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

  • Learning and retaining new information. For example: is more repetitive; has more trouble remembering recent conversations, events, appointments; more frequently misplaces objects.
  • Handling complex tasks. For example: has more trouble following a complex train of thought, performing tasks that require many steps such as balancing a checkbook or cooking a meal.
  • Reasoning ability. For example: is unable to respond with a reasonable plan to problems at work or home, such as knowing what to do if the bathroom flooded; shows uncharacteristic disregard for rules of social conduct.
  • Spatial ability and orientation. For example: has trouble driving, organizing objects around the house, finding his or her way around familiar places.
  • Language. For example: has increasing difficulty with finding the words to express what he or she wants to say and with following conversations.
  • Behavior. For example: appears more passive and less responsive; is more irritable than usual; is more suspicious than usual; misinterprets visual or auditory stimuli. In addition to failure to arrive at the right time for appointments; the clinician can look for difficulty discussing current events in an area on interest and changes in behavior and dress. It might also be helpful to follow up on areas of concern by asking the patient or family members relevant questions.
Guideline Development
The Agency for Health Care Policy and Research convened an 18-member private-sector, interdisciplinary panel composed of psychologists, psychiatrists, neurologists, an internist, geriatricians, nurses, a social worker, and consumer representatives. The panel conducted extensive literature searches to identify empirical studies of assessment of mental status instruments for differentiating persons with and without dementia and instruments used in the assessment of persons with Alzheimer's disease. It conducted additional literature searches related to assessment of functional impairment and risk factors for dementia and conducted meta-analyses. The panel also held a public hearing to give interested organizations, individuals, and agencies an opportunity to present oral or written testimony for the panel's consideration.

The results of the literature reviews and meta-analyses were used to develop a draft guideline. Copies were distributed for two peer review cycles. Reviewers were selected to represent a broad range of disciplines and clinical practice areas. A total of 109 reviewers submitted comments, which were collated and reviewed by the panel co-chairs and used to develop the final guideline.

Current Availability
You can now obtain copies of the Consumer Version free through InstantFAX, which operates all day every day. Using a fax machine equipped with a touch tone telephone, dial (301) 594-2800, push 0 and follow the voice prompts. The code for the publication is 967123.

Future Availability
Additional guideline information will be available later this year (Winter 1996) in several forms:

  • Clinical Practice Guideline, intended for the health care provider, contains a discussion of the issues and the panel's findings and recommendations, with supporting evidence and references. It also includes a series of tables and a flow chart summarizing the panel's recommended approach to early recognition and initial assessment of suspected dementia.
  • Quick Reference Guide for Clinicians, also intended for health care providers, is a brief summary of and companion piece to the Clinical Practice Guideline. It provides highlights of initial assessment and interpretation of findings and presents the tables and flow chart.
  • Consumer Version, published in English and Spanish, is a brochure for patients, their families, and the general public that describes the problem, outlines procedures for identifying dementia in its early stages, and provides resource information for those who must deal with a diagnosis of probable Alzheimer's disease or a related dementia.
To obtain further information on the availability of the Quick Reference Guide or Consumer Version, call the AHCPR Publications Clearinghouse at (800) 358-9295 or write to:
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