Research article Topical Sections

The physician's Alzheimer's disease management guide: Early detection and diagnosis of cognitive impairment, Alzheimer's disease and related dementia

  • Received: 19 July 2022 Revised: 07 September 2022 Accepted: 13 September 2022 Published: 27 September 2022
  • Primary care professionals play a critical role in the care of their patients. In clinical practice, early detection and diagnosis of Mild Cognitive Impairment, Alzheimer's disease and related dementia are often missed or delayed. Disclosure of diagnosis is not timely or not revealed. Though the methods that could improve early detection and diagnosis have remained the same over the decades with little change, they provide opportunities for early intervention, treatment and improvement in patient care. Emerging research suggests that though the disease process begins years prior to the clinical diagnosis, the healthcare system and health care professionals remain distant and reluctant to provide the service of annual cognitive assessment, which has been recommended by the Medicare program for older adults aged 65 years and older. Findings support that Alzheimer's disease and related cognitive impairments have gone under detected, underdiagnosed and undertreated. This article seeks to provide valuable and equitable information in the form of a clinician's guide for removing the barriers to early detection and diagnosis of cognitive impairments and offers an unprecedented opportunity to improve the clinical outcomes and care of older adults with various levels of cognitive decline, including mild cognitive impairment, Alzheimer's disease, and related dementias. This article provides information on understanding and addressing the challenges faced by health care professionals, including primary care clinicians; removing the barriers to cognitive assessments; educating this professional group on the importance of brain health, early detection, and diagnosis for their older adult patients; and providing these professionals with the ability to transfer their knowledge into more defined care planning. Until cognitive screening has been fully accepted and implemented for the optimal the care of older adults, health-related efforts should include the promotion and education of brain health, early detection, and diagnosis in the education of health care providers.

    Citation: Allison B. Reiss, Donna de Levante Raphael, Nathaniel A. Chin, Vivek Sinha. The physician's Alzheimer's disease management guide: Early detection and diagnosis of cognitive impairment, Alzheimer's disease and related dementia[J]. AIMS Public Health, 2022, 9(4): 661-689. doi: 10.3934/publichealth.2022047

    Related Papers:

  • Primary care professionals play a critical role in the care of their patients. In clinical practice, early detection and diagnosis of Mild Cognitive Impairment, Alzheimer's disease and related dementia are often missed or delayed. Disclosure of diagnosis is not timely or not revealed. Though the methods that could improve early detection and diagnosis have remained the same over the decades with little change, they provide opportunities for early intervention, treatment and improvement in patient care. Emerging research suggests that though the disease process begins years prior to the clinical diagnosis, the healthcare system and health care professionals remain distant and reluctant to provide the service of annual cognitive assessment, which has been recommended by the Medicare program for older adults aged 65 years and older. Findings support that Alzheimer's disease and related cognitive impairments have gone under detected, underdiagnosed and undertreated. This article seeks to provide valuable and equitable information in the form of a clinician's guide for removing the barriers to early detection and diagnosis of cognitive impairments and offers an unprecedented opportunity to improve the clinical outcomes and care of older adults with various levels of cognitive decline, including mild cognitive impairment, Alzheimer's disease, and related dementias. This article provides information on understanding and addressing the challenges faced by health care professionals, including primary care clinicians; removing the barriers to cognitive assessments; educating this professional group on the importance of brain health, early detection, and diagnosis for their older adult patients; and providing these professionals with the ability to transfer their knowledge into more defined care planning. Until cognitive screening has been fully accepted and implemented for the optimal the care of older adults, health-related efforts should include the promotion and education of brain health, early detection, and diagnosis in the education of health care providers.



    加载中


    Conflict of interest



    The authors declare no conflict of interest.

