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Alzheimer's Disease: Prevention, Treatment, Support, and Public Engagement

Introduction

1. Which of the following is the main pathological feature of AD?

A. Brain plaques

B. Brain tangles

C. The loss of connections between neurons

D. All of the above


2. In more than 90% of people with AD / ADRD, symptoms do not appear until after age _____, and the incidence of the disease increases with age.

A. 40

B. 50

C. 60

D. 70


Goal 1: Prevent and Effectively Treat Alzheimer’s Disease and Related Dementias by 2025

3. In genome-wide association study analyses, two of the top three hits associated with healthy aging were genes previously linked to cognitive function, suggesting that protection against cognitive decline contributes to healthy aging.

A. True

B. False


4. Which autoimmune disease-linked genetic alteration has been found to increase AD risk?

A. Psoriasis

B. Crohn’s disease and inflammatory bowel disease

C. Both (A) and (B)

D. None of the above


5. Which of the following can influence AD/ADRD risk and outcomes?

A. Race and ethnicity

B. Socioeconomic status

C. Both (A) and (B)

D. None of the above


6. Researchers have found an increased genetic risk for AD in _____ due to variations in a gene for the brain’s system for clearing out beta-amyloid protein fragments.

A. African Americans

B. Hispanics

C. Non-Hispanic Whites

D. Asians


7. A review of the available evidence showed that _____ may benefit cognitive performance in some areas for adults with normal cognition.

A. Some types of physical activity

B. Vitamin B12

C. Folic acid

D. All of the above


Goal 2: Enhance Care Quality and Efficiency

8. High-quality and efficient care often depends on:

A. Smooth transitions between care settings

B. Coordination among health care and LTSS providers

C. Dementia-capable health care

D. All of the above


9. The Staff Training in Assisted Living Residences-VA in VA Community Living Centers evaluation outcomes include:

A. Significant decreases in the frequency and severity of target behaviors.

B. Decreased symptoms of depression, anxiety, and agitation.

C. Both (A) and (B).

D. None of the above.


10. The aims of the VA psychotropic drug safety initiative is to decrease all of the following, except for:

A. Inappropriate use of antipsychotics and benzodiazepines.

B. Metabolic monitoring among older veterans prescribed an antipsychotic.

C. Benzodiazepine and sedative hypnotic use.

D. Use of highly anticholinergic medications.


11. Dementia-friendly communities foster the ability of people living with dementia to remain in the community and engage and thrive in day to day living; basic things like going to the store or the bank.

A. True

B. False


12. Dementia Friendly America has developed provider tools and resources that:

A. Support timely and accurate diagnosis and education for families after a diagnosis of AD/ADRD.

B. Offers dementia care guidelines.

C. Fosters safe transitions of care.

D. All of the above.


13. One barrier to counseling and support is that health care providers are not aware of available services and how to access them.

A. True

B. False


14. Providing an array of caregiver services in the community helps all of the following, except:

A. Improve medication adherence.

B. Avoid unnecessary hospitalizations and emergency room visits.

C. Delay nursing home placement.

D. Improve caregiver burden and mental health outcomes.


15. VHA recommends routine screening for cognitive impairment even in asymptomatic older adults.

A. True

B. False


16. All of the following are in the top six most common conditions associated with potentially avoidable hospitalizations among nursing facility residents, except for:

A. Pneumonia

B. Diabetes

C. Congestive heart failure

D. Urinary tract infections


17. Veterans with dementia who reside in VA and community nursing facilities have been successfully transitioned back into the community with the support of Veteran-Directed Home and Community-Based Services.

A. True

B. False


18. Medicare-Medicaid dual eligible beneficiaries are almost _____ times more likely to have dementia as their Medicare-only counterparts.

A. 2

B. 3

C. 4

D. 5


Goal 3: Expand Supports for People with Alzheimer’s Disease and Related Dementias and Their Families

19. United States Latinos are 80% more likely than non-Hispanic Whites to Develop Alzheimer’s disease.

A. True

B. False


20. Which of the following is expected to occur in the coming decades?

A. An increased need for caregiving.

B. A decreased ratio of individuals potentially available for caregiving.

C. Both (A) and (B).

D. None of the above.


21. Lack of support for informal caregivers may lead to burnout and placement of the care recipient in a facility that is more costly to the government than earlier support services may have been.

A. True

B. False


22. The National Center for Health Statistics-ASPE National Survey of Residential Care Facilities found that _____ of residential care facility residents aged 65+ had severe cognitive impairment.

A. Half

B. More than one-third

C. Nearly one quarter

D. None of the above


23. The National Center for Health Statistics-ASPE National Survey of Residential Care Facilities found that _____ of all residential care facility residents had at least one hospitalization in the past 12 months.

A. Half

B. More than one-third

C. Nearly one quarter

D. None of the above


24. The National Center for Health Statistics-ASPE National Survey of Residential Care Facilities found that _____ of all residential care facility residents had at least one emergency department visit in the past 12 months.

A. Half

B. More than one-third

C. Nearly one quarter

D. None of the above


25. Among residential care facility residents, living in a special care unit for dementia or a facility that only serves individuals with AD/ADRD decreases the risk of hospitalization.

A. True

B. False


26. The Goals of Care intervention, which combined a video decision aid and a structured care plan meeting for family decision makers, showed:

A. Improved end-of-life communication.

B. Enhanced palliative care plans.

C. Reduced hospital transfers for nursing home residents with advanced dementia.

D. All of the above.


27. Family caregivers have been found to be overwhelmingly receptive to the idea of website or smartphone technology interventions and detailed specific needs that technology could address, including:

A. Alleviating the psychological burden and social isolation inherent in caregiving.

B. Providing access to information and resources.

C. Helping them to ensure care recipients’ safety and track the progression of disease.

D. All of the above.


28. ACL’s Office of Long-Term Care Ombudsman Programs continue to identify _____ as the top complaint in nursing homes for the past 5 years.

A. Improper evictions

B. Elder abuse

C. Lack of caregiver support

D. Insufficient training


29. After taking into account characteristics associated with health care utilization and payment, HUD-assisted Medicare beneficiaries consistently have higher utilization and payment for health care services than unassisted Medicare beneficiaries.

A. True

B. False


30. HUD-assisted Medicare-Medicaid enrollees are much more likely to _____ than unassisted Medicare-Medicaid enrollees.

A. Use certain Medicare-covered services, such as acute inpatient stays and skilled nursing facility stays.

B. Use Medicaid-covered community-based supportive services such as personal care services, durable medical equipment, and HCBS.

C. Have significantly higher Medicare FFS payments.

D. All of the above.


31. Analysis of Medicare claims data indicate that Support and Services at Home participants, compared to non-participants, had lower rates of:

A. All-cause hospital admissions

B. Emergency room visits

C. Both (A) and (B)

D. None of the above


Goal 5: Improve Data to Track Progress

32. According to the CDC, death rates in the United States for AD have increased 55% from 1999 through 2014 in all of the following, except:

A. All states

B. All age groups

C. All racial and ethnic groups

D. Death rates increased in all of the above


33. Which of the following is not one of the two domains of risk found under the CMS list of Safety Concern Screening and Follow-Up for Patients with Dementia?

A. Dangerousness to self or others

B. Unable to perform ADL

C. Environmental risks

D. All of the above are domains of risk under the CMS list


34. CMS has worked on which measure to examine the evidence base and measurement gaps to develop de novo electronic clinical quality measures related to dementia care?

A. Cognitive Impairment Assessment Among Older Adults (75 years and older) - Cognitive Impairment.

B. Documentation of a Health Care Partner for Patients with Dementia or MCI - Health Care Partner.

C. Both (A) and (B).

D. None of the above.


Appendix 2: 2017 Recommendations and Federal Response

35. The 2017 National Plan should include and prioritize specific milestones for which population at high risk for AD/ADRD?

A. People with Down syndrome

B. African Americans

C. Both (A) and (B)

D. None of the above


36. At present, the United States spends only 5% of its annual care costs for ADRD on research.

A. True

B. False


37. NIH scientists hope the Collaborative Aging (in Place) Research using Technology (CART) will help elders remain independent while avoiding hospitalizations and transitions into care facilities and see the project as potentially transformative for the field of aging research and care for older adults.

A. True

B. False


38. An important part of the goal to standardize terminology dealing with cognitive and dementing disorders is to increase the lay public’s understanding of dementia diagnoses by using plain and clear language without sacrificing accuracy of terminology.

A. True

B. False


39. A major challenge in the development of effective therapies for AD/ADRD has been the inefficient recruitment of participants in clinical trials.

A. True

B. False


40. Training related to quality dementia care should enhance health care provider:

A. Awareness and understanding of the Medicare AWV.

B. Knowledge of validated cognitive assessment tools.

C. Methods for reporting all dementia-related quality measures active in the Quality Payment Program.

D. All of the above.


41. The first target for the Per Beneficiary Per Month payment model should be nursing facility residents with dementia.

A. True

B. False


42. In a recent study supported by NIA, it was estimated that of people with dementia living in the community, over 50% live by themselves.

A. True

B. False


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