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How to Make an Alzheimer's Diagnosis in Primary Care: A Podcast with Nathaniel Chin

GeriPal - A Geriatrics and Palliative Care Podcast

Release Date: 02/06/2025

Implementing Palliative Care in Nursing Homes show art Implementing Palliative Care in Nursing Homes

GeriPal - A Geriatrics and Palliative Care Podcast

The need for better palliative care in nursing homes is significant. Consider this: the majority of the 1.4 million adults residing in U.S. nursing homes grapple with serious illnesses, and roughly half experience dementia. Many also suffer from distressing symptoms like pain. In addition, about 25% of all deaths in the United States occur within these facilities. Despite these substantial needs, specialized palliative care beyond hospice is rare in nursing homes. Furthermore, only about half of nursing home residents nearing the end of life receive hospice care. So, how can we improve...

info_outline Lucid Episodes: Andrea Gilmore-Bykovskyi & Andrew Peterson show art Lucid Episodes: Andrea Gilmore-Bykovskyi & Andrew Peterson

GeriPal - A Geriatrics and Palliative Care Podcast

Have any of you watched the movie “”?  At the end, one of the characters, who has dementia, experiences an episode of lucidity.  When I watched it, between tears (I’m a complete softie) I remember thinking, “Oh no! This will give people false hope!  That their loved one is ‘in there.’ If only they could find the right key to unlock the lock and let them out.” Today we talk about lucid episodes and what they might mean to the person with dementia, their family and loved ones, to philosophers, to clinicians, to neuroscientists. Our guests are Andrea...

info_outline Music as Medicine: Jenny Chen, Tyler Jorgensen, & Theresa Allison show art Music as Medicine: Jenny Chen, Tyler Jorgensen, & Theresa Allison

GeriPal - A Geriatrics and Palliative Care Podcast

As you know, dear listeners, I love music. We start each podcast with a song in part to shift the frame, taking people out of their academic selves and into a more informal conversation. Well, today’s guests love music at least as much if not more than me, and they each make a strong case for music as medicine. Jenny Chen is a palliative care fellow at Yale who regularly sings for her seriously ill patients. Look for Jenny to potentially appear on the show (no lie). Tyler Jorgensen not only plays music for his patients, starting out with just pulling up a tune on his iPhone, he and others...

info_outline Nudges for Prognosis and Comfort Care in the ICU: Kate Courtright, Scott Halpern, & Jaspal Singh show art Nudges for Prognosis and Comfort Care in the ICU: Kate Courtright, Scott Halpern, & Jaspal Singh

GeriPal - A Geriatrics and Palliative Care Podcast

Our main focus today was on to consider a more palliative approach to care.  Our guests are all trained in critical care: Kate Courtright, Scott Halpern, and Jaspal Singh.  Kate and Scott have additional training in palliative medicine.  To start. we review: What is a nudge? Also called behavioral interventions, heuristics, and cognitive biases. Prior podcasts on the , and a different trial conducted by Kate and Scott in which the . What is sludge?  I’d never heard the term, perhaps outside of Eric’s pejorative reference to my coffee after adding copious...

info_outline Psilocybin in Serious Illness: A Podcast with James Downar, Ali John Zarrabi and Margaret Ross show art Psilocybin in Serious Illness: A Podcast with James Downar, Ali John Zarrabi and Margaret Ross

GeriPal - A Geriatrics and Palliative Care Podcast

We’ve covered psychedelics on the podcast before—first in 2019 with , and then again in 2023 with Stacy Fischer, Brian Anderson, and Theora Cimino, focusing on the . In today’s episode, we’re taking a closer look at the current state of the science around one specific psychedelic: psilocybin. We'll discuss three recent clinical trials involving patients with serious illness, joined by our guests , , and .  We begin with a refresher on psilocybin—what it is, how it might work, what conditions it may help treat (including demoralization), and how it’s typically administered....

info_outline HIV, Aging, and Palliative Care: Peter Selwyn and Meredith Greene show art HIV, Aging, and Palliative Care: Peter Selwyn and Meredith Greene

GeriPal - A Geriatrics and Palliative Care Podcast

Peter Selwyn, one of today’s guests, has been caring for people living with HIV for over 40 years.  In that time, care of people with HIV has changed dramatically.  Initially, there was no treatment, then treatments with marginal efficacy, complex schedules, and a tremendous burden of side effects and drug-drug interactions.  The average age at death was in the 30s. Now, more people in the US die with HIV rather than from HIV.  Treatment regimens are simplified, and the anti-viral drugs are well tolerated.  People are living with HIV into advanced ages.  The...

