Dementia: Diagnosis and Management
VKN NIMHANS ECHO for Primary Care Physicians
NIMHANS Digital Academy | Project VKN NIMHANS ECHO
October 2019 - March 2020
Introduction: A Growing Health Challenge
⚠️ Dementia is a growing health problem, particularly in the elderly population, with significant impact on a person's ability to perform various activities.
The Dementia Challenge
Dementia is a syndrome characterized by a decline in memory and other cognitive functions. Key facts:
- Alzheimer's disease accounts for 60-80% of dementia cases
- Mild Cognitive Impairment (MCI) - the earlier stage - is often missed by families, who consider it age-related cognitive decline
- Early identification and treatment can improve functioning, quality of life, and reduce caregiver burden
- Treatment gap: Shortage of qualified specialists (geriatric psychiatrists, neurologists, geriatricians)
The Solution: Training Primary Care Physicians
The best way to address this treatment gap is to train physicians at the primary care level to screen, diagnose, and manage dementia in their communities using the VKN NIMHANS ECHO model.
The VKN NIMHANS ECHO Model
Virtual Knowledge Network (VKN) + Project ECHO works on the principle of HUB and SPOKES - a knowledge-sharing network led by an expert multidisciplinary team at NIMHANS.
How It Works:
- Weekly multipoint video conferencing with community healthcare providers
- Focus: "Case-based learning" to disseminate best practices
- Remote providers present clinical cases and seek clarification from the multidisciplinary HUB team and peers
- "Guided practice" strengthens confidence and enhances skills
- Collaborative learning through learning loops with Hub specialists and other physicians
- Reduces social isolation and demonopolization of knowledge
ECHO vs Traditional Telemedicine
The ECHO model is NOT "traditional telemedicine" where the specialist assumes care of the patient. Instead, it aims to enhance the expertise of the clinician, who retains responsibility for managing their patient.
Patients get the best treatment in their own community without traveling to distant places.
Impact of Dementia ECHO Program
Program Success Metrics
Through this Dementia ECHO program, 25 accredited primary care physicians are now equipped to screen, diagnose, and manage mild cognitive impairment and Alzheimer's disease, providing quality dementia care to over 1,400 elderly patients in their communities across India.
Learning Objectives
On course completion, participants should be able to:
- Screen elderly patients who present with memory-related (cognitive) complaints
- Differentiate age-related cognitive decline from mild cognitive impairment and dementia
- Diagnose mild cognitive impairment and dementia due to Alzheimer's disease
- Provide basic minimum pharmacological and non-pharmacological treatments for mild cognitive impairment and dementia due to Alzheimer's disease
Program Overview
| Aspect | Details |
|---|---|
| Duration | 6 months (October 2019 - March 2020) Total: 30 hours • 20 hours: Fortnightly Tele-ECHO clinics (Real-time) • 10 hours: Self-paced e-learning |
| Schedule | 1st and 3rd Monday of each month 2:30 PM to 4:30 PM (2 hours per session) |
| Eligibility | • MBBS or above • Basic learning (Accredited or Certification) in Mental Health • Examples: Diploma in Community Mental Health, DPM, MD Psychiatry, or similar • Preferably doctors working with dementia patients or elderly with memory complaints |
| Method | Completely ONLINE - Blended Patient-Centric Learning • Real-time: Face-to-face Zoom video conferencing • Anytime: Self-paced e-learning (Google Classroom) |
| Focus | "Patient-centric", "Peer-led", "All teach-All learn" Model Primary focus on case discussion by participating healthcare providers |
| Recognition | Continuous Professional Development (CPD) Program |
Who Should NOT Enroll?
This program may not benefit:
- Experts or Specialists like Geriatric Psychiatrists
- Neurologists already specialized in dementia
This program is designed for primary care physicians seeking to develop competency in dementia care.
