Being a condition, which has no diagnostic tests except to rule out organic pathology; diagnosis is purely clinical; new guidelines will immensely help physicians especially primary care practitioners.

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Guy McKhann, MD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, who chaired the Alzheimer’s Disease Dementia Workgroup, was instrumental to the definition of the 1984 diagnostic criteria and headed the working group on dementia due to AD.

During the briefing, Dr. McKhann pointed out that the diagnosis of AD is still a clinical one in this document. “Primarily, we’re asking the physician, with the help of an informant — members of the family, even the patient — to make a judgment as to whether or not dementia has occurred or is occurring.”

Biomarkers can assist in the diagnosis of AD but are not essential; rather they are used in research studies to augment certainty about a given diagnosis, he said. “But for the practicing physician — and I would caution that people who see these folks first are not necessarily neurologists or psychiatrists; they are people who are geriatricians, general practitioners, internists — the people who see these people first, are first making this distinction on clinical grounds.”

They aimed to make the diagnostic criteria sufficiently flexible to serve both general healthcare providers without access to imaging, CSF measures, or neuropsychological testing, as well as specialized investigators in clinical trial settings, the study authors note.

Highlights:
1.In dementia due to AD, cognitive and behavioral symptoms hinder the patient’s ability to function in daily life.

2.The diagnosis of AD is still primarily a clinical diagnosis, with the physician determining whether or not dementia has occurred or is occurring, based on information from the family and even the patient.

3.As in the original AD criteria, it is essential to exclude other causes of dementia and to document progressive deterioration with time.

4.Memory impairment may not always be the most prominent or presenting feature of AD. Impairments in word-finding, vision/spatial issues, reasoning, judgment, and/or problem solving may be the initial or most troublesome symptoms.

5.The diagnostic criteria are intended to be useful to general healthcare providers without access to imaging, CSF measures, or neuropsychological testing, as well as to specialized investigators in clinical trial settings.

6.Diagnostic criteria for probable and possible AD include biomarker evidence, at least for research settings.

7.The diagnostic criteria for MCI are not much changed for the purposes of clinical practice and are meant to be used by physicians in any setting.

8.In MCI due to AD, there are mild, but noticeable and quantifiable, changes in memory and cognitive function. However, these are insufficient to cause impairments in activities of daily living.

9.Recognition of the mild impairment in MCI due to AD is gradually increasing and improving in medical and specialty practice.

10.A substantial percentage of, but not all, patients with MCI due to AD ultimately go on to have dementia due to AD.

11.Additional research is needed to help identify those individuals with MCI who will deteriorate to the category of dementia due to AD.

12.Biomarkers may be useful in this regard, but they are currently included only in the research setting.

13.The MCI working group developed 2 sets of criteria: “core clinical criteria,” intended for clinicians without availability of advanced imaging or CSF analysis; and research criteria, including biomarkers intended for use in clinical trials and other research settings.

14.4 clinical criteria for MCI due to AD include the following:

a.Concern regarding a change in cognition: The earlier criteria required that the patient had to report this concern and that an informant had to corroborate it, whereas the                   new criteria require that the concern can be expressed by the patient, an informant, or a skilled clinician.

b.Impairment in 1 or more cognitive domains, with test scores lower than expected for the patient’s age and education, and with worsening on subsequent testing, if available: Episodic memory impairment is most common in patients with MCI who progress to AD, but initial impairments in MCI may involve executive function, language, attention, or visuospatial skills.

c.Maintained independence in functional abilities: Patients with MCI should retain functional independence with minimal assistance, although they may take longer, be less efficient, and make more errors in tasks such as paying bills and cooking.

d.Not demented: In MCI, cognitive changes should be mild enough that there is no evidence of social or occupational impairment.

More: http://www.medscape.org/viewarticle/741690?src=cmemp