info_outline Potentially Unsafe Low-evidence Treatments: Adam Marks, Laura Taylor, & Jill Schneiderhan show art Potentially Unsafe Low-evidence Treatments: Adam Marks, Laura Taylor, & Jill Schneiderhan

GeriPal - A Geriatrics and Palliative Care Podcast

More and more people are, “”  Self-identified experts and influencers on (podcasts!) and social media endorse treatments that are potentially harmful and have little to no evidence of benefit, or have only been studied in animals.  An increasing number of federal have a of endorsing such products. We and our guests have noticed that in our clinical practices, patients and caregivers seem to be asking for such treatments more frequently.  Ivermectin to treat cancer.  Stem cell treatments. Chelation therapy.  Daneila Lamas wrote about this issue in the -after we...

info_outline Loss of DEI Hurts Everyone: Farah Stockman, Ali Thomas, Ken Covinsky show art Loss of DEI Hurts Everyone: Farah Stockman, Ali Thomas, Ken Covinsky

GeriPal - A Geriatrics and Palliative Care Podcast

I read Farah Stockman’s article in the NYT on , and thought, “Yes, and ‘everyone’ includes harm to our healthcare workforce, our patients, and their families.” So we’re delighted that Farah Stockman, pulitzer prize winning journalist, author of , and editorial board member at the New York TImes joins us to set the bigger picture for this discussion.  Farah provides clear examples from the Biden administration, in which having the most diverse cabinet in history was critical to building bridges, empathy, and inspiring others to feel included. We are also pleased to welcome Ali...

info_outline RCT of PC in ED: Corita Grudzen, Fernanda Bellolio, & Tammie Quest show art RCT of PC in ED: Corita Grudzen, Fernanda Bellolio, & Tammie Quest

GeriPal - A Geriatrics and Palliative Care Podcast

Early in my research career, I was fascinated by the (then) frontier area of palliative care in the emergency department.  I emergency medicine clinicians what they thought when a patient who is seriously ill and DNR comes to the ED, and some responded, (paraphrasing), what are they doing here? This is not why I went into emergency medicine. I went into emergency medicine to act. I can’t do the primary thing I’ve been trained to do: ABC, ABC, ABCs.  Most emergency providers wanted to for seriously ill patients, but they didn’t have the knowledge, skills, or experience to do...

info_outline GeriPal Takeover! Nancy Lundebjerg and Annie Medina-Walpole show art GeriPal Takeover! Nancy Lundebjerg and Annie Medina-Walpole

GeriPal - A Geriatrics and Palliative Care Podcast

Whelp, goodbye folks!  Eric and I have been DOGE’d. In a somewhat delayed April Fools, Nancy Lundebjerg and Annie Medina-Walpole have taken over podcast host duties this week. Their purpose is to interview me, Eric, and Ken Covinsky about your final AGS literature review plenary session taking place at the Annual Meeting in Chicago this May (for those attending, our session is the plenary the morning of May 10).  We discuss our favorite articles, parody songs, and memories from AGS meetings past, with a little preview of a song for this year’s meeting.   We covered: ...

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Things are changing quickly in the Alzheimer’s space. We now have biomarkers that can reasonably approximate the degree of amyloid build-up in the brain with a simple blood test.  We have two new FDA-approved medications that reduce that amyloid buildup and modestly slow down the progression of the disease.  So, the question becomes, what, if anything, should we do differently in the primary care setting to diagnose the disease?

On today’s podcast, we’ve invited Nathaniel Chin back to the GeriPal podcast to talk about what primary care needs to manage this new world of Alzheimer’s disease effectively.  Nate is a geriatrician and clinician-scientist at the University of Wisconsin, as well as the host of the Wisconsin ADRC's podcast, "Dementia Matters." In each bi-weekly episode, he interviews Alzheimer's disease experts about research advances and caregiver strategies. Nate also wrote a NEJM piece last year on “Alzheimer’s Disease, Biomarkers, and mAbs — What Does Primary Care Need?”

We address the following questions with Nate:

  • Has anything changed for the primary care doctor when diagnosing Alzheimer’s?  How should we screen for cognitive impairment?

  • Does a good history matter anymore?

  • What’s the role of assessing function?

  • What do we do with those who have only subjective cognitive complaints?

  • Can’t we skip all this and just send some blood-based biomarkers?

  • What is the role of the amyloid antibody treatments?


Lastly, take a look at the following if you want to take a deeper dive into some of the other articles and podcasts we discuss: