New Clinical Guideline for Evaluating Alzheimer's, Related Dementias

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The multidisciplinary workgroup developed evidence-based recommendations.
The multidisciplinary workgroup developed evidence-based recommendations.
The following article is part of conference coverage from the 2018 Alzheimer's Association International Conference in Chicago, Illinois. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAIC 2018.

CHICAGO — Twenty recommendations have been developed by the Alzheimer's Association workgroup to help clinicians evaluate Alzheimer disease and other dementias in the areas of primary and specialty care. The guidelines were presented at the 2018 Alzheimer's Association International Conference, July 22-26, 2018 in Chicago, Illinois.

Currently, there is no US consensus on best clinical practice guidelines that incorporate multispecialty recommendations for evaluating cognitive impairment that is thought to be due to Alzheimer disease and related dementias (ADRD) for use by physicians and nurse practitioners. The multidisciplinary workgroup, which included medical, neuropsychology, and nursing specialties, convened in 2017 to develop evidence-based consensus guidelines. Experts conducted systematic evidence reviews and searches to develop and grade recommendations.

Some of the major recommendations in the Best Clinical Practice Guidelines (CPG) include:

  • 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
  • Concerns should not be dismissed as “normal aging” without a proper assessment
  • Evaluation should involve not only the patient and clinician but, almost always, also involve a care partner (e.g., family member or confidant)
  • In a patient being evaluated for cognitive behavioral symptoms, the clinician should perform an examination of cognition, mood, and behavior (mental status exam), and a dementia focused neurological examination, aiming to diagnose the cognitive behavioral syndrome

The CPG discusses the more general category termed "Cognitive Behavioral Syndromes," which acknowledges that ADRD and other neurodegenerative disorders can result in both behavioral and cognitive symptoms of dementia. The resulting changes in mood, anxiety, sleep, and personality may be signs that are seen sooner than the more common memory and cognitive symptoms of ADRD. The CPG focuses on patient-specific selection of assessments and tests. The patients' history should be given by not only the patient but also from someone who knows the patient well for a more comprehensive diagnosis.

Diagnosing ADRD in a timely manner will broaden patient autonomy at earlier stages, allow for early intervention, and may ultimately lower healthcare costs.

"These new guidelines will provide an important new tool for medical professionals to more accurately diagnose Alzheimer's and other dementias. 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," stated James Hendrix, PhD, Alzheimer's Association director of Global Science Initiatives and staff representative to the workgroup.

"Also, with recent advances in available diagnostic technology, there is a need for guidance on use of such tests in specialty and subspecialty care settings," stated Bradford Dickerson, MD, MMSc, co-chair of the workgroup and director of the Frontotemporal Disorders Unit at Massachusetts General Hospital, and associate professor of neurology at Harvard Medical School in Boston.

Details of the workgroup document are being refined and a publication is anticipated later this year.

For more coverage of AAIC 2018, click here.

Reference

Atri A, Hendrix J, Carillo M, 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. Presented at: 2018 Alzheimer's Association International Conference. July 22-26, 2018; Chicago, IL. Oral presentation #O1-07-02.

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