Alzheimer's Disease Clinical Practice Guidelines (2018)

The Alzheimer's Association

Reviewed and summarized by Medscape editors

August 09, 2018

The clinical practice guidelines on Alzheimer's disease were released on July 22, 2018, by the AA.[1,2]

All middle-aged or older individuals who self-report or whose care partner or clinician report cognitive, behavioral or functional changes should undergo a timely evaluation.

Concerns should not be dismissed as “normal aging” without a proper assessment.

Evaluation should involve not only the patient and clinician but, almost always, also involve a care partner (eg, family member or confidant).

Alzheimer's disease and related dementias may lead to both behavioral and cognitive symptoms of dementia. As a result, these conditions can produce changes in mood, anxiety, sleep, and personality, as well as interpersonal, work, and social relationships, that are often noticeable before more familiar memory and thinking symptoms of Alzheimer's disease and related dementias appear.

Magnetic resonance imaging or computed tomography should be obtained to help establish etiology in a patient being evaluated for a cognitive behavioral syndrome.

Advocates molecular imaging with fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging when there is continued diagnostic uncertainty regarding etiology after structural imaging has been interpreted.

Suggests a dementia specialist obtain cerebrospinal fluid of amyloid beta-42 and tau/p-tau profiles to evaluate Alzheimer's disease pathology in a patient with an established cognitive behavioral syndrome in whom there is continued diagnostic uncertainty regarding etiology after structural imaging and/or FDG-PET. The other states that, if diagnostic uncertainty still exists, an amyloid PET scan may be obtained.

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