research to prevent and treat AD and other dementias 13 Apply data-supported pharmacologic management strategies including the roles (i.e., indications and benefits), cautions (i.e., risks, side-effects, warnings) and potential alternatives to using cholinesterase inhibitors, memantine, antipsychotics and antidepressants in dementia and AD 14 Integrate a holistic approach to management of problem behaviors and neuropsychiatric symptoms (e.g. aggression, apathy, anxiety, depression, psychosis) in individuals with dementia that stresses education, and behavioral and non-pharmacological interventions as first-line approaches to care 15 Implement appropriate psychosocial counseling, genetic counseling, and utilization of community support resources in the care of patients and caregivers 16 Develop appropriate practices concerning medico-legal and safety issues surrounding patients with dementia, including capacity with regards to medical care, finances, contracts, independent living, and driving 17 Integrate medico-legal and safety practices to support and safeguard patients and families with AD and dementias, and the public-at-large 18 Describe issues related to dementia neuroethics 19 Implement best practices in the long-term care/nursing-home environment and in end-stage dementia regarding medical, legal, and ethical issues. 20 Recognize and treat delirium/encephalopathy and pain 21 Provide palliation and hospice care and manage end-of-life issues related to dementia. GUEST FACULTY Clive G. Ballard, MDB ChB, MD (London, UK) David B. Carr, MD (St. Louis, MO) Rachelle S. Doody, MD, PhD (Houston, TX) James E. Galvin, MD, MPH (New York, NY) Kenneth M. Heilman, MD (Gainesville, FL) Helen C. Kales, MD (Ann Arbor, MI) Jason H. Karlawish, MD (Philadelphia, PA) Catherine A. Madison, MD (San Francisco, CA) Ann C. McKee, MD (Boston, MA) M.-Marsel Mesulam, MD (Chicago, IL) Meghan B. Mitchell, PhD (Tewksbury, MA) Ronald C. Petersen, MD, PhD (Rochester, MN) Paul R. Solomon, MD (Williamstown, MA) Robert A. Stern, PhD (Boston, MA) Eric G. Tangalos, MD (Rochester, MN) Sandra Weintraub, PhD (Chicago, IL) Sumer D. Verma, MD, MB (Boston, MA)
4 GENERAL INFORMATION TARGET AUDIENCE The course involves a multidisciplinary faculty (including cognitive and behavioral neurologists, geriatric psychiatrists, geriatricians, and neuropsychologists) and approach to understanding dementia and is designed for neurologists, psychiatrists, internists, primary care physicians, geriatricians, psychologists, nurse specialists, social workers, occupational therapists, research scientists, elder-care attorneys (particularly the Day 4 half-day optional symposium) and other health professionals involved in the diagnosis, management, and investigation of disease states causing dementia. ACGME COMPETENCIES This course is designed to meet one or more of the following Accreditation Council of Graduate Medical Education competencies: Patient Care, Medical Knowledge, Practice-based learning and improvement, Interpersonal and communication skills, Professionalism, Systems-based practice. ACCREDITATION The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Harvard Medical School designates this live activity for a maximum of 28.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity meets the criteria of the Massachusetts Board of Registration in Medicine for 2.25 credits of Risk Management Study. This includes: 0.5 Credit of Opioid Education and Pain Management Training 1.75 Credit of End-of-Life Care Studies. Please check your individual state licensing board requirements before claiming these credits. APA CE Credits for Psychologists: This program is sponsored by the The Center for Brain/Mind Medicine and Partners Neurology. The Center for Brain/Mind Medicine is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. The Center for Brain/Mind Medicine maintains responsibility for this program and its content. Depending on participation in optional additional programs, the program offers a maximum of 29 CE credits to psychologists upon successful completion. COURSE LOCATION All sessions for this course will be held at The Fairmont Copley Plaza Hotel, 138 St. James Avenue, Boston, MA ACCOMMODATIONS/TRAVEL A limited number of rooms have been reserved at the Fairmont Copley Plaza Hotel (Telephone: or ) until May 4, Please specify that you are enrolled in this course to receive a reduced room rate of $299 Moderate Room (Queen bed), $339 Fairmont Room (Queen bed), and $369 Deluxe Room (Two Doubles or one King bed). Hotel arrangements can also be made online at: Please do not purchase non-refundable airline ticket(s) until you have received an from our office confirming your paid registration. INQUIRIES By phone ( ), Mon Fri, 9 am to 5 pm (ET) or by at: hms-cme@hms.harvard.edu. For more information and registration:
