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There is growing recognition of the importance of diagnosing Alzheimer’s disease (AD) at early stages when symptoms are limited to mild cognitive impairment (MCI) and the patient can still perform everyday activities independently.2
Increasing evidence demonstrates the benefits an early diagnosis can provide for patients, their care partners, and society. However, substantial barriers in primary and secondary care continue to hinder early recognition of individuals at risk of developing AD dementia, leading to delayed diagnosis. A thorough understanding of these barriers will be an important step to inform required interventions in healthcare and evolve AD management.1-3
Evolving Alzheimer’s Disease Diagnosis
Timely AD diagnosis in clinical practice has been shown to optimize outcomes for patients and their families.2 The European Federation of the Neurological Societies (EFNS) guidelines for the diagnosis and management of Alzheimer’s provide examples on how to improve the diagnosis and management of AD following an integrated and person-centered approach.5
This approach is also reflected by the “World Health Organization (WHO) global action plan on the public health response to dementia 2017-2025” for a coordinated and efficient care pathway embedded in the health and social care system.6
The following focus areas have been highlighted by these organizations and other experts in this field as crucial for evolving AD diagnosis.1,5-7
Public awareness of AD to tackle stigma
Disseminating accurate information around Alzheimer’s disease is essential to eliminate the perception that an individual with AD is either elderly or sick. A good understanding and broad awareness of AD can encourage individuals to seek prompt medical support when early symptoms are present. This may optimize opportunities for brain health and improve the quality of life of patients and care partners.6,7
Access to AD training resources
Supporting better access to AD training for HCPs can enhance the diagnostic process and the timely identification of MCI symptoms through the administration of validated short cognitive assessments, accompanied by biomarker analysis.6,7
Integrated AD specialized care
The integrated AD care team is a multidisciplinary group which works together to provide patient-centered support. Based on the infrastructure of the clinic, and depending on the expertise of the HCP, the health care activities can be divided among the integrated AD care team. Continued support for patients and their relatives or care partners is instrumental in treating AD holistically.6,7
Person-centered support
Development of a person-centered support within the clinic has shown to improve patient stress levels, mood, and to reduce depression. The pathway should provide quality care and management that integrates multiple services, including primary health care, specialist medical care, social welfare services, and meaningful lifestyle changes. The AD care team should also advise the care partners/caregivers about their health needs. Supportive services may help care partners/caregivers to cope with their increasingly demanding role, thereby improving their confidence.6,7
What’s next
Early Intervention Matters
Close collaboration between primary and specialized care is needed to improve Alzheimer's disease management.
References
1.Krolak-Salmon P, Maillet A, Vanacore N, et al. Toward a Sequential Strategy for Diagnosing Neurocognitive Disorders: A Consensus from the "Act On Dementia" European Joint Action. J Alzheimers Dis. 2019;72(2):363-372.
2.Dubois B, Padovani A, Scheltens P, Rossi A, Dell'Agnello G. Timely Diagnosis for Alzheimer's Disease: A Literature Review on Benefits and Challenges. J Alzheimers Dis. 2016;49(3):617-631.
3.Judge D, Roberts J, Khandker R, Ambegaonkar B, Black CM. Physician Perceptions about the Barriers to Prompt Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease. Int J Alzheimers Dis. 2019;2019:3637954. Published 2019 May 21.
4.Scheltens P, De Strooper B, Kivipelto M, et al. Alzheimer's disease. Lancet. 2021;397(10284):1577-1590.
5.Hort J, O'Brien JT, Gainotti G, et al. EFNS guidelines for the diagnosis and management of Alzheimer's disease. Eur J Neurol. 2010;17(10):1236-1248.
6.World Health Organization (WHO). Global action plan on the public health response to dementia 2017 – 2025. www.who.int/mental_health/neurology/dementia/action_plan_2017_2025/en/. Accessed May 24, 2021.
7.Galvin JE, Aisen P, Langbaum JB, et al. Early Stages of Alzheimer's Disease: Evolving the Care Team for Optimal Patient Management. Front Neurol. 2021;11:592302. Published 2021 Jan 22.