New Guidelines on Diagnosing Alzheimer’s Disease and Related Cognitive Impairments: A Comprehensive Framework for Primary Care

The Alzheimer’s Association has released a new and revised clinical practice guideline for the evaluation, testing, counseling, and diagnostic disclosure of Alzheimer’s disease (AD) and related disorders (ADRD), according to an association news release.

_{©Zerbor/stock.adobe.com}

Published in a special issue of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the Alzheimer’s Association Clinical Practice Guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer’s Disease and Related Disorders (DETeCD-ADRD CPG) addresses a critical need in modern clinical practice, as existing US guidelines for diagnosing these conditions are more than 20 years old and were primarily designed for specialists and dementia subspecialists. The DETeCD-ADRD CPG expands its scope to include recommendations applicable to primary care and other clinical settings, offering a practical process for diagnosing cognitive impairment due to AD or ADRD. These related disorders include Lewy body disease, frontotemporal lobar degeneration, vascular cognitive impairment and dementia (VCID), and other potential contributing conditions.

Patient-Centered Diagnostic Process

The guideline emphasizes a patient-centered approach, beginning with aligning diagnostic goals between the clinician, patient, and often a care partner. “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,” Brad Dickerson, MD, Professor of Neurology at Harvard Medical School and a co-leader of the initiative, said in a press statement.

The comprehensive diagnostic process includes:

1. Reviewing the patient’s risk profile (eg, age, family history of dementia, hypertension, smoking).
2. Documenting the history of symptoms and their impact on daily life.
3. Assessing cognitive function through standardized testing.
4. Obtaining imaging (eg, brain MRI or CT) and laboratory tests to rule out other causes of cognitive impairment.

For select patients, advanced diagnostics such as cerebrospinal fluid biomarkers or emerging blood-based tests may be incorporated to enhance diagnostic accuracy. “We emphasize the importance of the involvement of a care partner throughout this process for most patients, since cognitive symptoms often compromise a person’s ability to process all of this information by themselves,” Dickerson added.

Three-Step Diagnostic Formulation

A key feature of the DETeCD-ADRD CPG is the introduction of a 3-step diagnostic formulation to synthesize findings into a concise, individualized summary:

1. Cognitive Functional Status: Categorizing impairment as mild cognitive impairment (MCI) or dementia.
2. Cognitive-Behavioral Syndrome: Describing predominant symptoms, such as progressive memory loss or language difficulties.
3. Likely Underlying Condition(s): Identifying the brain disease(s) or conditions contributing to the symptoms, such as AD or VCID.

“This framework enables clinicians to tailor the diagnostic process to each individual and facilitate better care planning,” Maria C Carrillo, PhD, chief science officer at the Alzheimer’s Association, said in the news release.

Broader Applicability and Emerging Advances

The guideline’s design ensures broad applicability across various clinical settings, including primary care. By operationalizing its 19 evidence-based recommendations into practical steps, it seeks to improve diagnostic accuracy, facilitate early intervention, and empower patients and families.

“This first US interdisciplinary national evaluation guideline provides a comprehensive foundation summarizing a high-quality and personalized process within which specific tests are slotted and can be updated as the field evolves,” Alireza Atri, MD, PhD, chief medical officer at Banner Research, said in the association announcement.

While the guideline does not propose specific diagnostic or staging criteria, it highlights the importance of integrating advanced biomarkers and tools as they become clinically validated. It also underscores the role of care partners throughout the diagnostic process, given the cognitive challenges many patients face in retaining and processing information.

Implications for Clinical Practice

The DETeCD-ADRD CPG aims to empower clinicians to provide high-quality, patient-centered diagnostic evaluations that enhance knowledge and autonomy for patients and families, the Alzheimer's Association announcement noted. It marks a significant step forward in addressing the growing prevalence of AD and ADRD in primary care and beyond.

As Carrillo noted, “These [recommendations] guide clinicians in evaluating memory complaints, which could have many underlying causes. That is the necessary start for an early and accurate Alzheimer’s diagnosis.”

The Alzheimer's Association encourages clinicians to review the guideline and integrate its recommendations into practice, paving the way for improved patient outcomes and personalized care planning.

Source New clinical practice guideline on the process for diagnosing Alzheimer’s disease or a related form of cognitive impairment or dementia. Press release. Alzheimer’s Association. December 23, 2024. Accessed January 7, 2025. https://www.alz.org/news/2024/clinical-practice-guideline-evaluation-alzheimers