CHALLENGES

Diagnosis:

  • Nearly 40% of patients with Alzheimer’s disease (AD) do not receive a clinical diagnosis.1
  • In primary care, physicians may have been concerned about the risks of misdiagnosis and/or the stigma associated with dementia.2
  • Primary healthcare providers may have limited familiarity with local dementia support or training or may have difficulty communicating with patients and caregivers.2
  • Moreover, healthcare providers may not always consider the effects of undiagnosed cognitive impairment on management of comorbid conditions and activities of daily living.2
  • Patients who are not told of an AD diagnosis are at higher risk of falls, medication errors, financial mistakes, and other unsafe activities or living conditions than informed patients.3
  • Early diagnosis remains a challenge. The slow onset of the disease can be overlooked in some patients, and comorbidities or medications may mimic or contribute to the symptoms of AD.2
  • Screening for cognitive impairments is not always part of the standard workup during the Medicare Annual Wellness Visit.4
  • The sensitivity of a clinical diagnosis is estimated to be between 71% and 87%, while the specificity is calculated to be between 44% and 71%, depending on the study.1
  • Brain imaging and biomarker tests can improve diagnostic accuracy, but they are not widely available.4
  • Brain imaging and biomarker tests are not appropriate in all patients.5

Treatment:

  • Current treatment approaches can improve cognitive function, global clinical status, and performance of activities of daily living in patients, but they do not alter the course of the disease and may be associated with dose-limiting adverse events that require switching medications.6
  • Management of comorbid conditions (eg, diabetes, cardiovascular disease, depression, osteoporosis) can lead to polypharmacy.6
  • More than 50,000 people are needed to participate in clinical research about AD and related dementias to advance prevention of and treatment for these diseases.7
  • Physicians should encourage patients with AD, caregivers, and healthy volunteers to enroll in clinical trials.7 Clinical trials can be found at https://trialmatch.alz.org/find-clinical-trials
References

  1. Beach TG, Monsell SE, Phillips LE, Kukull W. Accuracy of the clinical diagnosis of Alzheimer disease at National Institute on Aging Alzheimer Disease Centers, 2005-2010. J Neuropathol Exp Neurol. 2012;71:266-273.
  2. Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord. 2009;23:306-314.
  3. Amjad H, Roth DL, Samus QM, Yasar S, Wolff JL. Potentially unsafe activities and living conditions of older adults with dementia. J Am Geriatr Soc. 2016;64:1223-1232.
  4. Cordell CB, Borson S, Boustani M, et al. Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement. 2013;9:141-150.
  5. Johnson KA, Minoshima S, Bohnen NI, et al. Appropriate use criteria for amyloid PET: A report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer’s Association. Alzheimers Dement. 2013;9:e-1-16.
  6. Cummings JL, Isaacson RS, Schmitt FA, Velting DM. A practical algorithm for managing Alzheimer’s disease: what, when, and why? Ann Clin Transl Neurol. 2015;2:307-323.
  7. Alzheimer’s disease clinical trials fact sheet. www.alz.org/northcentraltexas/documents/alzheimers_disease_clinical_trials_fact_sheet.pdf Accessed April 27, 2017.

Epidemiology

Challenges

Diagnosis

Biomarkers

Treatments

Additional Reading