The Alzheimer’s Association Clinical Practice Guideline for the Diagnostic Evaluation, Testing, Counseling and Disclosure of Suspected Alzheimer’s Disease and Related Disorders (DETeCD-ADRD): Executive Summary of Recommendations for Primary and Specialty Care
Bradford Dickerson1, Alireza Atri2
1MGH/Harvard, 2Banner Sun Health Research Institute
Objective:
To develop evidence-supported clinical practice guidelines for the process of diagnostic evaluation and disclosure of a clinical diagnosis of AD or ADRD in U.S. contemporary primary and specialty care.
Background:

United States clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer’s Disease (AD) or a Related Disease (ADRD) are two decades old. This evidence-based guideline was developed to empower all clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. 

Design/Methods:

The Alzheimer’s Association convened a multi-disciplinary DETeCD-ADRD CPG expert workgroup composed of 10 voting members from primary care and specialties  and retained a team with expertise in developing clinical practice guidelines. The DETeCD-ADRD CPG workgroup in developing the guideline through a formalized process modeled after that described in the AAN CPG Manual, ensuring that the process was transparent, that conflict of interest was managed appropriately, that the workgroup was composed of multidisciplinary experts who were engaged in all steps of the process, and that the DETeCD-ADRD CPG Recommendations and Report underwent external peer review by a group including a patient advocate (all in accordance with best practices described in the Institute of Medicine’s Clinical Practice Guidelines We Can Trust (2011)).


The workgroup conducted a review of 7,374 publications (133 met inclusion criteria) and developed recommendations as steps in an evaluation process. 

Results:

This summary reviews core recommendations and details specialist recommendations of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing and disclosing the patient’s Cognitive Functional Status, Cognitive-Behavioral Syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed.

Conclusions:

If clinicians use the recommendations in this guideline and health care systems provide adequate resources, outcomes should improve in most patients in most practice settings.

10.1212/WNL.0000000000212291
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