Experts Share National Guidelines for Evaluating Patients Suspected of Having Alzheimer’s Disease

New guidelines for the diagnostic evaluation of people suspected of having cognitive impairment due to Alzheimer’s disease or related disorders is the first update since 2001 for specialists and the only guideline ever for primary care clinicians.

A special issue of the journal Alzheimer’s & Dementia highlights the 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). Brad Dickerson, MD, Tommy Rickles Chair in Progressive Aphasia Research and Director of the Massachusetts General Hospital Frontotemporal Disorders Unit and Laboratory of Neuroimaging, is one of the lead authors on a series of articles in the journal detailing the new guidelines and is available for interviews to discuss what it means for clinicians and patients.

The new guidelines provide context for using biomarkers in evaluations and cover a variety of diseases and conditions that contribute to cognitive-behavioral impairment, including Lewy body disease, frontotemporal lobar degeneration, vascular cognitive impairment and dementia (VCID), and more. Similar American guidelines are more than 20 years old and aimed at specialists or dementia subspecialists. The new guidelines are the first ever for use by primary care clinicians.

“These guidelines provide recommendations for practicing clinicians on the diagnostic evaluation process from start to finish,” said Dr. Dickerson. “This includes the establishment of shared goal setting for a person-centered clinical evaluation, the steps involved in obtaining information about symptoms and examination, a variety of diagnostic tests tailored to the patient, and a summary of best practices regarding the diagnostic disclosure process. We emphasize the importance of the involvement of a care partner throughout this process, since cognitive symptoms often compromise a patient’s ability to process all of this information by themselves.”

The workgroup’s guideline aims to provide clear, evidence-based steps for conducting an effective evaluation and disclosing findings. It includes 19 practical recommendations that can be used in any practice setting, including primary care, along with additional guidance for specialists and subspecialists.

“Some details of the guideline will likely require modification as new tools and biomarkers become sufficiently validated for appropriate clinical use in real-world practice,” said Alireza Atri, MD, PhD, Chief Medical Officer, Banner Research, and Director of the Banner Sun Health Research Institute, Banner Health, Sun City and Phoenix, Arizona, and Lecturer on Neurology, Brigham and Women’s Hospital and Harvard Medical School. “The workgroup leveraged best evidence and practices to empower persons with memory or thinking symptoms or concerns and their loved ones, clinicians, and health systems, to engage in a person-centered process that will enhance knowledge, appreciation and autonomy for the person with a potential illness — and facilitate doing what is right for them.”

Full press release available from the Alzheimer’s Association.

Papers cited:

Atri, et al. “The Alzheimer’s Association Clinical Practice Guideline for the Diagnostic Evaluation, Testing, Counseling and Disclosure of Suspected Alzheimer’s Disease and Related Disorders (DETeCD-ADRD): Executive Summary of Recommendations for Primary Care” DOI: 10.1002/alz.14333

Dickerson, et al. “The Alzheimer’s Association Clinical Practice Guideline for the Diagnostic Evaluation, Testing, Counseling and Disclosure of Suspected Alzheimer’s Disease and Related Disorders (DETeCD-ADRD): Executive Summary of Recommendations for Specialty Care,” DOI: 10.1002/alz.14337

Atri, et al. “The Alzheimer’s Association Clinical Practice Guideline for the Diagnostic Evaluation, Testing, Counseling and Disclosure of Suspected Alzheimer’s Disease and Related Disorders (DETeCD-ADRD): Validated Clinical Assessment Instruments,” DOI: 10.1002/alz.14335

Funding: Alzheimer's Association

Disclosures: Bradford C. Dickerson: consulting for Acadia, Alector, Arkuda, Biogen, Eisai, Med Learning Group, Quanterix; on DSMB for Lilly, Merck; royalties from Cambridge University Press, Elsevier, Oxford University Press, Up To Date. Alireza Atri: consulting for Acadia, AriBio, AZ Therapies, Biogen, Eisai, JOMDD, Lundbeck, Life Molecular Imaging, Merck, ONO, Prothena, Roche/Genentech, Novo Nordisk, Qynapse, Vaxxinity; royalties from Oxford University Press. Additional disclosures can be found in the journal.