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Interviewer: The Aging Brain Care Program at University of Utah Health offers a range of services that help prevent, manage, and educate patients and their loved ones about memory and thinking disorders as they get older.

Dr. Michelle Sorweid is a dementia and geriatric specialist who works with the group. Dr. Sorweid, now there's a lot of different cognitive disorders. I think a lot of us laypeople just think of memory disorders, like Alzheimer's or dementia. So why don't you walk us through some of the things the Aging Brain Care Program can help with?

Dr. Sorweid: Yeah. So the most common question that I get is, "What's the difference between Alzheimer's disease and dementia?" And I try to use kind of a picture or imagery of an umbrella. So the comparison I use is actually cancer or kind of a broad term. So dementia meaning folks who've had decline in memory and thinking in one or more areas over time and that has impacted their day-to-day life, meaning they might be needing help with things like managing their medications, managing their finances, there might be errors in driving, things like that. And so Alzheimer's disease is the most common cause of dementia, and so that's why it often gets overlapped with one another. But there's quite a few other causes, as you mentioned, things like Parkinson's disease and things in that family of conditions. There may be blood vessel disease causing someone's symptoms. And there's quite the spectrum, you know, before someone reaches a dementia syndrome or qualifies for that diagnosis. There may be symptoms that are consistent with normal aging or something we call mild cognitive impairment. And so that's kind of the spectrum we look at and help diagnose and determine, you know, what's the cause and how can we intervene to prevent decline.

Interviewer: You mentioned diagnosis, which is generally, in a lot of conditions, the most important thing, is to figure out actually what's going on, and it could also be one of the most challenging things. So a specialty clinic like this, how can you make a diagnosis more efficiently, more effectively, more accurately?

Dr. Sorweid: So just like when someone comes in with a cough, we usually need more information to figure out how we can treat that cough or how we can manage it. And so it's a little trickier because we're talking about the brain. But we do a pretty thorough physical exam and history, just as with any patient coming in with specific complaints. I usually like to have a brain MRI, because that's how we take a picture of the brain. It's the most specific way to look at it. And then we usually do additional, more objective testing. So if someone, you know, comes in with a specific complaint and symptoms, we don't necessarily just rely on that. We need some objective information. So we usually do a screening assessment and then, depending on the situation, might refer them to much longer, you know, three or four hours of memory and thinking assessments.

Interviewer: And after you have the diagnosis, then you would move on to what can be done about it. And as a layperson, my perception is, a lot of times, there's not a lot that can be done about it because it's part of the aging process, and once the cognitive decline starts, I mean, there's really no stopping it. There's no cure.

Dr. Sorweid: Absolutely. It's a common misperception that having memory changes is a part of the normal aging process, and though it is common, it is not normal. And so that's one common misperception, that memory changes are not necessarily a part of the normal aging process. And then, in addition, another common misperception is that there's nothing that can be done, and unfortunately, a lot of physicians have perseverated that misconception. And so, unfortunately, we're kind of working with an uphill battle because a lot of that has pervaded throughout the medical community as well. And that's why I kind of mentioned earlier is better. There's more we can do from a standpoint of intervention the earlier we know symptoms are developing. So that includes things like managing blood vessel disease risk factors, like high blood pressure, high cholesterol, sleep apnea. There's a lot of different conditions that we know we can treat and, therefore, prevent decline or slow decline.

Interviewer: So like physical conditions that could be causing that.

Dr. Sorweid: Absolutely.

Interviewer: Oh, okay. Well, that's encouraging because that's something that, you know, one could take care of.

Dr. Sorweid: Exactly. And so that's one piece of the puzzle. But the other piece is that a lot of families and patients aren't really well prepared for some of these changes, and knowing the diagnosis really helps us help them plan for their future, know how much financial impact this might make, know what to do as far as treatment goes, because the treatment varies depending on the diagnosis. And you may have heard in the news, there actually recently was a disease-modifying drug approved in early Alzheimer's disease. So we are looking at more and more options for treatment of Alzheimer's disease specifically.

Interviewer: And at the Aging Brain Care Program, you have a lot of different individuals that can help support that family, not just physicians and neurologists but also social work support and psychiatrists as well. How do they play into helping somebody that has a cognitive disorder?

Dr. Sorweid: Absolutely. So we have a social worker who helps provide both disease education and helping manage the expectations of families and patients as far as, again, you know, what is this disease going to look like, what do I need to prepare for. So she does a great job at supporting these families and ongoing management. We also have our geriatric psychiatry nurse practitioner who is amazing. And, you know, we know that depression is a very common symptom that goes hand in hand with a dementia process or cognitive disorders. And so she's a key player in our team in helping manage these patients.

