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With therapies focusing earlier in the disease continuum, assessing cognitive impairment as early as possible is more important than ever1

Stylized molecule art

With therapies focusing earlier in the disease continuum, assessing cognitive impairment as early as possible is more important than ever1

Potential benefits of timely detection and diagnosis of Alzheimer’s disease (AD)2,3

To provide a comprehensive evaluation, consider these clinical assessments when referring a patient with cognitive impairment to an Alzheimer’s disease specialist2,4

The following tests are representative only; alternative tools are available and can be used at the discretion of the clinician.

Click a test to learn more:

If cognitive impairment is detected, it is important to either evaluate the cause via a full diagnostic workup or refer your patient to a specialist2

When referring, please include the following information (if available)2,4:

  • Patient family history
  • Structural MRI
  • Blood panel or previous test results
  • AD blood-based biomarker test results
  • Any genetic testing results
  • Cognitive assessments and any other relevant test results
  • Standard CBC
  • Standard CMP
  • B12 vitamin panel
  • Liver function
  • Thyroid function
  • Folate

Commercially available blood-based biomarker tests used to detect amyloid positivity are not standalone tests. The results must be interpreted in conjunction with clinical assessment results. Patients must meet testing criteria.

Understand the role of blood-based biomarkers in AD

See how

AD8=Eight-item Interview to Differentiate Aging and Dementia; CBC=complete blood count; CMP=comprehensive metabolic panel; GPCOG=General Practitioner Assessment of Cognition; MCI=mild cognitive impairment; MMSE=Mini-Mental State Examination; MoCA=Montreal Cognitive Assessment; MRI=magnetic resonance imaging; SLUMS=Saint Louis University Mental Status.

*Different times reported. Times may vary.4,6,10

†Sensitivity: ability of the test to correctly identify those patients with disease.

‡Specificity: ability of the test to correctly identify those patients without disease.

§A cutoff point of <3 on the Mini-Cog© has been validated for classifying subjects as “probably impaired,” but many individuals with clinically meaningful cognitive impairment will score higher. When greater sensitivity is desired, a cutoff point of ≤3 is recommended, as it may indicate a need for further evaluation of cognitive status.

References:

  1. Aisen PS, Cummings J, Jack CR Jr, et al. On the path to 2025: understanding the Alzheimer’s disease continuum. Alzheimers Res Ther. 2017;9(1):60. doi:10.1186/s13195-017-0283-5
  2. Porsteinsson AP, Isaacson RS, Knox S, et al. Diagnosis of early Alzheimer’s disease: clinical practice in 2021. J Prev Alzheimers Dis. 2021;8:371-386. doi:10.14283/jpad.2021.23
  3. Galvin JE, Aisen P, Langbaum JB, et al. Early stages of Alzheimer’s disease: evolving the care team for optimal patient management. Front Neurol. 2021;11:592302. doi:10.3389/fneur.2020.592302
  4. Cordell CB, Borson S, Boustani M, et al. 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. doi:10.1016/j.jalz.2012.09.011
  5. Kansagara D, Freeman M. A Systematic Evidence Review of the Signs and Symptoms of Dementia and Brief Cognitive Tests Available in VA. VA-ESP Project #05-225. Dept of Veterans Affairs, Health Services Research & Development Service; 2010. Accessed September 29, 2016. https://www.hsrd.research.va.gov/publications/esp/dementia.pdf
  6. Li X, Dai J, Zhao S, et al. Comparison of the value of Mini-Cog and MMSE screening in the rapid identification of Chinese outpatients with mild cognitive impairment. Medicine (Baltimore). 2018;97(22):e10966. doi:10.1097/MD.0000000000010966
  7. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699. doi:10.1111/j.1532-5415.2005.53221.x
  8. Tariq SH, Tumosa N, Chibnall JT, et al. Comparison of the Saint Louis University Mental Status examination and the Mini-Mental State Examination for detecting dementia and mild neurocognitive disorder—a pilot study. Am J Geriatr Psychiatry. 2006;14(11):900-910. doi:10.1097/01.JGP.0000221510.33817.86
  9. Galvin JE, Roe CM, Powlishta KK, et al. The AD8: a brief informant interview to detect dementia. Neurology. 2005;65(4):559-564. doi:10.1212/01.wnl.0000172958.95282.2a
  10. Hort J, O’Brien JT, Gainotti G, et al. EFNS guidelines for the diagnosis and management of Alzheimer’s disease. Eur J Neurol. 2010;17(10):1236-1248. doi:10.1111/j.1468-1331.2010.03040.x