THE IMPORTANCE OF EARLY DETECTION OF ALZHEIMER’S DISEASE

Detecting mild cognitive impairment (MCI) due to Alzheimer’s disease (AD) early provides an opportunity to begin management that may help preserve existing function as long as possible.1

An opportunity to take action

Pathophysiological changes due to AD may occur many years before symptoms appear. MCI due to AD provides a potential window to detect and diagnose Alzheimer’s disease before significant neurodegeneration has begun.1-3

Yet, Alzheimer’s disease remains underdiagnosed and underreported. In fact, the average diagnosis is delayed by an average of 2 to 3 years after symptom onset.1,4 

MCI due to AD is the earliest stage when symptoms may be evident5

AD is the most common cause of MCI,* accounting for an estimated 34% to 75% of all patients.6,7 Patients with suspected MCI should undergo a comprehensive history and physical examination to distinguish MCI from normal aging or dementia, and separate it from other causes.8 Alzheimer’s disease biomarkers may provide evidence of the underlying cause.9

*In the Aging, Demographics, and Memory Study (ADAMS), individuals were classified as having cognitive impairment without dementia.6

Alzheimer’s Disease Continuum With Stages for Early Detection Highlighted10,11

Cognitive symptoms interfere with some daily activities Mild cognitive symptoms appear. But they do not interfere with daily activities Severe AD Dementia Moderate AD Dementia Mild AD Dementia MCI due to AD Preclinical AD Cognitive symptoms interfere with some daily activities Mild cognitive symptoms appear. But they do not interfere with daily activities Severe AD Dementia Moderate AD Dementia Mild AD Dementia MCI due to AD Preclinical AD

Recognition of MCI due to AD is low, despite a high prevalence of AD

Studies show that cognitive impairment may remain unrecognized in up to 80% of affected patients in primary care. 

However, among patients with cognitive impairment, 60% to 80% have AD.10,12

Understanding and overcoming barriers to early diagnosis of AD

Low recognition of AD may be caused by several barriers, including12,13:

  1. oneThe time burden associated with testing and counseling
  2. twoReluctance of patients and caregivers to report signs or symptoms due to stigma around Alzheimer's disease
  3. threeLack of diagnostic resources

Detection of MCI due to AD

Early detection and diagnosis of AD may be possible during the MCI stage when the earliest symptoms of AD first appear. The following steps may be helpful for building a process to detect and diagnose.2,3,5

  • check-icon Assess if the patient has concerns about changes in cognition or if there is evidence of cognitive deterioration
  • check-icon Screen for MCI and determine if the patient is still functioning independently and does not suffer from dementia
  • check-icon Rule out other pathologies including vascular, traumatic, or medical causes
  • check-icon Determine if the patient’s memory is affected
  • check-icon Decide if biomarker assessments such as magnetic resonance imaging (MRI), amyloid beta positron emission tomography (PET) scan, or cerebrospinal fluid (CSF) analysis are appropriate for confirming disease pathology14,15
LEARN MORE ABOUT THE BIOMARKER CONFIRMATION OF AD

Biomarker confirmation of AD at the MCI stage affords clinicians the opportunity to confidently begin appropriate management.9

Cognitive Tests Inform the Alzheimer's Disease Diagnosis

Read these patient profiles to see how cognitive tests can strengthen assessments and biomarker testing can confirm the diagnosis of different patient types.

Diagnosing MCI due to AD in a high-functioning patient

MARK
64-Year-old male
Diagnosis: MCI due to AD
MARK
64-Year-old male
DETECT
COMPLAINT

Difficulty learning, forgetting job details

FAMILY HISTORY

No dementia

ASSESS
COGNITIVE ASSESSMENT

Elevated subjective memory complaints; MMSE=28/30; at 6-month follow-up, patient restated complaints and reassessment was made; MoCA=25/30

FUNCTIONAL DEPENDENCE

Fully independent (30/30 on FAQ)

