dementia case study

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Psychiatry Investig
• v.14(4); 2017 Jul

A Case Report of a 37-Year-Old Alzheimer's Disease Patient with Prominent Striatum Amyloid Retention

Yoo hyun um.

1 Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Woo Hee Choi

2 Department of Radiology, Division of Nuclear Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.

Won Sang Jung

3 Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.

Young Ha Park

Chang-uk lee.

4 Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Hyun Kook Lim

With recent advancement in amyloid imaging, diagnostic application of this new modality has become a great interest among researchers. New ligands, such as 18F- florbetaben, florbetapir and flutemetamol, have been discovered to overcome limitations of preexisting ligand Pittsburgh compound B. We report here a case of a 37-year-old male patient whose initial complaints comprised of gradual cognitive decline, apraxia, disorientation and sleep disturbances. 18F-Florbetaben amyloid imaging of the patient showed diffuse amyloid retention with prominent striatal uptake. This finding supports the clinical utility of amyloid imaging in diagnostic process of early-onset AD. Moreover, striatal dominant uptake pattern demonstrated in this patient include some meaningful clinical implications that warrant special attention among clinicians.

INTRODUCTION

Amyloid deposition has long been considered one of the pathognomonic markers of Alzheimer's disease (AD). Moreover, disruption in amyloid hypothesis has been frequently discussed as important targets of intervention for many years. 1 To date, most validated research results have been narrowed down to yield a model for biological trajectory of AD, where amyloid deposition far precedes clinical symptoms. 2 Thus, early detection of amyloid deposition has emerged a major target of intervention in AD patients. In this regard, amyloid imaging has emerged as an effective diagnostic tool that could enable early intervention in patients in AD trajectory, and the clinical utility of amyloid imaging has become a main topic of interest among researchers over the recent years. 3 If validated further, clinical usage of amyloid imaging is expected to extend beyond confirming AD pathology in patients with high risk factors, helping to differentiate AD from various types of dementia in those who present with atypical course or symptoms. 4

Pittsburgh compound B has been the first ligand used to detect amyloid deposition in AD patients. 5 However, its short half-life and resultant limitations in applying it to clinical setting have resulted in the development of new ligands for detecting amyloid deposition, such as 18F-florbetaben, florbetapir and flutemetamol. 6 Amyloid deposition usually initiates from temporal and orbitofrontal cortices, which later extends to frontal, parietal, precuneus, anterior and posterior cingulate cortices. 7 However, differential uptake patterns in autosomal dominant gene carriers have been noted that warrant special clinical attention. While typical amyloid deposition occurs from cortical structures, those with autosomal dominant gene carriers demonstrated initial amyloid deposition in striatum. 8 , 9

We report here a case where a case of early-onset AD patient who received a confirmatory diagnosis of AD by beta-amyloid imaging. There is relatively few evidence on the clinical application of beta-amyloid imaging in early-onset AD patients, and therefore, we expect our case can contribute to this line of inquiry. Moreover, validity of utilizing beta-amyloid imaging in differential diagnosis of dementias will be discussed.

A 37-year old male patient visited outpatient clinic, with complaints of gradual cognitive decline which had started 3 years earlier. Working as an industrial researcher, he started to make serious calculation mistakes that made him quit the job and began working as a manager in a company. However, his frequent forgetfulness, along with aggravation in recent memory impairments hampered him from fulfilling his duties, making him change jobs frequently. Apraxia and apathy had started 2 years before his visit to our clinic, and disorientation to time and person was worsened to a degree which it became impossible to commute daily between his workplace and home. At time of his visit to our clinic, not only he was fired from his recent job, but also he needed frequent reminder from his family to maintain hygiene. His sleep disturbance became prominent, frequently waking up middle of the night self-talking.

Before his visit to our clinic, he had visited two hospitals for evaluation and management of his symptoms, but to no avail. For a thorough examination of his symptoms, he was immediately admitted to our psychiatric ward. His laboratory findings did not reveal any abnormalities, and his tests for human immunodeficiency virus, syphilis all turned out to be negative. Upon his psychiatric admission, a neuropsychological test battery was implemented to evaluate the patient's cognitive status. He scored 22 in Mini-mental status examination, 1 in Clinical dementia rating scale (CDR), 10 and 4.5 in Clinical Dementia Rating-Sum of Box score(CDR-SB). 11 In his cognitive tests, in contrast to his relatively preserved language function, he displayed serious impairments in free recall, 20-minute delayed recall and recognition.

Brain magnetic resonance imaging demonstrated global cerebral atrophy of grade 1 by cortical atrophy scale 12 and notable medial temporal lobe atrophy of grade 2 by medial temporal lobe atrophy visual rating scale ( Figure 1A and B ). 13 Atypically early onset of dementia symptoms made the patient an eligible candidate for amyloid positron emission tomography (PET) imaging. 14 18-Florbetaben PET images revealed diffuse amyloid deposition with score 3 in brain beta-amyloid plaque load (BAPL), 15 with predominant amyloid deposition in the striatum ( Figure 1C and D ).

The patient's history, along with neuroimaging results and cognitive test results all satisfied the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association Alzheimer's (NINCDS-ADRDA) criteria16 for probable Alzheimer's disease with high level of evidence. 5 mg of donepezil was prescribed, and the patient was discharged on the 10th day of his admission. To control his persistent cognitive decline even after the discharge, donepezil was increased up to 23 mg with combination of memantine, which was also increased up to 20 mg. His cognitive decline has been relatively plateaued, but we advised the patient and his caregiver to regularly visit the clinic for monitoring of his symptoms.

This is one of the few case reports that demonstrated diagnosis of early-onset AD by 18F-florbetaben PET imaging. The patient demonstrated early onset of cognitive decline with accelerated deterioration. The fact that he meandered along various departments at different hospitals for confirmatory diagnosis reflect major role amyloid imaging played in the diagnostic process of the patient.

Amyloid imaging is usually indicated in patients with progressive MCI with dubious etiology, patients with atypical presentations and clinical course, and patients with early-onset progressive dementias. 14 Considering the patient in the case exhibited dementia symptoms at atypically early age, amyloid imaging was appropriately prescribed to diagnose the etiology of his cognitive decline. Integration of information attained from his history, clinical data indicated his diagnosis to be early-onset AD.

There have been relatively few reports utilizing 18F-labelled amyloid beta PET tracers that include clinical implications related to autosomal dominant AD. One study adopted 18F-florbetaben PET imaging in Down syndrome patients, suggesting potential role of amyloid imaging in identifying population at risk of dementia. 17 Similar study was conducted on patients with Down syndrome, but with 18F-florbetapir tracer. 18 An attempt to differentiate Down Syndrome pathology from AD has also been made with 18F-florbetapir tracer. 19 Future studies on autosomal dominant AD with 18F-labelled amyloid beta PET tracers could increase validity of adopting these new ligands in the diagnostic process.

Most notable test results in the case report arise from uptake patterns of 18F-florbetaben PET imaging. Unlike typical uptake patterns demonstrated by late-onset AD patients, where striatum is usually involved in the later course of illness, there was a dominant striatal uptake pattern in the patient. A previous study conducted on nondemented young adults with Down syndrome compared their results with that of studies conducted on autosomal dominant early-onset AD patients, where two groups of subjects concordantly showed predominant striatal uptake. 8 Indeed, previous studies on autosomal early-onset AD patients consistently showed high striatal amyloid deposition. 20 , 21 The aforementioned finding could explain 18F-florbetaben uptake patterns in the case.

The underlying mechanisms have been discussed in prior studies on the relatively early involvement of the striatum in autosomal dominant early-onset AD patients. Axonal mistrafficking induced by presenillin-1 gene mutation has been suggested as a potential culprit for striatal amyloid deposition in one animal study. 22 Such axonal mistrafficking is considered to stem from disruption in APP processing. 22 Indeed, APP processing patterns differed between autosomal dominant AD patients and sporadic AD patients. 23 Striatal vulnerability to early stages of tau protein accumulation in autosomal dominant AD has also been elucidated, and such phenomenon is considered more toxic to induce significant striatal neuronal injury. 24

The most prominent limitation of our case report is lack of genotype testing in the patient. If the genetic testing had been done, one missing puzzle in the diagnosis of patient would have been complete. Nevertheless, we believe our case report affirms diagnostic usefulness and clinical application of amyloid imaging in the differential diagnosis of early-onset dementia. We expect more prevalent use of amyloid imaging with accumulation of evidences and validation studies over time.

Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2015R1C1A1A02036578).

