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 Medical Self-Care: Early Alzheimer's Disease: Recognition and Assessment. - Guideline Overview No. 19 
 

  • No evidence exists to support recommending some of the most frequently used screening tests over others.
  • None of the tests has a high sensitivity for early or mild dementia.
  • No evidence supports the efficacy of a general screen for Alzheimer's disease or related dementias, given the lack of unequivocally effective treatment and the difficulty of recognizing early dementia.
The panel subsequently limited its scope specifically to the subject of recognition and initial assessment and therefore did not address differential diagnosis, management, or treatment issues after diagnosis.

Principal Objective
The panel's principal objective was to increase the likelihood of early recognition and assessment of a potential dementing illness so that (1) concern can be eliminated if it is not warranted; (2) treatable conditions can be identified and addressed appropriately; and (3) nonreversible conditions can be diagnosed early enough to permit the patient and family to plan for contingencies such as long-term care.

Specifically, the panel's goals were to:

  • Improve the detection of Alzheimer's disease and related dementias in their early stages in persons exhibiting certain signs and behaviors.
  • Educate health professionals, patients, and their families about symptoms that suggest the need for an initial assessment for a dementing disorder.
  • Identify areas for further research on early recognition of dementia.
Findings
The panel's major findings include:

  • Certain triggers should prompt a clinician to undertake an initial assessment for dementia rather than attribute apparent signs of decline to aging.
  • An initial clinical assessment should combine information from a focused history and physical examination, an evaluation of mental and functional status, and reliable informant reports. It also should include assessment for delirium and depression.
  • An assessment instrument known as the Functional Activities Questionnaire is a particularly useful informant-based measure in the initial assessment for functional impairment.
  • Among effective mental status tests, the Mini-Mental State Examination, the Blessed Information-Memory-Concentration Test, the Blessed Orientation-Memory-Concentration Test, and the Short Test of Mental Status are largely equivalent in discriminative ability for early-stage dementia.
  • Clinicians should assess and consider factors such as sensory impairment and physical disability in selection of mental and functional status tests, and other confounding factors such as age, educational level, and cultural influences in interpretation of test results.
In asymptomatic persons who have possible risk factors (e.g., family history and Down syndrome for Alzheimer's disease), the clinician's judgment and knowledge of the patient's current condition, history, and social situation (living arrangements, support services, isolation) should guide the decision to initiate an assessment for dementia.

Initiating an Assessment
For a diagnosis of dementia, current criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), require evidence of decline from previous levels of functioning and impairment in multiple cognitive domains, not solely memory. Because evidence of decline in previous abilities is critical in establishing dementia, a personal knowledge of the patient is invaluable to the clinician in assessing symptoms and interpreting results of an initial assessment for dementia.

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