These research findings now need to be translated into clinical practice. Healthcare systems are required to provide resources at both the primary and secondary care level to inform an effective referral process for timely diagnosis. In addition, resources are needed to allow physicians to better care for their patients and care partners in a holistic way.1,4,5
Individuals with a cognitive complaint present to specialist like neurologists, psychiatrists, and geriatricians. However, the General Practitioners (GPs) or Primary Care Providers (PCPs) are often the first point of contact and thus play a key role to detect, disclose, and evaluate a cognitive complaint or an at-risk situation.4 Establishing a clinical diagnosis of AD is a stepwise process that is often a shared responsibility between GPs/PCPs and specialists.1,2,6
This section is intended to support healthcare professionals in their person-centered approach by providing suggestions on how to engage with patients before, during, and after a diagnosis of AD at the early disease stages.
It is never too early or never too late for evidence-based prevention of cognitive decline. Physicians can play a key role in empowering their patients to gain greater control over their brain health and to implement appropriate lifestyle changes that could prevent or mitigate the risk of dementia throughout their life. This strategy also highlights the need for increased awareness of Alzheimer's disease, supported by both public health programs and individually tailored interventions.5,7
An open dialogue between HCPs and their patients, along with disease awareness can help tackle stigma and fears associated with Alzheimer's disease. The stigma of AD may prevent people from talking with their doctors about their cognitive complaints.8
One proposed strategy to foster an accurate understanding and identification of early signs of the disease is to include the monitoring of cognitive health during regular check-ups. For example, special attention should be paid to those patients in consultation due to a chronic disease known to be associated with an increased risk of developing AD, such as diabetes, heart diseases, or a history of stroke.9
The essential elements of a comprehensive cognitive evaluation include assessment of diverse cognitive domains, patient functionality, and behaviour.6,13 Several brief assessment tools for screening and monitoring cognitive health in clinical practice are available and should be used where possible.14 Cognitive assessment tools can be grouped into two different subtypes: subjective assessment and objective cognitive assessment.
Subjective assessment tools are questionnaires which can be completed as self-report or informant-report (e.g., by the care partner) via interview or self-administered, i.e., in the waiting room prior to the physician visit.
Subjective tools use an intra-individual measure of change to characterize whether cognitive decline has occurred and how that decline interferes with social and occupational functioning.
Since the person serves as their own control, these tools are less subject to age, gender, racial, ethnic, cultural, educational, or socioeconomic biases.
In addition to cognition, some tools also cover behavioural, and functional aspects.
Objective cognitive performance assessments are administered by a healthcare professional to assess the cognitive performance ability of the individual.
Existing tests screen the amnestic domain alone or in combination with non-amnestic domains and rely on inter-individual norms.
Combining performance, informant-, and self-reports is an efficient approach to greatly enhance the ability to capture early cognitive change, and inform further assessment of the main cognitive domains.15-18 Such a screening approach is recommended in primary care settings to facilitate recognition of cognitive impairment, to support differential diagnosis, and to more accurately inform an individual care strategy.1,14
The informant- or self-report questionnaire “Eight-item Interview to Differentiate Ageing and Dementia” (AD8)19 can, for example, be combined with the cognitive screening tool Montreal Cognitive Assessment (MoCA).20 The self-administered AD8 and the HCP-administered MoCA are the top two validated screening tools with the highest administration efficiency, (i.e., number of cognitive domains tested per minute) and sensitivity to detect individuals with mild cognitive impairment.20-22
Considerations when using short
cognitive tests
The AD8 test is a short “yes/no” questionnaire where the patient or informant rates subjective changes about memory, orientation, judgment, and everyday function.22
MoCA test is the most sensitive screening tool for MCI due to potential AD because it addresses additional frontal-executive function domains not commonly found in other brief performance tests.20
The recommended complementary approach to combine different sources of information to improve MCI diagnosis has triggered the validation of several screening tools, integrating objective cognitive performance assessment with subjective self- or informant-reports.15-17
The GPCOG is an online screening tool for cognitive impairment which has been designed for general practitioners, primary care physicians, and family doctors. The GPCOG score is not influenced by the cultural and linguistic background of a person, making it an invaluable screening tool especially in multicultural patient settings.15
After confirmation of the MCI clinical criteria and exclusion of other medical causes, a biomarker evaluation of amyloid beta is a minimal requirement to confirm Alzheimer's disease.31,32
Stigma, fears, and negative stereotypes associated with AD may predispose people to not accept a confirmed diagnosis or a suspicion of AD.2
Supporting patients in a holistic way includes disease education and a close collaboration with the patient and their care partner, and between primary and specialized care. This in turn can help to increase adherence to the medical strategy.8
In conclusion, a timely and accurate diagnosis of Alzheimer’s disease can lead to the initiation of interventions when they might be most effective to benefit patients.13
When communicating about diagnosis and intervention options, Alzheimer’s disease, like other neurodegenerative diseases, requires gradual information over a period of time suited to the recipient’s personal characteristics.34,35
WHAT'S NEXT
Lifestyle interventions, including social and cognitive activity, may help preserve brain health.
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