5 REGISTRATION INFORMATION 3-Day Course (Days 1-3) Fee FEE SCHEDULE CHOOSE ONE OF THE FOLLOWING REGISTRATIONS 4-Day Course (Days 1-3 plus Day 4, Saturday, half-day Special Symposium) Fee 3-Day Course (Days 1-3) PLUS Clinical Pearls Dinner with Faculty Fee 4-Day Course (Days 1-3 & Saturday Symposium) PLUS Clinical Pearls Dinner with Faculty Fee Day 4 ONLY (for half-day Saturday Special Symposium without full course registration for Days 1-3) Registration to Day 2 (Thursday May 28, 2015) Lunch and Learn: Healthy Cognitive Aging, Cognitive Reserve & Dementia Protective Strategies *MUST REGISTER TO ATTEND. Will you attend Day 2 Lunch & Learn (Lunch is provided): YES/NO Processing (service fee) $ 5 Physician $ $ $ $ $ $ $ $ $ $ *FREE Trainee/Allied Health Professional *FREE Registration by credit card (VISA, MasterCard or American Express) or check can be made through Harvard Medical School s secure online registration system at Registration by check (draft on a United States bank), please make payable to Harvard Medical School. Learners who choose to pay by check will be prompted to download an online form to send in with a payment. Telephone or fax registration is not accepted. Registration with cash payment is not permitted. Upon receipt of your payment, you will receive an confirmation. Be sure to include an address that you check frequently. Your address is used for critical information including registration confirmation, evaluation and certificate. REFUND POLICY Refunds, less an administrative fee of $75, will be issued for all cancellations received two weeks prior to the start of the course. Refund requests must be received by postal mail, , or fax. No refund will be issued should cancellation occur less than two weeks prior. No shows are subject to the full course fee and no refunds will be issued once the conference has started. DISCLOSURE POLICY Harvard Medical School (HMS) adheres to all ACCME Essential Areas, Standards, and Policies. It is HMS s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that HMS may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations. me.hms.harvard.edu/courses/dementia
6 SCHEDULE WEDNESDAY, MAY 27, :30 8:40 AM Directors Welcome and Introductory Remarks Alireza Atri, MD, PhD Bradford Dickerson, MD, MMSc 8:40 9:25 AM Cognitive Systems in Health, Aging and Dementia David Caplan, MD, PhD 9:25 10:05 AM Memory Systems & Amnesia Andrew Budson, MD 10:05 10:20 AM Coffee Break 10:20 11:00 AM Can Alzheimer s Disease be prevented? Prevention trials in preclinical AD Reisa Sperling, MD, MMSc 11:00 11:45 AM Clinical use of Biomarkers in Dementia: Neuroimaging, Bradford Dickerson, MD, MMSc Molecular Studies & Genetics 11:45 12:15 PM Panel Discussion and Q/A AM Faculty 12:15 1:45 PM Lunch Break 1:45 5:30 PM Plenary Session: The Alzheimer s Disease Clinical Drs. Atri, Doody & Petersen Spectrum: Annual Update on Evaluation & Management 1:45 3:00 PM Current Trends in Alzheimer s Dementia Evaluation, Alireza Atri, MD, PhD Treatment & Care 3:00 3:15 PM Coffee Break 3:15 4:00 PM Mild Cognitive Impairment: Diagnosis & Care Ronald Petersen, MD, PhD 4:00 4:40 PM Experimental Trials & Future Therapies for the Rachelle Doody, MD, PhD Alzheimer s Disease Clinical Spectrum 4:40 5:30 PM Panel Discussion and Q/A All Faculty 5:30 6:30 PM Reception with Course Faculty THURSDAY, MAY 28, :30 9:15 AM Neuropsychology of Aging & Dementia Sandra Weintraub, PhD 9:15 10:00 AM Executive Systems & Frontotemporal Dementias Kirk Daffner, MD 10:00 10:45 AM Language Dementias: The Primary Progressive Aphasia M. Marsel Mesulam, MD Spectrum 10:45 11:00 AM Coffee Break 11:00 11:45 AM Neurodegenerative Dementias with Parkinsonism Stephen Gomperts, MD, PhD 11:45 12:30 PM Panel Discussion and Q/A