As the U.S. population ages, the number of people affected by Alzheimer’s disease and other neurodegenerative diseases (NDDs) that cause dementia is increasing. New treatments targeting specific types of dementia are most effective when used early, making a timely and accurate diagnosis essential.
Primary care providers (PCPs) play a key role in early evaluation, but many face challenges such as limited time and a lack of confidence in assessing cognitive and behavioral complaints. Biomarkers—tools that help identify NDDs—can improve diagnosis, but they need to be paired with clinical observations for accurate results. Additionally, current biomarkers only address some types of NDDs.
The Assessment of Cognitive Complaints Toolkit for Alzheimer’s Disease (ACCT-AD)
The California Alzheimer’s Disease Centers developed the ACCT-AD toolkit to guide PCPs on performing a thorough assessment. The toolkit has many components that address various aspects of the diagnostic evaluation. The entire process does not need to be accomplished in a single visit, and not all components need to be performed by the primary provider. Each practice would develop its plan to collect most of the information to ensure accuracy, with the PCP integrating all the information to arrive at a diagnosis and treatment plan.
The toolkit includes:
- Background reading about the major causes of cognitive and behavioral changes in aging
- An approach for the initial identification of potentially concerning symptoms, based on a few questions and limited cognitive testing—this screening would be suitable for an annual wellness check in older patients
- A pre-visit questionnaire designed to streamline a complete cognitive and behavioral assessment by identifying the significant areas of concern
- A set of questions and guidance on the physical exam findings that address the potential causes of cognitive and behavioral complaints
- A concrete interpretation guide that addresses potential responses to questions, exam findings, and laboratory and imaging findings from the assessment
- Decision trees to guide diagnosis and referral
- Scripts to use as examples for diagnostic disclosure
- Billing guidance that covers various scenarios
