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Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias Clinical Practice Guideline No

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Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias Clinical Practice Guideline No 19: Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias Clinical Practice Guideline No. 19. [THIS DOCUMENT IS NO LONGER VIEWED AS GUIDANCE FOR CURRENT MEDICAL PRACTICE] AHCPR Publication No. 97-0702: November 1996 Link to the National Guideline Clearinghouse AHCPR The Agency for Health Care Policy and Research (AHCPR) was established in December 1989 under Public Law 101-239 (Omnibus Budget Reconciliation Act of 1989) to enhance the quality, appropriateness, and effectiveness of health care services and access to these services. AHCPR carries out its mission by conducting and supporting general health services research, including medical effectiveness research, facilitating development of clinical practice guidelines, and disseminating research findings and guidelines to health care providers, policymakers, and the public. The legislation also established within AHCPR the Office of the Forum for Quality and Effectiveness in Health Care (the Forum). The Forum has primary responsibility for facilitating the development, periodic review, and updating of clinical practice guidelines. The guidelines will assist practitioners in the prevention, diagnosis, treatment, and management of clinical conditions. Guidelines are available in formats suitable for health care practitioners, the scientific community, educators, and consumers. AHCPR invites comments and suggestions from users. Please send written comments to Director, Office of the Forum for Quality and Effectiveness in Health Care, AHCPR, Willco Building, Suite 310, 6000 Executive Boulevard, Rockville, MD 20852. Availability of Guidelines For each clinical practice guideline developed under the sponsorship of the Agency for Health Care Policy and Research (AHCPR), several versions are produced to meet different needs. The Clinical Practice Guideline presents recommendations for health care providers with brief supporting information, tables and figures, and pertinent references. The Quick Reference Guide is a distilled version of the Clinical Practice Guideline, with summary points for ready reference on a day-to-day basis. The Consumer Guide, available in English and Spanish, is an information booklet for the general public to increase consumer knowledge and involvement in health care decisionmaking. To order single copies of the Quick Reference Guide or Consumer Guide, or to obtain further information on their availability, call the AHCPR Publications Clearinghouse toll-free at 800- 358-9295 or write to: AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907. Single copies of the Clinical Practice Guideline are available for sale from the Government Printing Office, Superintendent of Documents, Washington, DC 20402, with a 25-percent discount given for bulk orders of 100 copies or more. The Quick Reference Guide and the discount given for bulk orders of 100 copies or more. The Quick Reference Guide and the Consumer Guide in English also are available for sale in bulk quantities only. Call (202) 512- 1800 for price and ordering information. The Guideline Technical Report contains supporting materials for the Clinical Practice Guideline, including background information, methodology, literature review, scientific evidence tables, recommendations for research, and a comprehensive bibliography. The Technical Report may be ordered from the National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161. Call (703) 487-4650 for price and ordering information. The full text of guideline documents for online retrieval is available on Internet through the AHCPR Home Page. Access the guideline products by using a Web browser, specifying URL http://www.ahcpr.gov/guide/ and selecting "Clinical Practice Guidelines Online." A fact sheet describing Online Access for Clinical Practice Guidelines (AHCPR Publication No. 94-0075) and copies of the Quick Reference Guide and the Consumer Guide of each guideline are available through AHCPR's InstantFAX, a fax-on-demand service that operates 24 hours a day, 7 days a week. AHCPR's InstantFAX is accessible to anyone using a facsimile machine equipped with a touchtone telephone handset: Dial (301) 594-2800, push "1," and then press the facsimile machine's start button for instructions and a list of currently available publications. Alzheimer's Disease and Related Dementias Guideline Panel Paul T. Costa, Jr., PhD (Cochair) T. Franklin Williams, MD, FACP (Cochair) Marilyn S. Albert, PhD Nelson M. Butters, PhD (Deceased) Marshal F. Folstein, MD Sid Gilman, MD Barry J. Gurland, FRCPhys, FRCPsych Lisa P. Gwyther, MSW, CCSW, ACSW Albert Heyman, MD Alfred W. Kaszniak, PhD, ABPP Ira R. Katz, MD, PhD Linda L. Levy, MA, OTR/L, FAOTA Nancy Emerson Lombardo, PhD Nancy K. Orr-Rainey, MSG Linda R. Phillips, PhD, RN, FAAN Martha Storandt, PhD Eric G. Tangalos, MD, FACP May L. Wykle, PhD, RN, FAAN Guideline Development and Use Guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical conditions. This guideline was developed by a private-sector panel convened by the Agency for Health Care Policy and Research (AHCPR). The guideline reflects the state of knowledge, current at the time of publication, on effective and appropriate care. The panel employed an explicit science-based methodology and expert clinical judgment to develop specific statements on patient assessment and management for the clinical condition selected. Extensive literature searches were conducted, and critical reviews and syntheses were used to evaluate empirical evidence and significant outcomes. Peer review was undertaken to evaluate the reliability and utility of the guideline in clinical practice. The panel's recommendations are primarily based on the published scientific literature. When the scientific literature was incomplete or inconsistent in a particular area, the recommendations reflect the professional judgment of panel members and consultants. We believe that this AHCPR-assisted clinical practice guideline will make positive contributions to the quality of care in the United States. We encourage practitioners and patients to use the information provided in the guideline. The recommendations may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the practitioner based on available resources and circumstances presented by individual patients. Clifton R. Gaus, ScD Administrator Agency for Health Care Policy and Research Publication of this guideline does not necessarily represent endorsement by the U.S. Department of Health and Human Services. Abstract 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. Acknowledgments Many people and professional organizations contributed importantly to the development of this Clinical Practice Guideline, from its earliest stages through two review cycles. The consultants, technical advisors, and reviewers listed at the end of this guideline devoted considerable time and effort to this collaborative effort and greatly helped the panel. Several persons helped immeasurably in identifying key issues, compiling relevant literature, and critiquing manuscript drafts of the guideline. These persons were Alan Zonderman, PhD, and Jeffrey Herbst of the Gerontology Research Center, National
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