Interviewer: And what is your ultimate hope for a patient that comes into the clinic when they leave? What would be the ultimate best outcome for you?

Dr. Sorweid: I think just kind of dissuading these common misconceptions that we discussed, is that we can do something to help them, that there is hope, that they are well supported, that they don't just get a diagnosis and scooted out the door, but that they have a team on their side to help support them through this journey.

Interviewer: It seems to me, you know, the purpose of a lot of health care is to improve quality of life or maintain quality of life. How important is that to what you do, and what does that look like?

Dr. Sorweid: Absolutely, and that's kind of the common theme in geriatrics, specifically, is that quality of life is our most important goal.

Interviewer: And what does quality of life for somebody who has some sort of cognitive disorder, a memory or thinking disorder look like?

Dr. Sorweid: That's an interesting question. I think that's a very evolving question and very patient-centered, meaning that may be very different for any one individual person. That might change from year to year or month to month even, and that's something that's kind of a moving target for a lot of people. So it's something that we have an ongoing discussion with patients and families about.

Interviewer: So the Aging Brain Care Program, is it just for people who have already started noticing a decline in their cognitive abilities, or could a person come in and access your services that would benefit them before issues start to arise? Say, you know, they have a family history and they suspect that that might be an issue in the future, and they want to be proactive about it.

Dr. Sorweid: I've certainly seen patients and families who have a strong family history of dementia or who have some mild symptoms that they've noticed, and perhaps all of their screening turned out to be more of a baseline or normal, and so that is an option. I think, traditionally, that's not typically who we see in our clinic. It's mostly patients who have had some symptoms even though they may be mild. But the key thing that I would focus on with regards to a healthy aging brain is that a lot of these interventions really play a role even in midlife. So we know now that there's data that shows controlling blood pressure, even to possibly a more aggressive level, can actually help prevent mild cognitive impairment or mild memory changes.

Interviewer: When you start to recognize cognitive decline, at what point should you really consider coming into the Aging Brain Care Program? At first outset? Because, I mean, some of us can feel really weird, you know, if it's just one thing or a couple of things. How do you help a patient navigate that thought process?

Dr. Sorweid: I would really encourage at the very onset of any symptoms to seek help. Worst case scenario, you're seeking help earlier than what is needed, and, I mean, that's a good thing. Then we have a baseline. And really seeking help early, again, just kind of focusing on those interventions that we know are helpful can really make a difference in someone's quality of life, whether or not they are aware of what's to come. You know, if a loved one is complaining of, "Hey, I misplaced my keys," or "I'm forgetting names more often," there's a chance that's due to normal aging, but there's also a chance that something else is going on, especially if it's a change for them.

Interviewer: Do you recommend that somebody go to their primary care physician first, or when they start recognizing these symptoms, is it just better to come to the Aging Brain Care Program first?

Dr. Sorweid: I think if someone has a really great relationship with their primary care provider, they know them well, they're already established with someone, that is a really great place to start. There's something called the Medicare Annual Wellness Visit, and that provides all primary care physicians the opportunity every year to screen for a lot of different conditions, including cognitive disorders. And so that's something I would encourage patients to ask their provider to use as far as a tool to screen them for any problems with memory and thinking. And then, yeah, so next step or if they feel that their primary care provider doesn't feel comfortable with any of those screening assessments, then, yes, we're happy to see them.

Interviewer: And we're really fortunate to live in the Salt Lake City area and have access to University of Utah Health and the Aging Brain Care Program. How can individuals who are not in the immediate area access this great resource?

Dr. Sorweid: One of the silver linings of the COVID pandemic is having access to telehealth, and so that's one opportunity that we have to offer visits for our patients who maybe are limited by distance or who have a difficult time physically getting to the clinic. It's not ideal because there's limitations with physical exam or if they have difficulty, as many of our older adult patients do, with a video exam. But generally speaking, they're with a loved one who can help with that, so that's one opportunity. And then just to keep in mind that many of these visits aren't super frequent. It's up to the patient to how often they come to see me or one of our other providers.

Interviewer: Yeah. And a combination of perhaps those ways of visiting might work out too, I'd imagine. Maybe the initial visit is in-person because, you know, you can facilitate more of the types of physical examinations that you need to do, and then more of the follow-up visits could be virtual. Dr. Sorweid, if patients are in the Salt Lake area, where are you located, and what is the best way to reach you?

Dr. Sorweid: Located on the main University of Utah Hospital and Clinics campus, just at the corner of Mario Capecchi and Foothill, 555 Foothill Drive. And our clinic phone number is 801-581-2628. Just asking for a referral from your primary care provider would be appropriate, but we also take self-referrals.

Interviewer: If you or a loved one would like more information about the University of Utah Health Aging Brain Care Program, you can find a link to their website included in the description of this podcast.