AM Faculty 12:30 2:00 PM Lunch Break 12:45 1:45 PM Lunch and Learn: Healthy Cognitive Aging, Cognitive Reserve & Dementia Protective Strategies Catherine Madison, MD Alireza Atri, MD, PhD *Optional Lunch & Learn Program Requires Advanced Registration (Free Lunch Will Be Provided) 2:00 2:45 PM Vascular Cognitive Impairment & Dementia Anand Viswanathan, MD, PhD 2:45 5:30 PM Mini-Symposium: Office-based screening of Cognitive Impairment & Differential Diagnosis of Rapildy Progressive Dementias 2:45 3:10 PM Office-based Cognitive Screening Instruments Meghan Mitchell, PhD 3:10 3:35 PM What may we learn from performance patterns on Paul Solomon, PhD office-based dementia screening instruments: Case Examples 3:35 3:50 PM Coffee Break 3:50 4:50 PM Subacute and Rapidly Progressive Dementias Jeremy Schmahmann, MD 4:50 5:30 PM Panel Discussion and Q/A All Faculty
7 6:30 9:00 PM Clinical Pearls Dinner with Faculty Program: Creativity in Dementia & Controversies in Dementia** Program: 1. Creativity & Dementia 2. Controversies in Dementia 3. Practical Tips for Management of Dementia 6:30 7:00 PM Creativity & Dementia: Dr. Heilman 7:00 7:30 PM Controversies in Dementia: Dr. Verma 7:30 9:00 Practical Management Tips for Managing Problem Behaviors in Dementia (at tables with faculty) Discussion (involving all faculty) 7:30 9:00 Dinner at Tables with Faculty (1-2 faculty per table of participants) FRIDAY, MAY 29, :30 9:10 AM Neuropathology of Dementias: What Practicing Clinicians Need to Know ** *OPTIONAL PROGRAM WITH AD- DITIONAL $150 FEE REQUIRED An Additional $150 fee required for this 3-course small group dinner CME program that has a very limited attendance. Faculty: Kenneth Heilman, MD Sumer Verma, MD, MB and others including: Drs. Atri, Budson, Caplan, Carr, Daffner, Dickerson, Galvin, Kales, Schmahmann, and Solomon Matthew Frosch, MD, PhD 9:10 12:00 PM Plenary Session: Management of Neuropsychiatric and Behavioral Issues in dementia 9:10 9:55 AM Non-Pharmacological Approaches to Neuropsychiatric Helen Kales, MD Symptoms and Problem Behaviors in Dementia 9:55 10:40 AM Pharmacological Management of Behavioral Problems Clive Ballard, MDB ChB, MRC Psych, MD in Dementia: Psychosis, Agitation & Aggression 10:40 10:55 AM Coffee Break 10:55 11:25 AM Pharmacological Management of Mood, Anxiety, James Ellison, MD, MPH Apathy & Odd Behaviors in Dementia 11:25 12:15 PM Panel Discussion and Q/A AM Faculty 12:15 1:45 PM Lunch Break 1:45 2:30 PM Delirium & Dementia Sharon Inouye, MD 2:30 3:15 PM The Importance of Caregivers in Dementia: Costs, James Galvin, MD, MPH Benefits, Burdens and Interventions 3:15 3:25 PM Coffee Break 3:25 5:10 PM Mini-Symposium: Head Injury, Chronic Traumatic Encephalopathy (CTE) & Dementia 3:25 4:05 PM The Neuropathology and Neurophysiology of CTE Ann McKee, MD 4:05 4:45 PM The Clinical Presentation and Diagnosis of CTE Robert Stern, PhD 4:45 5:10 PM Panel Discussion and Q/A All Faculty 5:10 5:15 PM Concluding Comments on 3-Day Portion of the Course Drs. Atri & Dickerson SATURDAY, MAY 30, 2015 SPECIAL ½ DAY SYMPOSIUM (8:30 AM 1:30 PM) From Capacity to Comfort: Medico-legal, Driving & Long-term Care Issues in Dementia*** *** ADDITIONAL FEE REQUIRED FOR THIS OPTIONAL 1/2 DAY SYMPOSIUM: $95 FOR 3-DAY COURSE REGISTRANTS $345 FOR SYMPOSIUM ONLY REGISTRANTS 8:30 8:40 AM Introduction to the Symposium Drs. Atri & Dickerson Bruce Price, MD 8:40 9:15 AM Where There s A Will There s A Way: Transactional Bruce Price, MD Capacity & End of Life Legal Issues in Dementia 9:15 9:55 AM Mental Competence and Legal Issues in Dementia Barry Fogel, MD 9:55 10:25 AM Defining and Assessing Driving Risk in Older Adults David Carr, MD with Cognitive Impairment: The Clinician Perspective 10:25 10:40 AM Coffee Break 10:40 11:10 AM Driving & Dementia: Assessment of capacity and Margaret O Connor, PhD Medico-legal Considerations 11:10 11:40 PM Neuroethics of Dementia Jason Karlawish, MD 11:40 12:20 PM Medical Management of Dementia in the Long-Term Erik Tangalos, MD Care Setting: Focus on Pain, Palliation & Hospice Care 12:20 1:25 PM Panel Discussion and Q/A 1:25 1:30 PM Symposium Concluding Comments Drs. Atri, Dickerson & Price *Please Note: Program changes/substitutions may be made without notice.
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