Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer's disease (MCI and dementia) in primary care: a review and synthesis

J L Liss; S Seleri Assunção; J Cummings; A Atri; D S Geldmacher; S F Candela; D P Devanand; H M Fillit; J Susman; J Mintzer; T Bittner; S A Brunton; D R Kerwin; W C Jackson; G W Small; G T Grossberg; C K Clevenger; V Cotter; R Stefanacci; A Wise-Brown; M N Sabbagh

doi:10.1111/joim.13244

Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer's disease (MCI and dementia) in primary care: a review and synthesis

J Intern Med. 2021 Aug;290(2):310-334. doi: 10.1111/joim.13244. Epub 2021 Mar 31.

Authors

J L Liss¹, S Seleri Assunção², J Cummings^{3

4}, A Atri^{5

6

7}, D S Geldmacher⁸, S F Candela⁹, D P Devanand¹⁰, H M Fillit^{11

12}, J Susman¹³, J Mintzer^{14

15}, T Bittner¹⁶, S A Brunton¹⁷, D R Kerwin^{18

19}, W C Jackson²⁰, G W Small²¹, G T Grossberg²², C K Clevenger²³, V Cotter²⁴, R Stefanacci²⁵, A Wise-Brown², M N Sabbagh⁴

Affiliations

¹ From, The Columbus Memory Center, Columbus, GA, USA.
² US Medical Affairs - Neuroscience, Genentech, A Member of the Roche Group, South San Francisco, CA, USA.
³ Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.
⁴ Lou Ruvo Center for Brain Health - Cleveland Clinic Nevada, Las Vegas, NV, USA.
⁵ Banner Sun Health Research Institute, Sun City, AZ, USA.
⁶ Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
⁷ Harvard Medical School, Boston, MA, USA.
⁸ Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁹ Health & Wellness Partners, LLC, Upper Saddle River, NJ, USA.
¹⁰ Division of Geriatric Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA.
¹¹ Departments of Geriatric Medicine, Medicine, and Neuroscience, Icahn School of Medicine and Mt. Sinai, New York, NY, USA.
¹² Alzheimer's Drug Discovery Foundation, New York, NY, USA.
¹³ Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
¹⁴ Roper St Francis Healthcare, Charleston, SC, USA.
¹⁵ Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
¹⁶ F.Hoffmann-LaRoche, Basel, Switzerland.
¹⁷ Department of Family Medicine, Touro University, Vallejo, CA, USA.
¹⁸ Kerwin Medical Center, Dallas, TX, USA.
¹⁹ Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
²⁰ Departments of Family Medicine and Psychiatry, University of Tennessee College of Medicine, Memphis, TN, USA.
²¹ Division of Geriatric Psychiatry, UCLA Longevity Center, Semel Institute for Neuroscience & Human Behavior, University of California - Los Angeles, Los Angeles, CA, USA.
²² Division of Geriatric Psychiatry, St Louis University School of Medicine, St Louis, MO, USA.
²³ Department of Neurology, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
²⁴ Johns Hopkins School of Nursing, Baltimore, MD, USA.
²⁵ Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA.

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.

Keywords: Alzheimer disease; biomarkers; dementia; disease-modifying therapies; mild cognitive impairment; primary health care.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Alzheimer Disease / complications
Alzheimer Disease / diagnosis*
Alzheimer Disease / psychology*
Humans
Primary Health Care*
Time Factors