Accreditation Criteria
To receive the Completion Certificate, participants must fulfill ALL of the following criteria:
- Attendance: >80% participation in fortnightly sessions with >60 minutes video presence per session (measured by software)
- Case Presentations: Presentation of 2 or more case summaries from elderly age group with detailed history of cognitive functions
- Assignments: Score >80% in Two Assignments (Two attempts provided, each assignment to be completed within 3 working days)
- Monthly Reports: Submit monthly reports of patients evaluated for Cognitive Impairment for 6 months after training starts
- Post-assessment: Complete post-assessment on knowledge and self-efficacy at the end of three months
Important Notes:
- HIPAA compliant case intake form designed to protect patient privacy
- Within one month of last LIVE session, all submissions must be completed
- Two attempts allowed for each assignment
12-Session Curriculum
Case Demo 1 by Hub Team
Case Demo 1 by Hub Team
2 Case Summary Discussions
Reading: Self Practice Test 1
2 Case Summary Discussions
Reading: Patient resource materials for MCI and mild AD
2 Case Summary Discussions
2 Case Summary Discussions
Reading: Patient resource material for moderate to severe AD
Assignment 1
2 Case Summary Discussions
Reading: Pharmacological treatment in detail
2 Case Summary Discussions
Reading: Self Practice Test 2
2 Case Summary Discussions
Reading: Depression and Delirium in Dementia
2 Case Summary Discussions
Reading: Social and legal aids for elderly with dementia
2 Case Summary Discussions
Assignment 2
2 Case Summary Discussions
Post Course Assessment
Key Topics Covered
- Screening and Assessment: History taking, mental status examination, cognitive function assessment
- Diagnosis: Differentiating MCI from dementia, Alzheimer's disease diagnosis
- Severity Assessment: Tools and scales for measuring dementia severity
- Atypical Presentations: When to refer to specialists
- Reversible Dementia: Identification and management
- Pharmacological Treatment: Cognitive enhancers and other medications
- BPSD Management: Behavioral and psychological symptoms
- Non-pharmacological Interventions: Evidence-based approaches
- Prevention Strategies: Risk reduction and health promotion
- Comorbidities: Depression and delirium in dementia
- Support Resources: Social and legal aids for elderly
Outcome Evaluation Framework
This program uses Moore's Evaluation Framework (2015) for Continuing Medical Education (CME) to assess outcomes:
| Level | Focus | Measurement Method |
|---|---|---|
| Level 1: Participation | Number of physicians who participated | iECHO Spark |
| Level 2: Satisfaction | Expectations about setting and delivery met | Zoom polls |
| Level 3: Learning | Declarative and procedural knowledge | Assessments, assignments, case presentations, pre/post tests |
| Level 4: Competence | Ability to apply knowledge in educational setting | Self-efficacy reports (pre and post) |
| Level 5: Performance | Application in practice | Monthly reports (6 months post-training), case types, qualitative data |
| Level 6: Patient Health | Impact on patient outcomes | Long-term monitoring |
| Level 7: Community Health | Broader community impact | Population-level metrics |
Hub Team
Lead Facilitators and Specialists:
- Dr. Preeti Sinha - MD, Faculty, Geriatric Psychiatry, NIMHANS (Lead Facilitator)
- Dr. Shruti Nair - Senior Resident (Co-facilitator)
- Dr. Prashant Sahu - Senior Resident (Co-facilitator)
Support Team:
- Mr. Aurobind - M.Tech (Edutech Support)
- Ms. Maria - BA (Clinic Coordinator)
Mentoring Coaches:
- Dr. Mathew Varghese - Professor and Head, Geriatric Psychiatry, NIMHANS
- Dr. P. T. Sivakumar - Professor, Geriatric Psychiatry, NIMHANS
- Dr. Prabhat Chand - Professor of Psychiatry, Digital Learning Expert, Officer-in-Charge NIMHANS Digital Academy
Patient Resources Developed
Throughout the program, participants receive patient education materials:
- Patient resource materials for MCI and mild Alzheimer's Disease
- Patient resource materials for moderate to severe Alzheimer's Disease
- Information on Depression and Delirium in Dementia
- Social and legal aids for elderly with dementia
Learning Methodology
Blended Learning Approach:
| Component | Hours | Format |
|---|---|---|
| Real-time Live Multipoint Video Conference | 24 hours | Fortnightly sessions via Zoom |
| Self-paced E-learning | 6 hours | Google Classroom (Anytime access) |
| Self-practice Tests | - | Formative Assessment |
| Final Assignments | - | Summative Assessment |
Contact Information
NIMHANS Digital Academy
Project VKN NIMHANS ECHO
Department of Geriatric Psychiatry
National Institute of Mental Health and Neurosciences
For more information about future cohorts of this program, please contact the NIMHANS Digital Academy.
Bridging the Dementia Care Gap
Empowering primary care physicians with the knowledge and skills to screen, diagnose, and manage Alzheimer's disease and dementia in community settings.
Over 1,400 elderly patients have received quality dementia care from our 25 accredited primary care physicians, improving their functioning, quality of life, and reducing caregiver burden.