Despite more than two decades of advances in diagnostic criteria and technology, symptoms of Alzheimer's disease and Related Dementias (ADRD) too often go unrecognized, causing delays in appropriate diagnoses and care that are both harmful and costly.

Contributing to the variability and inefficiency is the lack of multidisciplinary ADRD evaluation guidelines to inform U.S clinicians in primary and specialty care settings.

Responding to the urgent need for more timely and accurate Alzheimer's disease diagnosis and improvement in patient care, a workgroup convened by the Alzheimer's Association has developed 20 recommendations for physicians and nurse practitioners.

There currently are no U.S. national consensus best clinical practice guidelines that provide integrated multispecialty recommendations for the clinical evaluation of cognitive impairment suspected to be due to ADRD for use by primary and specialty care medical and nursing practitioners.

The recommendations range from enhancing efforts to recognize and more effectively evaluate symptoms to compassionately communicating with and supporting affected individuals and their caregivers. 

The recommendations were reported at the Alzheimer's Association International Conference (AAIC) 2018 by Alireza Atri, MD, Co-chair of the AADx-CPG workgroup, and Director of the Banner Sun Health Research Institute, Sun City, AZ, and Lecturer in Neurology at the Center for Brain/Mind Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. 

At their core, the recommendations include guidance that:

1. All middle-aged or older individuals who self-report or whose care partner or clinician report cognitive, behavioral or functional changes should undergo a timely evaluation.

2. Concerns should not be dismissed as "normal aging" without a proper assessment.

3. Evaluation should involve not only the patient and clinician but, almost always, also involve a care partner (e.g., family member or confidence).

"Too often cognitive and behavioral symptoms due to Alzheimer's disease and other dementias are unrecognized, or they are attributed to something else," said James Hendrix, Ph.D., Alzheimer's Association Director of Global Science Initiatives and staff representative to the workgroup."

"This causes harmful and costly delays in getting the correct diagnosis and providing appropriate care for persons with the disease. These new guidelines will provide an important new tool for medical professionals to more accurately diagnose Alzheimer's and other dementias," said Hendrix.

"As a result, people will get the right care and appropriate treatments; families will get the right support and be able to plan for the future," said Hendrix.

In 2017, the Alzheimer's Association convened a Diagnostic Evaluation Clinical Practice Guideline workgroup (AADx-CPG workgroup) of experts from multiple disciplines in dementia care and research, representing medical, neuropsychology, and nursing specialties. The AADx-CPG workgroup used a rigorous process for evidence-based consensus guideline development.

"Our goal is to provide evidence-based and practical recommendations for the clinical evaluation process of cognitive behavioral syndromes, Alzheimer's disease and related dementias that are relevant to a broad spectrum of U.S. health care providers," Atri said.

"Until now, we have not had highly specific and multispecialty U.S. national guidelines that can inform the diagnostic process across all care settings, and that provide standards meant to improve patient autonomy, care, and outcomes," Atri said.