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 timely and accurate diagnosis essential. However, relying solely on specialists in Neurology and Psychiatry for diagnosing cognitive and behavioral changes can lead to delays, especially in underserved communities where access to specialists is limited.
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.
Advancing Diagnosis of Dementia in Primary Care Practice
This project aims to empower PCPs to diagnose dementia more effectively by using a comprehensive diagnostic toolkit developed by the California Alzheimer’s Disease Centers. The toolkit includes:
- A pre-visit questionnaire designed to streamline assessments.
- Expert-led case conferences to support PCPs in distinguishing between mild cognitive impairment, Alzheimer’s-disease-related dementia, and other less common NDD syndromes.
Implementation Plan
The project will:
- Introduce the diagnostic model in five primary care practices serving underserved communities in California.
- Train at least 30 PCPs to assess approximately 750 patients using the toolkit.
- Re-evaluate patients at expert centers, collecting blood biomarkers to confirm diagnoses.
- Support PCPs in providing biomarker-informed diagnoses to patients.
The project investigators will examine the accuracy of PCP diagnoses, using expert opinions and biomarkers as the gold standard, and evaluate the feasibility of using the toolkit in the practices through surveys, interviews, and focus groups. To help address the sensitivity of pre-visit questions to atypical symptoms of NDD, we will also recruit 200 patients with atypical presentations at UCSF.
Successful implementation will establish a practical model for earlier and more precise diagnosis of dementia caused by Alzheimer’s disease and other NDDs. This approach will improve access to timely treatment for patients, particularly those in underserved communities.
