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| Search	 	 This book      All books PubMedNavigationAbout this bookAHCPR Archived Clinical Practice Guidelines19. Recognition and Initial Assessment of Alzheimer's Disease andRelated Dementias			Executive Summary		1. Overview2.  Characteristics, Epidemiology, and Costs3.  Risk Factors and Causes of Dementia4.  Recommendations for Recognition and Initial Assessment ofDementia			Acronyms					Glossary					Contributors					Attachments		Tables and FiguresReferences | Surgeon General Reports, SAMHSA TIPs, SAMHSA PEPsAHCPR Archived Clinical Practice Guidelines19. Recognition and Initial Assessment of Alzheimer's Disease andRelated Dementias*[THIS DOCUMENT IS NO LONGER VIEWED AS GUIDANCE FOR CURRENT MEDICAL PRACTICE.]*Recognition and Initial Assessment of Alzheimer'sDisease and Related Dementias
Clinical Practice Guideline No. 19.

AHCPR Publication No. 97-0702:

 November 1996 

				Link to the National Guideline Clearinghouse
AHCPR
The Agency for Health Care Policy and Research (AHCPR) was established inDecember 1989 under Public Law 101-239 (Omnibus Budget Reconciliation Act of1989) to enhance the quality, appropriateness, and effectiveness of health careservices and access to these services.  AHCPR carries out its mission byconducting and supporting general health services research, including medicaleffectiveness research, facilitating development of clinical practiceguidelines, and disseminating research findings and guidelines to health careproviders, policymakers, and the public.

The legislation also established within AHCPR the Office of the Forum forQuality and Effectiveness in Health Care (the Forum).  The Forum has primaryresponsibility for facilitating the development, periodic review, and updatingof clinical practice guidelines.  The guidelines will assist practitioners inthe prevention, diagnosis, treatment, and management of clinical conditions.

Guidelines are available in formats suitable for health care practitioners,the scientific community, educators, and consumers. AHCPR invites comments andsuggestions from users.  Please send written comments to Director, Office of theForum for Quality and Effectiveness in Health Care, AHCPR, Willco Building,Suite 310, 6000 Executive Boulevard, Rockville, MD 20852.
Availability of Guidelines
For each clinical practice guideline developed under the sponsorship of theAgency for Health Care Policy and Research (AHCPR), several versions areproduced to meet different needs.

The *Clinical Practice Guideline* presents recommendations for healthcare providers with brief supporting information, tables and figures, andpertinent references.

The *Quick Reference Guide*is a distilled version of the *ClinicalPractice Guideline*, with summary points for ready reference on a day-to-daybasis.

The *Consumer Guide,* available in English and Spanish, is aninformation booklet for the general public to increase consumer knowledge andinvolvement in health care decisionmaking.

To order single copies of the *Quick Reference Guide* or*ConsumerGuide*, or to obtain further information on their availability, call theAHCPR Publications Clearinghouse toll-free at 800-358-9295 or write to: AHCPRPublications Clearinghouse, P.O.  Box 8547, Silver Spring, MD 20907.

Single copies of the *Clinical Practice Guideline*are available forsale from the Government Printing Office, Superintendent of Documents,Washington, DC 20402, with a 25-percent discount given for bulk orders of 100copies or more.  The *Quick Reference Guide*and the *Consumer Guide*in English also are available for sale in bulk quantities only.  Call (202)512-1800 for price and ordering information.

The *Guideline Technical Report* contains supporting materials for the*Clinical Practice Guideline,* including background information,methodology, literature review, scientific evidence tables, recommendations forresearch, and a comprehensive bibliography.  The*Technical Report* may be ordered from the National Technical InformationService, 5285 Port Royal Road, Springfield, VA 22161.  Call (703) 487-4650 forprice and ordering information.

The full text of guideline documents for online retrieval is available onInternet through the AHCPR Home Page.  Access the guideline products by using aWeb browser, specifying URL http://www.ahcpr.gov/guide/ and selecting "ClinicalPractice Guidelines Online."

A fact sheet describing Online Access for Clinical Practice Guidelines(AHCPR Publication No. 94-0075) and copies of the Quick Reference Guide and theConsumer Guide of each guideline are available through AHCPR's InstantFAX, afax-on-demand service that operates 24 hours a day, 7 days a week.  AHCPR'sInstantFAX is accessible to anyone using a facsimile machine equipped with atouchtone telephone handset: Dial (301) 594-2800, push "1," and then press thefacsimile machine's start button for instructions and a list of currentlyavailable publications.
Alzheimer's Disease and Related Dementias Guideline Panel
- 						Paul T. Costa, Jr., PhD (Cochair)					
- 						T. Franklin Williams, MD, FACP (Cochair)					
- 						Marilyn S. Albert, PhD					
- 						Nelson M. Butters, PhD (Deceased)					
- 						Marshal F. Folstein, MD					
- 						Sid Gilman, MD					
- 						Barry J. Gurland, FRCPhys, FRCPsych					
- 						Lisa P. Gwyther, MSW, CCSW, ACSW					
- 						Albert Heyman, MD					
- 						Alfred W. Kaszniak, PhD, ABPP					
- 						Ira R. Katz, MD, PhD					
- 						Linda L. Levy, MA, OTR/L, FAOTA					
- 						Nancy Emerson Lombardo, PhD					
- 						Nancy K. Orr-Rainey, MSG					
- 						Linda R. Phillips, PhD, RN, FAAN					
- 						Martha Storandt, PhD					
- 						Eric G. Tangalos, MD, FACP					
- 						May L. Wykle, PhD, RN, FAAN					

