19 : Recognition and Initial Assessment of Alzheimer ' s Disease and Related Dementias Clinical Practice Guideline

Dementia in the adult U.S. population is a devastating disorder that is often unrecognized or misdiagnosed in its early stages. Despite the current lack of unequivocally effective treatment, recognition of early-stage dementia may offer substantial benefits. These include avoidance of inappropriate treatment related to misdiagnosis and time for the patient and family to address issues of financial, legal, and medical care planning. This Clinical Practice Guideline is intended to help primary care providers recognize and assess Alzheimer's disease and related dementias in their early stages. Differential diagnosis is beyond the scope of the guideline; however, the guideline contains a list of resources for further clinical evaluation once probable dementia has been identified. Guideline recommendations focus on the following areas: Triggers that should prompt a clinician to undertake an assessment for early-stage dementia. The components of an initial assessment, including tests of mental status and functional performance. A flow chart for early recognition and initial assessment, including assessment for delirium and depression. Interpretation of test results and appropriate actions. The role of neuropsychological testing. Knowledge of the individual patient is emphasized, including change in ability from baseline, as is the value of reliable informant reports to initial assessment and clinical judgment. This guideline should help clinicians recognize symptoms of possible dementia and decrease underrecognition and misdiagnosis of this devastating condition. This document is in the public domain and may be used and reprinted without special permission, except for those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. AHCPR appreciates citation as to source, and the suggested format is provided below: Costa PT Jr, Williams TF, Somerfield M, et al. Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias. Clinical Practice Guideline No. 19. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 97-0702. November 1996.