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Interviewer: The job description, if you are a nurse, can vary quite a bit depending on the size of the community that you are in. We are with Angela Booker, Chief Nursing Officer at Teton Valley Hospital, who has had some experience not only in the larger hospital, but also here at Teton Valley. And the first thing I want to talk about a little bit is, what is the difference? Because the nurse is not a nurse. She is not a nurse, necessarily.

Angela Booker: The biggest difference in working at a rural hospital compared to a larger hospital, like the University of Utah. It is that, we are considered generalists. So, we might take care of an emergency room patient, a patient having a heart attack or who has been in a car crash compared to a pediatric patient who is in for pneumonia. And then, take care of the patient reaching the end of his or her life and take care of the post-op patients, all in a single shift.

Interviewer: And very different training or it's the same training? I mean how does that work exactly?

Angela Booker: Same training. In a larger facility, the units are separated. You might have an oncology floor, an emergency department, a labor and delivery department. Whereas in a small hospital, there is one patient care area and one group of nurses to take care of those patients.

Interviewer: How do you manage all that knowledge? It sounds very difficult to me.

Angela Booker: Well, we don't have that specialty knowledge. So, I wouldn't be well versed in taking care of a patient with a particular type of cancer.

Interviewer: Yeah. So how would take care of that patient then here?

Angela Booker: Really, the patients are transferred out to a larger hospital, if they need that specialty care.

Interviewer: At the University of Utah, we have a nurse exchange program where rural or smaller hospital nurses will come to University of Utah and they'll learn from some of the specialties. And then vice-versa, we'll send some of our nurses to the smaller hospitals. As somebody who's been in both, what would you hope to take and learn in that exchange program? Which I understand you are going to participate in.

Angela Booker: Yeah. Well, we would expect to learn from that is, how to manage specific illness very well. How to handle larger volume of patients. Our patients volume being rural, is fairly low. Whereas, in a larger facility, you are busy most of the time. So, that would be one skill we'd pickup is how to multitask a little better with a wide variety of patients in a single shift.

Interviewer: What are some of the challenges here, at the Teton Valley Hospital, for nurses that you might want to learn more information about?

Angela Booker: A trauma. For a nurse coming to work in our facility that doesn't have emergency department experience, they might not see one or two traumas in their entire orientation period that might last 90 days. So, if we were to go to the U, where you are receiving facility for traumas, then we'd anticipate really getting a lot of experience in a short period of time.

Interviewer: Yeah, sure, and see some traumas. Trauma is an issue here, I take it with the beautiful outdoors.

Angela Booker: There are lots of outdoor activities. Skiing, snow machining, walking down the sidewalk where it's icy.

Interviewer: Yeah, sure. That could be dangerous. What do you think that your nursing staff here could bring to the nurses of the University of Utah? What do you feel your strengths are?

Angela Booker: Our strengths are taking care of different patients. We might have, in one room, someone who is struggling with pneumonia, perhaps is nearing the end of her life. And in the next room, we might have a patient, an 18 month old baby with R.S.V. Well, in a larger facility, one nurse would never take care of a geriatric and a pediatric patient because they are just not intermingled.

Interviewer: Since you've been in both sizes, do you find that smaller hospital nurses tend to be more patient centric?

Angela Booker: Well, we can't be because I don't have the volume of patients to take care.

Interviewer: More of personal relationship with the patient. You can take care of their mental needs as well, I suppose.

Angela Booker: Well, I probably know them. I shopped beside them in the grocery store, the single grocery store in town. So, I see them all over town. I can remember how they looked when I saw them the last time, compared to how they look today. I can remember what their allergies are because I've taken care of them, maybe four or five times in the last year. I can know what their medical history is when they come in unconscious on the ambulance because I recognize them by sight.

Interviewer: Tell me, what's the most exciting thing for you in this relationship?

Angela Booker: What we can learn. The services that you have, that we can refer our patients to, that that referral relationship will be in place and cemented and it won't be a blind call to the transfer center, which works well right now. But, that we'll be one of your affiliates.

Interviewer: In some of those specific services that we offer, what excites you? Tell, I hear a lot about telestroke.

Angela Booker: Telestroke very much excites me. Hemorrhagic patients with a hemorrhagic stroke go to the U already, because you are our closest experts. The teleburn is the next program. Alison [SP] psychiatry is very much in need in eastern Idaho, so those three, in particular, I am excited to get off the ground.

Interviewer: Tell me, specifically, how is this going to affect the level of patient care in Driggs?

Angela Booker: It'll improve an already good situation, and those services will be immediately available via the teleservices.

Recording: We are your daily dose of science, conversation and medicines. This is The Scope, University of Utah Health Sciences Radio.