The Dementia Care Pathway
The Dementia Care Pathway is comprised of a suite of tools and educational materials that are specifically designed to improve the ability of non-specialists to more effectively diagnose and treat dementia in their patients.

The UCSF Memory and Aging Center has partnered with Quest Diagnostics to build the Dementia Care Pathway. This pathway is comprised of a suite of tools and educational materials that are specifically designed to improve the ability of non-specialists to more effectively diagnose and treat dementia in their patients.

Neurologists, neuropsychologists, psychiatrists, geriatricians, primary care providers, and nurses collaboratively developed recommendations based on the accepted diagnostic criteria for all major categories of neurodegenerative syndromes that cause neurocognitive symptoms. These consensus recommendations lie at the foundation of the Dementia Care Pathway and aim to guide non-specialists to collect appropriate data from patients at different stages of neurodegenerative disease, enabling them to correctly apply established diagnostic criteria in a manner that realistically reflects existing clinical practice parameters.

The Dementia Care Pathway includes the following components:

  1. Pathway Navigator: This technologically integrated decision tree, tiered by patient symptom severity, is designed to guide non-specialists through the best consensus practices for screening, assessment, diagnosis, and care of dementia patients and patients at risk for dementia (includes support for rapidly progressive dementias and delirium). This tool provides a step-by-step overview of the process of dementia diagnosis and care by incorporating divergent testing and care pathways according to patient factors (such as diagnosis, test results, socioeconomic status, education level) and care setting (such as differences in availability of diagnostic procedures and social support resources).
  2. Brain Health Assessment: The Brain Health Assessment (BHA) is a tablet-based screening tool that allows non-specialists to identify and evaluate patients with suspected neurological deficits. This assessment evaluates cognitive skills that are commonly affected by neurocognitive disorders, including memory, executive/speed, visuospatial, and language. It includes both direct cognitive testing and targeted questions to the patient and family about symptoms. The goals of this brief screen are to ensure that it is quick, freely available to PCPs, easy to administer, and sensitive to early changes in cognition and behavior. The BHA can be administered in 10 minutes, and scoring is automated.
  3. Neuroimaging System: This pipeline provides guidance for clinicians seeking neuroimaging for their patients. The system includes a protocol for structural MRI acquisition appropriate for a dementia-specific diagnostic read, a set of key dementia-specific elements for the radiologic read of the scan, and a web-based interpretive report providing: quantitative volumetric characteristics of diagnostically key regions of the patient’s structural MRI relative to age-matched healthy controls, quantitative metrics of white matter hyperintensity burden relative to healthy controls, and probabilities of classification into key diagnostic categories of neurodegenerative syndrome.
  4. Educational Materials: This assortment of multimedia educational content is designed to provide information on the clinical care of patients on the continuum of neurodegenerative disease. These materials describe tests, procedures, and results as they relate to neurodegenerative disease and include separate formats intended for physicians and for patients and their families.

Protocols

General Dementia Acquisition Protocol: This protocol details standards for a consistent structural MRI acquisition for dementia and includes additional standards tailored to the needs of RPD diagnosis.

MRI Visual Read Manual: This manual is designed to guide radiologists through a dementia-specific visual interpretation of MRI scans

Billing Recommendations

Reimbursement coding and billing procedures are governed by the American Medical Association and the Center for Services. However, each carrier/payer may have different testing and/or billing guidelines.

Reimbursement code for neuropsychological testing, including tablet based neurocognitive assessment:

96118 – Testing & Interpretation

This includes selection, administration and interpretation of neuropsychological tests directly by neuropsychologist/healthcare professional time

  • May be performed by clinical psychologists, nurse practitioners, certified nurse specialist, physician assistants
  • Reported by hour of the qualified healthcare professional time
  • A minimum of 31 minutes must be provided to report any hour code
  • Includes both face to face time administering test to the patient, time spent interpreting the test results, formulating differential diagnosis and preparing the report.

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