Alzheimer’s disease recommendations for physicians and nurse practitioners released

A set of 20 recommendations to be followed by physicians and nurse practitioners for Alzheimer’s patients has been released to reduce the delay in appropriate diagnosis and care.

The recommendations have been released by a workgroup convened by the Alzheimer’s Association. The recommendations range from enhancing efforts to recognize and more effectively evaluate symptoms to compassionately communicating with and supporting affected individuals and their caregivers.

At their core, the recommendations include guidance that:

  • 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 2017, the Alzheimer’s Association convened a Diagnostic Evaluation Clinical Practice Guideline workgroup (AADx-CPG workgroup) of experts from multiple disciplines in dementia care and research, representing medical, neuropsychology, and nursing specialties. The AADx-CPG workgroup used a rigorous process for evidence-based consensus guideline development.

The goal of the workgroup was to provide evidence-based and practical recommendations for the clinical evaluation process of cognitive behavioral syndromes, Alzheimer’s disease and related dementias that are relevant to a broad spectrum of U.S. health care providers.

The Clinical Practice Guidelines (CPG) recognize the broader category of “Cognitive Behavioral Syndromes” — indicating that neurodegenerative conditions such as ADRD lead to both behavioral and cognitive symptoms of dementia. As a result, these conditions can produce changes in mood, anxiety, sleep, and personality — plus interpersonal, work and social relationships — that are often noticeable before more familiar memory and thinking symptoms of ADRD appear.

The 20 consensus recommendations describe a multi-tiered approach to the selection of assessments and tests that are tailored to the individual patient. The recommendations emphasize obtaining a history from not only the patient but also from someone who knows the patient well to:

  • First, establish the presence and characteristics of any substantial changes, to categorize the cognitive behavioral syndrome.
  • Second, investigate possible causes and contributing factors to arrive at a diagnosis/diagnoses.
  • Third, appropriately educate, communicate findings and diagnosis, and ensure ongoing management, care and support.

According to the workgroup, a timely and accurate diagnosis of ADRD increases patient autonomy at earlier stages when they are most able to participate in treatment, life and care decisions; allows for early intervention to maximize care and support opportunities, and available treatment outcomes; and may also reduce health care costs.

The Alzheimer’s Association encourages early diagnosis to provide the opportunity for people with Alzheimer’s to participate in decisions about their care, current and future treatment plans, legal and financial planning, and may also increase their chances of participating in Alzheimer’s research studies.

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