Dementia Diagnosis in Primary Care Practice
The Assessment of Cognitive Complaints Toolkit for Alzheimer’s Disease provides comprehensive guidance for detailed assessments, emphasizing history-taking, physical exams, and cognitive testing using common tools, and aids in interpreting results.

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

Download the Assessment of Cognitive Complaints Toolkit for Alzheimer's Disease (ACCT-AD)

Advancing Diagnosis of Dementia in Primary Care Practice Research Study

This project, funded by the National Institute on Aging, aims to empower PCPs to diagnose dementia more effectively by using a comprehensive diagnostic toolkit developed by the California Alzheimer’s Disease Centers (CADCs). The Assessment of Cognitive Complaints Toolkit for Alzheimer's Disease (ACCT-AD) provides primary care providers with the tools necessary to recognize normal cognition, diagnose Alzheimer's disease, and identify other cognitive problems requiring specialty referral. The study is being conducted as a collaboration between several primary care practices in Southern and Northern California, and three CADCs: UCSF in San Francisco, UCSF-Fresno, and USC-Rancho Los Amigos in Los Angeles. The main goals of the study are to verify that PCP diagnoses facilitated by this toolkit are accurate and to identify potential barriers that might prevent broader use of this toolkit and opportunities to overcome these obstacles.

Implementation Plan

Over the course of five years, this project will introduce the diagnostic model in the partnering primary care practices, with a goal of training at least 30 PCPs to assess approximately 750 patients with complaints about memory or thinking using the toolkit. After evaluation by the PCPs, patients will participate in a second evaluation by a dementia expert at one of the CADCs. The PCP diagnosis will be compared with the expert diagnosis, and blood biomarkers for Alzheimer’s disease will also be assessed to provide additional information about the likely cause of the patient’s concerns.

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.

Training Materials

Educational Materials for Patients Undergoing Cognitive and Behavioral Assessment

The three videos below discuss the medical assessment in basic language, including Video 3, which focuses on biomarkers for AD, in particular, the phosphorylated tau 217 (p-tau217) test that was recently approved by the FDA and is being used for this study. We recommend that Videos 1 and 2 be shown to the patient and their study partner prior to the assessment in primary care. The third video should ideally be shown to the patient and their study partner after the expert assessment.