Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer’s disease (MCI and dementia) in primary care: a review and synthesis
Document Type
Article
Abstract
The critical role of primary care clinicians (PCCs) in Alzheimer’s disease (AD) prevention, diagnosis and management must evolve as new treatment paradigms and disease-modifying therapies (DMTs) emerge. Our understanding of AD has grown substantially: no longer conceptualized as a late-in-life syndrome of cognitive and functional impairments, we now recognize that AD pathology builds silently for decades before cognitive impairment is detectable. Clinically, AD first manifests subtly as mild cognitive impairment (MCI) due to AD before progressing to dementia. Emerging optimism for improved outcomes in AD stems from a focus on preventive interventions in midlife and timely, biomarker-confirmed diagnosis at early signs of cognitive deficits (i.e. MCI due to AD and mild AD dementia). A timely AD diagnosis is particularly important for optimizing patient care and enabling the appropriate use of anticipated DMTs. An accelerating challenge for PCCs and AD specialists will be to respond to innovations in diagnostics and therapy for AD in a system that is not currently well positioned to do so. To overcome these challenges, PCCs and AD specialists must collaborate closely to navigate and optimize dynamically evolving AD care in the face of new opportunities. In the spirit of this collaboration, we summarize here some prominent and influential models that inform our current understanding of AD. We also advocate for timely and accurate (i.e. biomarker-defined) diagnosis of early AD. In doing so, we consider evolving issues related to prevention, detecting emerging cognitive impairment and the role of biomarkers in the clinic.
Publication Date
8-1-2021
Publication Title
Journal of Internal Medicine
ISSN
09546820
E-ISSN
13652796
Volume
290
Issue
2
First Page
310
Last Page
334
PubMed ID
33458891
Digital Object Identifier (DOI)
10.1111/joim.13244
Recommended Citation
Liss, J. L.; Seleri Assunção, S.; Cummings, J.; Atri, A.; Geldmacher, D. S.; Candela, S. F.; Devanand, D. P.; Fillit, H. M.; Susman, J.; Mintzer, J.; Bittner, T.; Brunton, S. A.; Kerwin, D. R.; Jackson, W. C.; Small, G. W.; Grossberg, G. T.; Clevenger, C. K.; Cotter, V.; Stefanacci, R.; Wise-Brown, A.; and Sabbagh, M. N., "Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer’s disease (MCI and dementia) in primary care: a review and synthesis" (2021). Neurology. 999.
https://scholar.barrowneuro.org/neurology/999