    [1] Code of Federal RegulationsTitle 42 CFR 410.15(a) Detection of any cognitive impairment (2022). Available from: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.15#p-410.15(a)(Detection%20of%20any%20cognitive%20impairment).
    [2] Alzheimer's Foundation of America (AFA)What is a memory screening? (2022). Available from: https://alzfdn.org/memory-screening/what-is-memory-screening/.
    [3] Centers for Disease Control and Prevention (CDC)What is dementia (2022). Available from: https://www.cdc.gov/aging/dementia/index.html.
    [4] Jessen F, Amariglio R, Buckley R, et al. (2020) The characterization of subjective cognitive decline. Lancet Neurol 19: 271-278. https://doi.org/10.1016/S1474-4422(19)30368-0
    [5] Cullen NC, Leuzy A, Palmqvist S, et al. (2021) Individualized prognosis of cognitive decline and dementia in mild cognitive impairment based on plasma biomarker combinations. Nat Aging 1: 114-123. https://doi.org/10.1038/s43587-020-00003-5
    [6] Jessen F, Amariglio RE, van Boxtel M, et al. (2014) A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's disease. Alzheimers Dement 10: 844-852. https://doi.org/10.1016/j.jalz.2014.01.001
    [7] Chen YX, Liang N, Li XL, et al. (2021) Diagnosis and treatment for mild cognitive impairment: A systematic review of clinical practice guidelines and consensus statements. Front Neurol 12: 719849. https://doi.org/10.3389/fneur.2021.719849
    [8] National Institute of AgingAlzheimer's Disease Fact Sheet (2022). Available from: https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet#:~:text=Estimates%20vary%2C%20but%20experts%20suggest,of%20dementia%20among%20older%20adults.
    [9] Livingston G, Sommerlad A, Orgeta V, et al. (2017) Dementia prevention, intervention, and care. Lancet 390: 2673-2734. https://doi.org/10.1016/S0140-6736(17)31363-6
    [10] Alzheimer's Association.2022 Alzheimer's disease facts and figures. Alzheimers Dement (2022) 18: 700-789. https://doi.org/10.1002/alz.12638
    [11] Dafsari FS, Jessen F (2020) Depression—an underrecognized target for prevention of dementia in Alzheimer's disease. Transl Psychiatry 10: 1-13. https://doi.org/10.1038/s41398-020-0839-1
    [12] Aminzadeh F, Molnar FJ, Dalziel WB, et al. (2012) A review of barriers and enablers to diagnosis and management of persons with dementia in primary care. Can Geriatr J 15: 85-94. https://doi.org/10.5770/cgj.15.42
    [13] Chai DSC (2013) Early diagnosis of dementia in the primary care setting. Singapore Fam Physician 39: 15-18.
    [14] Staffaroni AM, Tsoy E, Taylor J, et al. (2020) Digital Cognitive Assessments for Dementia: Digital assessments may enhance the efficiency of evaluations in neurology and other clinics. Pract Neurol 2020: 24.
    [15] Tsoy E, Sideman AB, Piña Escudero SD, et al. (2021) Global perspectives on brief cognitive assessments for dementia diagnosis. J Alzheimers Dis 82: 1001-1013. https://doi.org/10.3233/JAD-201403
    [16] Judge D, Roberts J, Khandker R, et al. (2019) Physician perceptions about the barriers to prompt diagnosis of mild cognitive impairment and Alzheimer's disease. Int J Alzheimers Dis . https://doi.org/10.1155/2019/3637954
    [17] Dubois B, Padovani A, Scheltens P, et al. (2016) Timely diagnosis for Alzheimer's disease: A literature review on benefits and challenges. J Alzheimers Dis 49: 617-631. https://doi.org/10.3233/JAD-150692
    [18] de Levante Raphael D (2022) The knowledge and attitudes of primary care and the barriers to early detection and diagnosis of Alzheimer's disease. Medicina 58: 906. https://doi.org/10.3390/medicina58070906
    [19] Mansfield E, Noble N, Sanson-Fisher R, et al. (2019) Primary care physicians' perceived barriers to optimal dementia care: a systematic review. Gerontologist 59: e697-e708. https://doi.org/10.1093/geront/gny067
    [20] Collins R, Hunt A, Quinn C, et al. (2022) Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL programme. Dementia 21: 1135-1153. https://doi.org/10.1177/14713012211069449
    [21] Dooley J, Bailey C, McCabe R (2015) Communication in healthcare interactions in dementia: a systematic review of observational studies. Int Psychogeriatr 27: 1277-1300. https://doi:10.1017/S1041610214002890
    [22] American Family Physician.Screening for Cognitive Impairment in older adults: Recommendation statement. Am Fam Physician (2020) .
    [23] de Levante Raphael D (2022) Stigmas of Alzheimer's disease and help seeking for Alzheimer's disease among African Americans. Walden University ProQuest Dissertation Publishing . Available from: https://www.proquest.com/openview/802dc2def82170fbb123ee9b4d89ea93/1?pq-origsite=gscholar&cbl=18750&diss=y.
