Recognizing the urgent need for Alzheimer’s disease diagnosis, the Alzheimer’s Association this year has released the first set of 20 consensus recommendations for efficiently evaluating and diagnosing the disease and cognitive behavioural syndromes in general.

The workgroup assumed a multi-tiered approach to the various assessments and tests needed to be performed on patients. Out of the 20 recommendations, 16 are ‘A’ recommendations that must be adhered to under all circumstances to improve outcomes, 2 are ‘B’ recommendations that if performed will improve outcomes in most cases, and 2 are ‘C’ recommendations that if done will improve outcomes.

The chief ‘A’ Recommendations

1. Patients who self-report or have care takers report behavioural, cognitive, or functional impairments should be evaluated immediately or referred to a specialist if progressive or non-typical behavioural symptoms are present.

2. Doctor should perform the following assessments to evaluate for cognitive behavioural syndrome:

• Cognition exam
• Dementia-focused test
• Exam to check mental status- mood and behaviour

3. Once cognitive behavioural syndrome traits are ascertained, the doctor should carefully look at the possible causes and contributing factors to support the diagnosis.

4. The clinician should convey the diagnosis or findings to the patient/care partner to begin or continue ongoing care and management.

5. History taking is crucial and should include information on sensory and motor function changes, cognitive changes, changes in daily activities, and neuropsychiatric symptoms- all of which should be relayed by the patient or the care taker.

6. A specialist should conduct an in-clinic examination to confirm the presence of the above symptoms.

7. The doctor must rely on neuropsychological examinations pertaining to learning, language, memory, recall and recognition, and visuospatial and executive function, when the above assessments are not sufficient.

8. Genetic testing should be performed when cognitive behavioural syndrome is confirmed in patients with a family history.

9. Patients and caretakers should be educated and informed about their diagnosis and its future progressions by the doctor.

‘B’ Recommendations

1. MRI or CT scans should be advised for patients being evaluated for cognitive behavioural syndrome

2. FDG positron emission tomography should done in case of uncertainty after structural imaging.

‘C’ Recommendations

1. The specialist should obtain CSF amyloid beta-42 and tau/p-tau profiles for patients to confirm Alzheimer’s disease pathology in patients with established cognitive behavioural syndrome, but persisting uncertainty of etiology after imaging.

2. If diagnostic uncertainty continues, the specialist can order for an amyloid PET scan.

The new guidelines have been framed to empower the doctors and patients and their families, and aim at clearing any ambiguity during diagnosis and evaluation, and enable better case detection and timely intervention.

Source: Alireza Atri, MD, PhD, et al. Alzheimer’s Association Best Clinical Practice Guidelines for the Evaluation of Neurodegenerative Cognitive Behavioral Syndromes, Alzheimer’s Disease and Dementias in the United States. Alzheimer’s Association.