Communication Toolkit for Alzheimer’s Disease

Communicating Treatment & Monitoring

This page is part of a larger communication toolkit which provides general advice and best practices around communication of Alzheimer's disease (AD) in clinical practice.

See a full list of resources available on communicating a diagnosis of Alzheimer's disease.

Conversational Dynamics

The patient

Different patients have different conversational needs. Some may be keen to participate, seeking additional information proactively, while others may be apprehensive and unwilling to receive a lot of information.

While it is important to evaluate patients’ conversational needs on an individual basis, some general patterns have been recorded.

Patients’ preference for involvement varies by decision topic.¹
Patients want great involvement in conversations around social decisions, but prefer that healthcare providers be heavily involved in medication decisions.

Patients with lower cognitive impairment may prefer to be more involved.¹
According to a study by Hamman et al (2011), patients with higher MMSE scores desire more involvement in decision making, while patients with lower MMSE score refrain from participation.

The Triad: Complex conversations in AD communications

The patient’s care partners play a critical role in medical conversations and patient care. Their involvement creates a triad, which can enhance communication and lead to superior comprehension.

Triadic interactions are more complex than dyadic HCP-patient conversations, and require active management to ensure that patients are not excluded from care discussions.²

MANAGING TRIADIC INTERACTIONS²

Common problems and potential solutions

There is sometimes confusion around who is to speak, and when.

Agree on rules of conduct and roles at the start of the conversation. Who talks? About what? When?

Conversations tend to become a series of dyadic interactions. The patient is initially the focus, but as conversation about treatment progresses, focus shifts to care partner.²

Explicitly articulate the goal of ensuring that the patient participates optimally in their own care decisions if they desire.

Communicating Treatment

Communicating treatments for AD

An estimated 6.7 million Americans age 65 and older are living with Alzheimer's disease in 2023.³ Given the impact of AD, there is an urgent need for effective therapies.⁶
High quality healthcare communication has been shown to have a positive effect on patient outcomes such as treatment adherence, well-being, illness recovery and physiological reactions to diagnoses.⁷
A timely and accurate diagnosis of AD is more important than ever with the availability of amyloid-targeting therapies.^8,9

A recommended conversation flow when discussing treatment for AD. — The steps are:
Recap conversation so far around the diagnosis and symptoms;
Explain that there are treatment options available;
Be hopeful, but realistic about treatment outcomes by discussing possible benefits as well as any risks or side effects;
Explain mode of administration and any monitoring required.

General Advice and Good Practices

Use strategies for nonverbal communication

80% of communication in medical and nonmedical situations occurs nonverbally, involuntarily, and outside conscious awareness, while only 20% is verbal and voluntary.⁵

Eye contact, active listening, engaged and body language

Patient talking with the healthcare provider

Use patient-centric language. Patient-centered HCP–patient communication has been demonstrated to increase patient adherence to treatment, improve satisfaction with care, and decrease patient distress.⁴

Be concrete with treatment options and recommendations, preferably accompanying verbal information with hand-outs.

References

Hamann, J., Bronner, K., Margull, J., Mendel, R., Diehl-Schmid, J., Bühner, M., Klein, R., Schneider, A., Kurz, A. and Perneczky, R. (2011), Patient Participation in Medical and Social Decisions in Alzheimer's Disease. J Am Geriatr Soc. 59: 2045-2052. https://doi.org/10.1111/j.1532-5415.2011.03661.x
Karnieli-Miller O, Werner P, Aharon-Peretz J, Sinoff G, Eidelman S. Expectations, experiences, and tensions in the memory clinic: the process of diagnosis disclosure of dementia within a triad. Int Psychogeriatr. 2012;24(11):1756-1770. doi:10.1017/S1041610212000841
(2023), 2023 Alzheimer's disease facts and figures. Alzheimer's Dement. 19: 1598-1695. https://doi.org/10.1002/alz.13016
Stubbe DE. Alleviating Anxiety: Optimizing Communication With the Anxious Patient. Focus (Am Psychiatr Publ). 2017;15(2):182-184. doi:10.1176/appi.focus.20170001
Rita Gorawara-Bhat, Mary Ann Cook, Greg A Sachs, Nonverbal communication in doctor–elderly patient transactions (NDEPT): Development of a tool, Patient Education and Counseling, Volume 66, Issue 2, 2007, Pages 223-234, ISSN 0738-3991, https://doi.org/10.1016/j.pec.2006.12.005.
Casey DA, Antimisiaris D, O'Brien J. Drugs for Alzheimer's disease: are they effective? P T. 2010 Apr;35(4):208-11. PMID: 20498822; PMCID: PMC2873716.
Dooley J, Bailey C, McCabe R. Communication in healthcare interactions in dementia: a systematic review of observational studies. International Psychogeriatrics. 2015;27(8):1277-1300. doi:10.1017/S1041610214002890
Porsteinsson AP, Isaacson RS, Knox S, Sabbagh MN, Rubino I. Diagnosis of Early Alzheimer's Disease: Clinical Practice in 2021. J Prev Alzheimers Dis. 2021;8(3):371-386. doi:10.14283/jpad.2021.23
Pemberton HG, Collij LE, Heeman F, et al. Quantification of amyloid PET for future clinical use: a state-of-the-art review. Eur J Nucl Med Mol Imaging. 2022;49(10):3508-3528. doi:10.1007/s00259-022-05784-y

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Communicating Treatment & Monitoring

Conversational Dynamics

The patient