    [24] Yiannopoulou KG, Papageorgiou SG (2020) Current and Future Treatments in Alzheimer Disease: An Update. J Cent Nerv Syst Dis 12: 1179573520907397. https://doi.org/10.1177/1179573520907397
    [25] Atri A, Shaughnessy L, Locascio J, et al. (2008) Long term course and effectiveness of combination therapy in Alzheimer's disease. Alzheimer Dis Assoc Discord 22: 209-221. https://doi:10.1097/WAD.0b013e31816653bc
    [26] Porsteinsson AP, Isaacson RS, Sabbagh MN, et al. (2021) Diagnosis of early Alzheimer's disease: Clinical practice in 2021. J Prev Alzheim 8: 371-386. https://doi.org/10.14283/jpad.2021.23
    [27] Myrberg K, Hydén LC, Samuelsson C (2019) The mini-mental state examination (MMSE) from a language perspective: an analysis of test interaction. Clin Linguist Phonet 34: 652-670. https://doi.org/10.1080/02699206.2019.1687757
    [28] Mini-CogQuick screening for early dementia detection. Available from: https://dementiacare.com.my/abc-of-dementia/quick-screening-test-for-dementia/.
    [29] Buschke H, Kuslansky G, Katz M, et al. (1999) Screening for dementia with the memory impairment screen. Neurology 52: 231.
    [30] Montreal Cognitive Assessment (MoCA) (2022). Available from: https://mocatest.org.
    [31] Hoops S, Nazem S, Siderowf AD, et al. (2009) Validity of MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 73: 1738-1745. https://doi.org/10.1212/WNL.0b013e3181c34b47
    [32] SLU Mental Status Exam (2022). Available from: https://www.slu.edu/medicine/internal-medicine/geriatric-medicine/aging-successfully/assessment-tools/mental-status-exam.php.
    [33] Mendiondo M, Ashford JW, Schmitt F, et al. (2003) Designing a Brief Alzheimer Screen (BAS). J Alzheimers Dis 5: 391-398. https://doi.org/10.3233/JAD-2003-5506
    [34] General Practitioner Assessment of Cognition (2022). Available from: http://gpcog.com.au/.
    [35] Yokomizo JE, Seeher K, de Oliveira GM, et al. (2018) Cognitive screening test in primary care: Cut points for low education. Rev Saude Publica 52: 88. https://doi.org/10.11606/S1518-8787.2018052000462
    [36] Galvin J, Zweig Y The AD8: The Washington University Dementia Screening Test (2021). Available from: https://hign.org/consultgeri/try-this-series/ad8-washington-university-dementia-screening test.
    [37] Kim S, Jahng S, Yu KH, et al. (2018) Usefulness of the clock drawing test as a cognitive screening instrument for mild cognitive impairment and mild dementia: an evaluation using three scoring systems. Dement Neurocogn Disord 17: 100-109. https://doi.org/10.12779/dnd.2018.17.3.100
    [38] Ding Y, Niu J, Zhang Y, et al. (2018) Informant questionnaire on cognitive decline in the elderly (IQCODE) for assessing the severity of dementia in patients with Alzheimer's disease. BMC Geriatrics 18: 146. https://doi.org/10.1186/s12877-018-0837-9
    [39] Dementia Australia, Rowland Universal Dementia Assessment Scale (RUDAS). Available from: https://www.dementia.org.au/resources/rowland-universal-dementia-assessment-scale-rudas.
    [40] Kumar R, Bhattacharya S, Sharma N, et al. (2019) Cultural competence in family practice and Primary care setting. J Family Med Prim Care 8: 11-14. https://doi.org/10.4103/jfmpc.jfmpc_393_18
    [41] Stubble D (2020) Practicing cultural competence and cultural humility in the care of diverse patients. Focus 18: 49-51. https://doi.org/10.1176/appi.focus.20190041
    [42] Connel CM, Boise L, Stuckey JC, et al. (2004) Attitudes toward the diagnosis and disclosure of dementia among family caregivers and primary care physicians. Gerontologist 44: 500-507. https://doi.org/10.1093/geront/44.4.500
    [43] Huang SC, Morgan A, Peck V, et al. (2021) Improving communications with patients and families in geriatric care. The how, when and what. J Patient Experience 8: 23743735211034047. https://doi.org/10.1177/23743735211034047
    [44] Alzheimer's AssociationNew Alzheimer's Association report shows significant disconnect between seniors, physicians when it comes to cognitive assessment (2019). Available from: https://www.alz.org/news/2019/new-alzheimer-s-association-report-shows-signifi.
  • Reader Comments
  • © 2022 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(3505) PDF downloads(329) Cited by(3)

Article outline

Figures and Tables

Figures(1)  /  Tables(3)

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog