Guidelines for Evaluating, Diagnosing, and Disclosing Dementia Published by Alzheimer’s Association

The Diagnostic Evaluation, Testing, Counseling, and Disclosure Clinical Practice Guideline (DETeCD-ADRD CPG) Workgroup, convened and funded by the Alzheimer’s Association, has developed new recommendations for clinicians to use when evaluating patients with possible Alzheimer disease (AD) or AD and related dementias (ADRD). An executive summary of the recommendations for use in primary care and other practice settings was published in Alzheimer’s & Dementia, along with a companion article summarizing specific guidance for specialists.

The Workgroup included representatives from  primary, specialty, subspecialty, long-term, and palliative care disciplines as well as the fields of health economics and bioethics. The Workgroup conducted a systematic review of literature and developed their recommendations using a modified-Delphi approach. The executive summary includes 19 practical recommendations, while the companion article provides further commentary for consideration by specialty care physicians.

The articles frame patient evaluation as a 3-step process that should assess for cognitive functional status (defined as the level of impairment), cognitive-behavioral syndrome (defined as the symptoms experienced), and underlying brain disease (including AD/ADRD). The recommendations discuss the characterization, diagnosis, and disclosure of these 3 factors, with specific guidance provided for:

• Incorporating communications from patients and caregivers into a multi-tiered evaluation strategy and develop a partnership
• Implementing of multiple tiers of evaluation, including patient history, cognition, sensory and motor function, risk factors, and laboratory tests
• Assessing and communicating the presence of cognitive-behavioral syndrome
• Referring patients to specialists when necessary

The articles also provide illustrative figures and tables for use when evaluating patents with suspected cognitive impairment. These include a diagram that distills the published recommendations into a process comprised of 7 core elements, with additional flow charts to follow in the primary and specialty care settings.

"We recommend that medical professionals begin by making sure their thinking about the goals of the evaluation aligns with that of the patient, which usually requires a discussion to educate the patient on the specific steps of the process,” said Brad Dickerson, MD, Director of the Massachusetts General Hospital Frontotemporal Disorders Unit and Professor Neurology at Harvard Medical School. “Then we outline the steps involved in obtaining information about symptoms and examination, followed by a variety of diagnostic tests tailored to the patient, and summarize best practices regarding the diagnostic disclosure process."