MRI

Hippocampal atrophy, periventricular white matter hyperintensities

CONFIRM
BIOMARKER CONFIRMATION - AMYLOID PET IMAGING

Amyloid deposition detected with increased tracer retention

DIAGNOSIS
MCI due to AD

Diagnosing mild AD dementia in a patient with declining function

LINDA
75-Year-old female
Diagnosis: Mild AD dementia
LINDA
75-Year-old female
DETECT
COMPLAINT

Worsening cognitive problems, memory failure

FAMILY HISTORY

No dementia

ASSESS
NEUROLOGICAL TESTS

Difficulty with ideomotor apraxia testing, like mimicking the combing of her hair, and some diminished balance

COGNITIVE ASSESSMENT

Elevated subjective memory complaints; MMSE=24/30; conceptual and spatial/planning errors in the Clock Drawing Test without hands and with gaps in number spacing, respectively

FUNCTIONAL DEPENDENCE

Difficulty with daily functioning, including housework, shopping, and remembering her medications. Dependent on assistance to manage finances (Stage 4 on FAST [Functional Assessment Staging Test]—mild AD dementia)

MRI

Ventricular dilatation, hippocampal atrophy, mild frontal and anterior temporal cortical atrophy

CONFIRM
BIOMARKER CONFIRMATION – CSF TEST

CSF AB42/40 detected below LLN (Lower Limit of Normal) cutoff

DIAGNOSIS
Mild AD dementia

Get the complete picture

Learn more with these practical examples of
early-stage Alzheimer’s disease diagnosis
containing additional information.

DOWNLOAD THE MCI DUE TO AD PATIENT PROFILE
DOWNLOAD THE MILD AD DEMENTIA PATIENT PROFILE

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What’s Next?

Early diagnosis of Alzheimer’s disease

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References

1.
Alzheimer's Association. Alzheimer's Association Report: 2018 Alzheimer's disease facts and figures. Alzheimers Dement. 2018;14:367-429.
2.
Petersen RC. Mild cognitive impairment. Continuum (Minneap Minn). 2016;22(2):404-418.
3.
Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging–Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):270-279.
4.
Sabbagh MN, Lue L-F, Fayard D, Shi J. Increasing precision of clinical diagnosis of Alzheimer’s disease using a combined algorithm incorporating clinical and novel biomarker data. Neurol Ther. 2017;6(suppl 1):S83-S95.
5.
Morris JC, Blennow K, Froelich L, et al. Harmonized diagnostic criteria for Alzheimer’s disease: recommendations. J Intern Med. 2014;275(3):204-213.
6.
Plassman BL, Langa KM, Fisher GG, et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148(6):427-434.
7.
Knopman DS, Gottesman RF, Sharrett AR. Mild cognitive impairment and dementia prevalence: the Atherosclerosis Risk in Communities Neurocognitive Study. Alzheimers Dement (Amst.). 2016;2:1-11. doi:10.1016/j.dadm.2015.12.002.
8.
Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. JAMA. 2014;312(23):2551-2561.
9.
Oboudiyat C, Glazer H, Seifan A, Greer C, Isaacson RS. Alzheimer’s disease. Semin Neurol. 2013;33(4):313-329.
10.
Alzheimer’s Association. Alzheimer's Association Report: 2020 Alzheimer’s disease facts and figures. Alzheimers Dement. 2020;16(3):391-460.
11.
Food and Drug Administration; US Department of Health and Human Services. Early Alzheimer’s disease: developing drugs for treatment, guidelines for industry. Draft guidance: February 2018. www.fda.gov/media/110903/download. Accessed February 20, 2020.
12.
Cordell CB, Borson S, Boustani M, et al; and Medicare Detection of Cognitive Impairment Workgroup. Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement. 2013;9(2):141-150.
13.
Galvin JE, Sadowsky CH; NINCDS-ADRDA. Practical guidelines for the recognition and diagnosis of dementia. J Am Board Fam Med. 2012;25(3):367-382.
14.
Shaw LM, Arias J, Blennow K, et al. Appropriate use criteria for lumbar puncture and cerebrospinal fluid testing in the diagnosis of Alzheimer’s disease. Alzheimers Dement. 2018;14(11):1505-1521.
15.
Johnson KA, Minoshima S, Bohnen NI, et al. Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer’s Association. Alzheimers Dement. 2013;9(1):e1-e16.

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