Dementia: Diagnosis and Dilemmas

The diagnosis, treatment, and care of individuals with dementia requires renewed attention given the complex questions and dilemmas generated from advances in presymptomatic and symptomatic dementia testing and corresponding treatment options. This month’s issue of Practical Neurology highlights diagnostic modalities and considerations and various dilemmas confronting clinicians caring for individuals with dementia, including gene and biomarker tests, legal and ethical considerations in clinical practice, and disparities and gaps in dementia care.

Genetic counselors Jennifer Pagano, Jamie C. Fong, Elisabeth M. Wood, Rachel A. Paul, Jill Goldman, Victoria Klee, Malia Rumbaugh, Diane Lucente, and Chelsea Chambers, begin this issue with their review, Clinical Genetic Testing for Alzheimer Disease and Related Dementias. They provide an overview of the most common hereditary dementias and examine how genetic testing can be applied in the clinical setting.

Dementia test results are an important step in the diagnosis of dementia, but it is also important to evaluate and manage other conditions which may contribute to cognitive impairment. In their article Cerebrospinal Fluid Testing in Dementia Diagnosis, Drs. Ana C. Pereira and Suzanne E. Schindler, review the diagnostic utility and limits of cerebrospinal fluid testing in individuals with atypical dementia syndromes.

Advancements in Alzheimer disease (AD) treatments combined with developments in AD biomarker research have driven a need for clinical guidelines governing the implementation of AD treatments. In Clinical Use of Alzheimer Disease Biomarkers: Legal, Ethical, and Social Considerations, Margaret A. Manchester, MPH, Catherine E.A. Scipion, MD, MPH, MS, Yufei Wang, MPH, and Jalayne J. Arias, JD, MA review important legal, ethical, and social considerations related to the adoption of AD biomarkers in clinical practice.

In his article, Understanding Disparities Associated with Alzheimer Disease and Related Dementias, Dr. James E. Galvin, emphasizes the increasing diversity of the older adult population and the increased risks of dementia experienced by minoritized populations. He highlights risk factors in minoritized populations and identifies practical approaches to improve cognitive outcomes in these populations, including increasing cognitive, physical, and social activity; improving nutrition; and managing comorbid conditions.

Lastly, the article, Incorporating the Lived Experience of Patients and Caregivers From Dementia Diagnosis Through the Caregiving Journey, based on a conversation between Dr. Daniel C. Potts and Dr. Marie Marley, highlights multiple issues related to communication of results, diagnoses, and care in the present healthcare environment. They discuss Dr. Marley’s experience being diagnosed with mild cognitive impairment and AD and her experiences as a caregiver for a loved one with AD. The article includes helpful recommendations and resources designed to assist caregivers and physicians in the dementia caregiving journey.

Thanks to the authors for their contributions and insights. We are excited to share these articles with you and we hope you enjoy this issue of Practical Neurology.