Diagnosis of Suspected Alzheimer’s Disease and Related Disorders Source: Alzheimer's Association

https://reference.medscape.com/cc2/p10/guideline-suspected-alzheimers-disease-2026a1000647?ecd=mkm_ret_260716_mscpmrk-OUS_BO_etid8502080&uac=148436CN&impID=8502080 This Medscape summary of Alzheimer’s Association guidance covers diagnostic evaluation, testing, counseling, and disclosure of suspected AD and related disorders. For a complete set of recommendations, including strengths of evidence, methods, rationale, and discussion, refer to the full guidelines. A list of abbreviations can be found at the end of this summary. Key Takeaways from the Guideline The clinician should initiate a multitiered evaluation of patients who self-report or whose care partner or clinician reports cognitive, behavioral, or functional changes Use individualized communication to develop a partnership with the patient and/or their care partner to assess their capacity to set goals and set those goals Establish a diagnostic formulation, using tiers of assessments according to the patient’s presentation, risk factors, and profile, to determine the degree of impairment, cognitive–behavioral syndrome, and likely cause(s) and contributing factors Consult an informant to obtain reliable information on changes in the patient’s cognition, ability to perform activities of daily living, mood and other neuropsychiatric symptoms, and sensory and motor function Perform an examination of cognition, mood, and behavior and a dementia-focused neurologic examination, using structured and validated tools to assess cognition if possible Routinely conduct laboratory tests tailored to the patient’s medical risks and profile, and order structural brain imaging, such as MRI (or CT if MRI is unavailable), to aid in establishing the cause(s) of cognitive or behavioral symptoms Establish a dialogue to ensure understanding of Alzheimer's disease, and honestly and compassionately inform the patient and care partner of the disease's name, characteristics, severity, likely cause, disease stage, future expectations, treatment options, safety concerns, and available support services Strongly consider referral to a specialist or a dementia subspecialist for patients presenting with atypical cognitive abnormalities, sensorimotor dysfunction, mood/behavioral disturbances, early onset, rapid progression, fluctuating course, or incongruent findings The specialist should take a comprehensive history and perform an office-based examination to narrow or widen the differential diagnosis and guide the selection of further diagnostic tests Use advanced diagnostic tools sequentially if uncertainty remains, including FDG-PET imaging, CSF analysis, or amyloid PET scanning to identify specific neuropathologic changes or cerebral amyloid pathology. CSF=cerebrospinal fluid; CT=computed tomography; FDG=fluorodeoxyglucose; MRI=magnetic resonance imaging; PET=positron emission tomography