December 23, 2024
We have entered a new era of improved and emerging biologically-based diagnostic biomarkers for Alzheimer’s disease (AD) and AD-related neurodegenerative disorders (ADRD) that are rapidly impacting evaluation and care paradigms in every clinical setting: primary care, specialty care and dementia subspecialty care. A comprehensive evaluation includes setting goals in partnership with the patient and usually a care partner; obtaining information about the patient’s risk profile for AD or a related disease (e.g., age, family history of dementia, hypertension, smoking), describing the history of symptoms and their impact on daily life; evaluating the patient’s ability to perform tests of thinking abilities; and obtaining a brain MRI or CT scan along with laboratory tests for conditions that may contribute to cognitive impairment. The integration of new brain scans, spinal fluid tests, or other specialized tests into this comprehensive evaluation will add critical value to the diagnostic formulation and care plan for persons in whom there is a clinical concern for AD or an ADRD.
A special issue of the journal Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association highlights the new Alzheimer’s Association Clinical Practice Guideline for the Diagnostic Evaluation, Testing, Counseling and Disclosure of Suspected Alzheimer’s Disease and Related Disorders (DETeCD-ADRD CPG) that summarizes the process of diagnostic evaluation and disclosure for persons suspected of potentially having cognitive-behavioral impairment due to AD or ADRD. ADRDs include Lewy Body Disease, Frontotemporal Lobar Degeneration, Vascular Cognitive Impairment and Dementia (VCID), and a host of other diseases and conditions that may cause or substantially contribute to cognitive-behavioral impairment. Similar American guidelines are more than 20 years old and aimed at specialists or dementia subspecialists.
“It is surprising to recognize that United States guidelines for the evaluation of patients suspected of having Mild Cognitive Impairment or dementia are more than 20 years old, and frankly outdated. Furthermore, there have never been guidelines geared for primary care, nor have prior guidelines discussed the importance of shared decision-making and described the diagnostic disclosure process. With this guideline, we expand the scope of prior guidelines by providing recommendations for practicing clinicians on the process from start to finish,” said Brad Dickerson, M.D. “We believe that if clinicians use the recommendations in this guideline and health care systems provide adequate resources, outcomes should improve in most patients in most practice settings.”