Call our 24 hours, seven days a week helpline at 800.272.3900

• Professionals

• Younger/Early-Onset Alzheimer's
• Is Alzheimer's Genetic?
• Women and Alzheimer's
• Creutzfeldt-Jakob Disease
• Dementia with Lewy Bodies
• Down Syndrome & Alzheimer's
• Frontotemporal Dementia
• Huntington's Disease
• Mixed Dementia
• Normal Pressure Hydrocephalus
• Posterior Cortical Atrophy
• Parkinson's Disease Dementia
• Vascular Dementia
• Korsakoff Syndrome
• Traumatic Brain Injury (TBI)
• Know the 10 Signs
• Difference Between Alzheimer's & Dementia
• 10 Steps to Approach Memory Concerns in Others
• Medical Tests for Diagnosing Alzheimer's
• Why Get Checked?
• Visiting Your Doctor
• Life After Diagnosis
• Stages of Alzheimer's
• Earlier Diagnosis
• Part the Cloud
• Research Momentum
• Our Commitment to Research
• TrialMatch: Find a Clinical Trial
• What Are Clinical Trials?
• How Clinical Trials Work
• When Clinical Trials End
• Why Participate?
• Talk to Your Doctor
• Clinical Trials: Myths vs. Facts
• Can Alzheimer's Disease Be Prevented?
• Brain Donation
• Navigating Treatment Options
• Lecanemab Approved for Treatment of Early Alzheimer's Disease
• Aducanumab Discontinued as Alzheimer's Treatment
• Medicare Treatment Coverage
• Donanemab for Treatment of Early Alzheimer's Disease — News Pending FDA Review
• Questions for Your Doctor
• Medications for Memory, Cognition and Dementia-Related Behaviors
• Treatments for Behavior
• Treatments for Sleep Changes
• Alternative Treatments
• Facts and Figures
• Assessing Symptoms and Seeking Help
• Now is the Best Time to Talk about Alzheimer's Together
• Get Educated
• Just Diagnosed
• Sharing Your Diagnosis
• Changes in Relationships
• If You Live Alone
• Treatments and Research
• Legal Planning
• Financial Planning
• Building a Care Team
• End-of-Life Planning
• Programs and Support
• Overcoming Stigma
• Younger-Onset Alzheimer's
• Taking Care of Yourself
• Reducing Stress
• Tips for Daily Life
• Helping Family and Friends
• Leaving Your Legacy
• Live Well Online Resources
• Make a Difference
• Daily Care Plan
• Communication and Alzheimer's
• Food and Eating
• Art and Music
• Incontinence
• Dressing and Grooming
• Dental Care
• Working With the Doctor
• Medication Safety
• Accepting the Diagnosis
• Early-Stage Caregiving
• Middle-Stage Caregiving
• Late-Stage Caregiving
• Aggression and Anger
• Anxiety and Agitation
• Hallucinations
• Memory Loss and Confusion
• Sleep Issues and Sundowning
• Suspicions and Delusions
• In-Home Care
• Adult Day Centers
• Long-Term Care
• Respite Care
• Hospice Care
• Choosing Care Providers
• Finding a Memory Care-Certified Nursing Home or Assisted Living Community
• Changing Care Providers
• Working with Care Providers
• Creating Your Care Team
• Long-Distance Caregiving
• Community Resource Finder
• Be a Healthy Caregiver
• Caregiver Stress
• Caregiver Stress Check
• Caregiver Depression
• Changes to Your Relationship
• Grief and Loss as Alzheimer's Progresses
• Home Safety
• Dementia and Driving
• Technology 101
• Preparing for Emergencies
• Managing Money Online Program
• Planning for Care Costs
• Paying for Care
• Health Care Appeals for People with Alzheimer's and Other Dementias
• Social Security Disability
• Medicare Part D Benefits
• Tax Deductions and Credits
• Planning Ahead for Legal Matters
• Legal Documents
• ALZ Talks Virtual Events
• ALZNavigator™
• Veterans and Dementia
• The Knight Family Dementia Care Coordination Initiative
• Online Tools
• Asian Americans and Pacific Islanders and Alzheimer's
• Native Americans and Alzheimer's
• Black Americans and Alzheimer's
• Hispanic Americans and Alzheimer's
• LGBTQ+ Community Resources for Dementia
• Educational Programs and Dementia Care Resources
• Brain Facts
• 50 Activities
• For Parents and Teachers
• Resolving Family Conflicts
• Holiday Gift Guide for Caregivers and People Living with Dementia
• Trajectory Report
• Resource Lists
• Search Databases
• Publications
• Favorite Links
• 10 Healthy Habits for Your Brain
• Stay Physically Active
• Adopt a Healthy Diet
• Stay Mentally and Socially Active
• Online Community
• Support Groups
• Find Your Local Chapter
• Any Given Moment
• New IDEAS Study
• RFI Amyloid PET Depletion Following Treatment
• Bruce T. Lamb, Ph.D., Chair
• Christopher van Dyck, M.D.
• Cynthia Lemere, Ph.D.
• David Knopman, M.D.
• Lee A. Jennings, M.D. MSHS
• Karen Bell, M.D.
• Lea Grinberg, M.D., Ph.D.
• Malú Tansey, Ph.D.
• Mary Sano, Ph.D.
• Oscar Lopez, M.D.
• Suzanne Craft, Ph.D.
• About Our Grants
• Andrew Kiselica, Ph.D., ABPP-CN
• Arjun Masurkar, M.D., Ph.D.
• Benjamin Combs, Ph.D.
• Charles DeCarli, M.D.
• Damian Holsinger, Ph.D.
• David Soleimani-Meigooni, Ph.D.
• Donna M. Wilcock, Ph.D.
• Elizabeth Head, M.A, Ph.D.
• Fan Fan, M.D.
• Fayron Epps, Ph.D., R.N.
• Ganesh Babulal, Ph.D., OTD
• Hui Zheng, Ph.D.
• Jason D. Flatt, Ph.D., MPH
• Jennifer Manly, Ph.D.
• Joanna Jankowsky, Ph.D.
• Luis Medina, Ph.D.
• Marcello D’Amelio, Ph.D.
• Marcia N. Gordon, Ph.D.
• Margaret Pericak-Vance, Ph.D.
• María Llorens-Martín, Ph.D.
• Nancy Hodgson, Ph.D.
• Shana D. Stites, Psy.D., M.A., M.S.
• Walter Swardfager, Ph.D.
• ALZ WW-FNFP Grant
• Capacity Building in International Dementia Research Program
• ISTAART IGPCC
• Alzheimer’s Disease Strategic Fund: Endolysosomal Activity in Alzheimer’s (E2A) Grant Program
• Imaging Research in Alzheimer’s and Other Neurodegenerative Diseases
• Zenith Fellow Awards
• National Academy of Neuropsychology & Alzheimer’s Association Funding Opportunity
• Part the Cloud-Gates Partnership Grant Program: Bioenergetics and Inflammation
• Pilot Awards for Global Brain Health Leaders (Invitation Only)
• Robert W. Katzman, M.D., Clinical Research Training Scholarship
• Funded Studies
• How to Apply
• Portfolio Summaries
• Supporting Research in Health Disparities, Policy and Ethics in Alzheimer’s Disease and Dementia Research (HPE-ADRD)
• Diagnostic Criteria & Guidelines
• Annual Conference: AAIC
• Professional Society: ISTAART
• Alzheimer's & Dementia
• Alzheimer's & Dementia: DADM
• Alzheimer's & Dementia: TRCI
• International Network to Study SARS-CoV-2 Impact on Behavior and Cognition
• Alzheimer’s Association Business Consortium (AABC)
• Global Biomarker Standardization Consortium (GBSC)
• Global Alzheimer’s Association Interactive Network
• International Alzheimer's Disease Research Portfolio
• Alzheimer’s Disease Neuroimaging Initiative Private Partner Scientific Board (ADNI-PPSB)
• Research Roundtable
• About WW-ADNI
• North American ADNI
• European ADNI
• Australia ADNI
• Taiwan ADNI
• Argentina ADNI
• WW-ADNI Meetings
• Submit Study
• RFI Inclusive Language Guide
• Scientific Conferences
• AUC for Amyloid and Tau PET Imaging
• Make a Donation
• Walk to End Alzheimer's
• The Longest Day
• RivALZ to End ALZ
• Ride to End ALZ
• Tribute Pages
• Gift Options to Meet Your Goals
• Founders Society
• Fred Bernhardt
• Anjanette Kichline
• Lori A. Jacobson
• Pam and Bill Russell
• Gina Adelman
• Franz and Christa Boetsch
• Adrienne Edelstein
• For Professional Advisors
• Free Planning Guides
• Contact the Planned Giving Staff
• Workplace Giving
• Do Good to End ALZ
• Donate a Vehicle
• Donate Stock
• Donate Cryptocurrency
• Donate Gold & Sterling Silver
• Donor-Advised Funds
• Use of Funds
• Giving Societies
• Why We Advocate
• Ambassador Program
• About the Alzheimer’s Impact Movement
• Research Funding
• Improving Care
• Support for People Living With Dementia
• Public Policy Victories
• Planned Giving
• Community Educator
• Community Representative
• Support Group Facilitator or Mentor
• Faith Outreach Representative
• Early Stage Social Engagement Leaders
• Data Entry Volunteer
• Tech Support Volunteer
• Other Local Opportunities
• Visit the Program Volunteer Community to Learn More
• Become a Corporate Partner
• A Family Affair
• A Message from Elizabeth
• The Belin Family
• The Eliashar Family
• The Fremont Family
• The Freund Family
• Jeff and Randi Gillman
• Harold Matzner
• The Mendelson Family
• Patty and Arthur Newman
• The Ozer Family
• Salon Series
• No Shave November
• Other Philanthropic Activities
• Still Alice
• The Judy Fund E-blast Archive
• The Judy Fund in the News
• The Judy Fund Newsletter Archives
• Sigma Kappa Foundation
• Alpha Delta Kappa
• Parrot Heads in Paradise
• Tau Kappa Epsilon (TKE)
• Sigma Alpha Mu
• Alois Society Member Levels and Benefits
• Alois Society Member Resources
• Zenith Society
• Founder's Society
• Joel Berman
• JR and Emily Paterakis
• Legal Industry Leadership Council
• Accounting Industry Leadership Council

Find Local Resources

Let us connect you to professionals and support options near you. Please select an option below:

Use Current Location Use Map Selector

Search Alzheimer’s Association

Join Our END ALZ One-Week Match Challenge!

• Models of Care Case Studies

The Alzheimer’s Association is committed to connecting clinicians to effective, evidence-based models of care that can be replicated in community settings. Two of these models — the UCLA Alzheimer’s and Dementia Care program and the Age-Friendly Health Systems initiative — are detailed below.

UCLA Alzheimer's and Dementia Care program Age-Friendly Health Systems initiative UCLA Alzheimer’s and Dementia Care program

A dementia-specific model of care that significantly improved the experience for caregivers and people living with the disease.

About the program

The Alzheimer’s Association has partnered with UCLA to replicate the UCLA Alzheimer’s and Dementia Care (ADC) program through a grant from the John A. Hartford Foundation. The program follows a co-management model within the UCLA health system and partners with community-based organizations (CBOs) to provide comprehensive, coordinated, individualized care for people living with Alzheimer’s disease and other dementias.

The goals of the program are to:

• Maximize function, independence and dignity for people living with dementia.
• Minimize caregiver strain and burnout.
• Reduce unnecessary costs through improved care.

To qualify for the program, participants must have a diagnosis of dementia and live outside of a nursing home. The mean age of the first program participants was 82 years old. Almost all of the caregivers were the children (59%) or spouses (41%) of individuals living with Alzheimer’s or other dementias.

Comprehensive care

The ADC program utilizes a co-management model in which a nurse practitioner Dementia Care Specialist (DCS) partners with the participant’s primary care doctor to develop and implement a personalized care plan. The DCS provides support via four key components:

• Conducting in-person needs assessments of individuals living with Alzheimer’s and their caregivers.
• Creating and implementing individualized dementia care plans.
• Monitoring and revising care plans, as needed.
• Providing access 24/7, 365 days a year for assistance and advice to help avoid Emergency Department (ED) visits and hospitalizations.

Community resources

The ADC program also connects caregivers with resources provided by CBOs, including:

• Adult day care.
• Counseling.
• Case management.
• Legal and financial advice.
• Workforce development focused on training families and caregivers.

Program effectiveness

At one year, the quality of care provided by the program as measured by nationally accepted quality measures for dementia was exceedingly high — 92% compared to a benchmark of 38%. As a result, the improvements experienced by both caregivers and patients were significant:

• Ninety-four percent of caregivers felt that their role was supported.
• Ninety-two percent would recommend the program to others.
• Confidence in handling problems and complications of Alzheimer’s and other dementias improved by 79%.
• Caregiver distress related to behavioral symptoms, depression scores and strain improved by 31%, 24% and 15%, respectively.
• Despite disease progression, behavioral symptoms like agitation, irritability, apathy and nighttime behaviors in people living with dementia improved by 22%.
• Depressive symptoms experienced by individuals living with the disease were reduced by 34%.

Cost benefits of the program

An external evaluator compared utilization and cost outcomes and determined that over the course of 3 1/2 years, participants in UCLA’s program had lower total Medicare costs of care ($2,404 per year) relative to those receiving usual care.

In addition to cost savings for individuals and their families, the ADC program reports several financial benefits for health systems, including:

• Hospitalizations: 12% reduction
• ED visits: 20% reduction
• ICU stays: 21% reduction
• Hospital days: 26% reduction
• Hospice in last six months: 60% increase
• Nursing home placement: 40% reduction

UCLA finds that a care program following the ADC model may be able to pay for itself depending on local labor costs, comprehensiveness of billing and local overhead applied to clinical revenue.

To learn more or to contact UCLA about training and replication of the program, visit the UCLA Alzheimer’s and Dementia Care Program website.

Age-Friendly Health Systems initiative

A model of care that incorporates person-centered dementia care into a broader framework for the care of older adults.

About the initiative

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA). Together in 2017, they set a bold vision to build a social movement so all care with older adults is age-friendly care, that:

• Follows an essential set of evidence-based practices.
• Causes no harm.
• Aligns with “What Matters” to the older adult and their family caregivers.

The Age-Friendly Health Systems initiative defines “What Matters” as knowing and aligning care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.

• Health outcome goals relate to the values and activities that matter most to an individual, help motivate the individual to sustain and improve health, and could be impacted by a decline in health — for example, babysitting a grandchild, walking with friends in the morning, or volunteering in the community. When identified in a specific, actionable, and reliable manner, patients’ health outcome goals can guide decision making.
• Care preferences include the health care activities (e.g., medications, self-management tasks, health care visits, testing, and procedures) that patients are willing and able (or not willing or able) to do or receive.

The 4Ms framework of an Age-Friendly Health System

The 4Ms are not a program, but a framework to guide how care is provided to older adults through every interaction with a health system’s care and services. The 4Ms — What Matters, Medication, Mentation, and Mobility — make the complex care of older adults more manageable because they:

• Identify the core issues that should drive all care and decision making with the care of older adults.
• Organize care and focus on the older adult’s wellness and strengths rather than solely on disease.
• Are relevant regardless of an older adult’s individual disease(s).
• Apply regardless of the number of functional problems an older adult may have, or that person’s cultural, ethnic or religious background.

The 4Ms framework is most effective when all 4Ms are implemented together and are practiced reliably (i.e., for all older adults, in all settings and across settings, in every interaction).

The intention is to incorporate the 4Ms into existing care — rather than layering them on top —to organize the efficient delivery of effective care. This is achieved primarily through redeploying existing health system resources. Many health systems have found they already provide care aligned with one or more of the 4Ms for many of their older adult patients. Much of the effort, then, is to incorporate the other elements and organize care so all 4Ms guide every encounter with an older adult and their family caregivers.

Cost benefits of the initiative

The business case for becoming an Age-Friendly Health System focuses on its financial returns and is stronger when:

• The financial benefits are captured by the health system that is making the investment.
• Utilization and associated expenses of “usual” care are especially burdensome.
• The health system is effective in mitigating those costs.
• The added expense of becoming age-friendly is lower.

See the IHI report, The Business Case for Becoming an Age-Friendly Health System , for guidance on how to make the business case for your health system.

To learn more or to contact IHI about joining the initiative, visit the IHI Age-Friendly Health Systems website.

Health Systems and Medical Professionals Menu

• Alzheimer’s Association Innovation Roundtable (AAIR)
• Prescribing Lecanemab
• Cognitive Screening and Assessment
• Dementia Care Navigation Guiding Principles
• Dementia Care Navigation Roundtable
• Differential Diagnosis of Alzheimer's Disease
• Differential Diagnosis of Creutzfeldt-Jakob Disease
• Differential Diagnosis of Lewy Body Dementia
• Differential Diagnosis of Frontotemporal Dementia
• Differential Diagnosis of Huntington's Disease
• Differential Diagnosis of Korsakoff Syndrome
• Differential Diagnosis of Mixed Dementia
• Differential Diagnosis of Normal Pressure Hydrocephalus
• Differential Diagnosis of Parkinson's Disease Dementia
• Differential Diagnosis of Vascular Dementia
• Disclosure of Diagnosis
• Advanced Imaging and Biomarkers
• Care Planning Visit
• Advanced Care Planning
• Alzheimer's Network (ALZ-NET)
• Guidelines Index
• Clinical Trials Recruiting
• Downloadable Resources for Patients and Caregivers
• I Have Alzheimer's
• Clinical Trials
• Instructional Videos
• Cognitive Assessment Tools
• ISTAART Membership
• Alzheimer's & Dementia Journal
• Continuing Education on Alzheimer's and Dementia
• The Alzheimer’s and Dementia Care ECHO® Program for Health Systems and Medical Professionals