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

• Authors: Garrett Alexander, Emory University; JL Liss, The Columbus Memory Center; S Seleri Assunção, Genentech Inc; J Cummings, University of Nevada, Las Vegas; A Atri, Banner Sun Health Research Institute; DS Geldmacher, University of Alabama Birmingham; SF Candela, Health & Wellness Partners, LLC; DP Devanand, New York State Psychiatric Institute and Columbia University Irving Medical Center; HM Fillit, Icahn School of Medicine; J Susman, Northeast Ohio Medical University; J Mintzer, Roper St Francis Healthcare, Charleston SC; T Bittner, F.Hoffmann‐LaRoche; SA Brunton, Touro University; DR Kerwin, Kerwin Medical Center; WC Jackson, University of Tennessee; GW Small, University of California Los Angeles; GT Grossberg, St Louis University; Carolyn Clevenger, Emory University; V Cotter, Johns Hopkins School of Nursing; R Stefanacci, Thomas Jefferson University; A Wise-Brown, Genentech Inc; MN Sabbagh, Cleveland Clinic Nevada
• Journal Title: JOURNAL OF INTERNAL MEDICINE
• Volume: Volume 290, Number 2
• Publisher: WILEY | 2021-03-31, Pages 310-334
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1111/joim.13244
• Subjects: Health Sciences, Nursing; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; Alzheimer disease; biomarkers; dementia; disease‐ modifying therapies; mild cognitive impairment; primary health care

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.