Guideline Development and Use
Guidelines are systematically developed statements to assist practitionerand patient decisions about appropriate health care for specific clinicalconditions.  This guideline was developed by a private-sector panel convened bythe Agency for Health Care Policy and Research (AHCPR).  The guideline reflectsthe state of knowledge, current at the time of publication, on effective andappropriate care.

The panel employed an explicit science-based methodology and expert clinicaljudgment to develop specific statements on patient assessment and management forthe clinical condition selected.  Extensive literature searches were conducted,and critical reviews and syntheses were used to evaluate empirical evidence andsignificant outcomes.  Peer review was undertaken to evaluate the reliabilityand utility of the guideline in clinical practice.  The panel's recommendationsare primarily based on the published scientific literature.  When the scientificliterature was incomplete or inconsistent in a particular area, therecommendations reflect the professional judgment of panel members andconsultants.

We believe that this AHCPR-assisted clinical practice guideline will makepositive contributions to the quality of care in the United States. We encouragepractitioners and patients to use the information provided in the guideline. The recommendations may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by thepractitioner based on available resources and circumstances presented byindividual patients.	- 						Clifton R. Gaus, ScD					
- 						Administrator					
- 						Agency for Health Care Policy and Research					

*Publication of this guideline does not necessarily represent endorsementby the U.S. Department of Health and Human Services.*
Abstract
Dementia in the adult U.S. population is a devastating disorder that isoften unrecognized or misdiagnosed in its early stages.  Despite the currentlack of unequivocally effective treatment, recognition of early-stage dementiamay offer substantial benefits.  These include avoidance of inappropriatetreatment related to misdiagnosis and time for the patient and family to addressissues of financial, legal, and medical care planning.

This *Clinical Practice Guideline* is intended to help primary careproviders recognize and assess Alzheimer's disease and related dementias intheir early stages.  Differential diagnosis is beyond the scope of theguideline; however, the guideline contains a list of resources for furtherclinical evaluation once probable dementia has been identified.

Guideline recommendations focus on the following areas:	- 						Triggers that should prompt a clinician to undertake an assessment forearly-stage dementia.					
- 						The components of an initial assessment, including tests of mental statusand functional performance.					
- 						A  flow chart for earlyrecognition and initial assessment, including assessment for delirium anddepression.					
- 						Interpretation of test results and appropriate actions.					
- 						The role of neuropsychological testing.					

Knowledge of the individual patient is emphasized, including change inability from baseline, as is the value of reliable informant reports to initialassessment and clinical judgment.

This guideline should help clinicians recognize symptoms of possibledementia and decrease underrecognition and misdiagnosis of this devastatingcondition.

This document is in the public domain and may be used and reprinted withoutspecial permission, except for those copyrighted materials noted for whichfurther reproduction is prohibited without the specific permission of copyrightholders.  AHCPR appreciates citation as to source, and the suggested format isprovided below:  Costa PT Jr, Williams TF, Somerfield M, et al.  Recognition andInitial Assessment of Alzheimer's Disease and Related Dementias. ClinicalPractice Guideline No. 19.  Rockville, MD:  U.S.  Department of Health and HumanServices, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 97-0702.  November 1996.
Acknowledgments
Many people and professional organizations contributed importantly to thedevelopment of this *Clinical Practice Guideline,* from its earlieststages through two review cycles.  The consultants, technical advisors, andreviewers listed at the end of this guideline devoted considerable time andeffort to this collaborative effort and greatly helped the panel.  Severalpersons helped immeasurably in identifying key issues, compiling relevantliterature, and critiquing manuscript drafts of the guideline.  These personswere Alan Zonderman, PhD, and Jeffrey Herbst of the Gerontology Research Center,National Institute on Aging; Andrea Pinkham of the University of Iowa; and GaryVandenBos, PhD, executive director of publications and communications, AmericanPsychological Association.

Special acknowledgment goes to Mark Somerfield, PhD, who served with greatdedication and competence as project coordinator, overseeing the literaturereviews and data coding and extraction for the meta-analyses and without whomthis guideline would not have been possible.

The methodological and statistical expertise of Lawrence Hedges, PhD, of theUniversity of Chicago, and Victor Hasselblad, PhD, of Duke University School ofMedicine, made possible the meta-analyses that led to several of the guideline'skey recommendations.

The Cochairs also thank Barbara J. Shapiro, panel editor, for her superbwriting and editing skills and Carole Sherman, panel manager, for her deftsupervision of the support services provided by Technical ResourcesInternational, Inc.  Finally, thanks are due to the Agency for Health CarePolicy and Research for its continuing support of the panel's work and itscommitment to an evidence-based approach to improving clinical practice. |
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