Explain the Importance of a Diagnostic Evaluation to Individuals and Their Families

Primary care teams should support individuals and their families through the diagnostic journey by setting appropriate expectations, addressing misconceptions, and conveying information about the benefits of completing the process in an accessible way, free of jargon and judgment.

Results from public surveys about Alzheimer’s disease indicate that people have an interest in knowing the truth about their dementia-related symptoms or the symptoms of a family member.

In an international survey, 85% of respondents stated that if they were exhibiting confusion and memory loss, they would want to see a doctor to determine whether the cause of the symptoms was Alzheimer’s disease; more than 94% stated they would want the same care if a family member were exhibiting the symptoms.

(Harvard School of Public Health & Alzheimer Europe, 2011)

In addition, as described in the In Brief for Healthcare Professionals from the Alzheimer’s Association, primary care teams may want to convey to people prior to their visits that the team’s goal is to help them improve their health, delay their symptoms, and allow them to continue doing activities they enjoy. This type of communication is crucial because people may fail to follow through on the primary care team’s recommendations. Lack of follow-up may occur because of fear or shame about the possibility of a confirmed dementia diagnosis, reluctance to have others know about the diagnosis, and worry about consequences such as loss of the individual’s driver’s license, rejection for health or long-term care insurance, or refused admission to an assisted living facility or other senior residence.

Strategies to delay the progression of dementia are available.

Healthy Diet and Physical Activity

For example, a healthy diet and physical activity have been shown to prevent dementia progression (George, 2019). 

“New approaches for delaying progression of dementia require an accurate diagnosis”

New Approaches for Delaying Progression of Dementia

Importantly, new approaches for delaying progression of dementia require an accurate diagnosis.

For example, the U.S. Food and Drug Administration (FDA) has approved new monoclonal antibody infusion treatments for mild cognitive impairment or early-stage dementia due to Alzheimer’s disease. Coverage requires the presence of Alzheimer’s disease biomarkers, which can be demonstrated in the cerebrospinal fluid with a lumbar puncture, or with beta-amyloid positron emission tomography (PET) imaging. One blood test is available that is not FDA approved but has received breakthrough device designation and is available via self-pay (Anderson 2022). Blood tests are currently not recommended for primary care settings (Hansson 2022).

Given monitoring requirements and risks for cerebral microhemorrhages, the balance of potential harms and benefits for these new treatment approaches should be carefully weighed. Primary care teams may consider referral to a specialist to evaluate appropriateness for infusion treatments if patients meet recommendations for inclusion (contraindications include anticoagulation and history of autoimmune or inflammatory conditions) (Cummings, 2023).

Resources

Several resources are available to share with the individual about the benefits of a timely dementia diagnosis.

For example, Alzheimer’s and Dementia is a website from the National Institute on Aging that includes information about early diagnosis; it is also available in Spanish. 

Why Get Checked? from the Alzheimer’s Association is another helpful resource that is also available in Spanish.

Evaluate | Approaches to Implement