A Guide to the Diagnosis and Assessment of Alzheimer's Disease

Introduction

• Define the criteria for cognitive impairment and dementia
• Differentiate AD from other forms of dementia
• Describe the methods available for assessing patients with AD
• Provide a framework for establishing best practice for the diagnosis and management of patients with AD

The impact of this insidious disease on patients, caregivers and physicians is colossal. It places a tremendous economic and physical burden on healthcare resources. AD and related dementias affect as many as 4 million people in the USA with an estimated annual cost of $90 billion. Furthermore, the social and economic impact of AD is likely to increase as the population ages.

Recently there have been major advances in the diagnosis and management of AD. The availability of more accurate diagnostic techniques, and the development of potential symptomatic treatments and strategies, provide some hope to the patient and may ease the burden of caregivers. The need for an early diagnosis of AD to ensure effective management of this disease is paramount.

During a special meeting of the International Psychogeriatric Association, Alzheimer's Disease ­ Applied Diagnosis and Assessment Conference held in Geneva during 1996:

• The crucial role primary care physicians (PCPs) play in the early diagnosis and management of patients with AD was re-affirmed.

• There was a 'call to action' for the early diagnosis of AD

This Guide was developed to promote the PCP's role in the early diagnosis of AD. Many of the comments and points emphasized during the conference are reflected in this Guide.

This Guide provides a primary care-focused approach to the diagnosis and assessment of patient's with AD. It introduces a practical strategy to diagnose the disease and discusses the appropriate assessment tools that can be used to evaluate AD in the primary care setting. In addition, and more importantly, it includes an algorithm for the diagnosis and management of patients with AD in primary care. This strategy can easily be modified to reflect national approaches to the disease, and used as a template to develop local guidelines for best practice in the management of AD.

"It is possible to make a diagnosis of Alzheimer's disease, just as we can make a diagnosis of other major illnesses."

"AD is among the most stereotypic and characteristic of mental disease processes."

"There are pharmacologic therapies available to treat AD that may be of greatest benefit if an early diagnosis is made."

"The challenge today is to obtain an early, accurate and specific diagnosis of dementia using an effective diagnostic process."