There are new patient guidelines that can help identify people in the early stages of Alzheimer’s and get them the care they need much sooner than before, but your doctors might not yet be aware of these guidelines.

So it’s up to you to know about them—and insist that your doctors follow them.

Problem: Most patients have early warning signs of Alzheimer’s for about four years before they’re actually diagnosed with it. For those on Medicare, the free annual wellness visit is supposed to include an assessment of cognitive function. It’s designed to pick up early signs of Alzheimer’s disease or other forms of dementia. But only about 20% of patients are getting it…and even when it is given, it often doesn’t lead to Alzheimer’s being diagnosed any sooner. More evidence of gaps in care—more than half of patients who enter nursing homes with late-stage Alzheimer’s or other dementia were never given a formal diagnosis.

One reason that some doctors may be reluctant to evaluate patients for Alzheimer’s disease is that the diagnosis is devastating and there’s no treatment yet to stop the course of the disease. But early diagnosis means that you may be able to get longer benefits from medications that preserve cognitive function…you may be eligible for clinical trials of the latest treatments…and you will have more time to plan for the future and make life choices.


In 2018, the Alzheimer’s Association released clinical guidelines intended to help doctors better recognize cognitive impairment that could lead to Alzheimer’s and to reduce the time gap between a patient’s first serious symptoms and getting a diagnosis. Here are the key points…

  • All middle-aged or older patients who report cognitive changes or who have changes reported by others need a detailed evaluation.
  • Cognitive changes, including changes in memory, mood, anxiety, sleep, personality or work and social relationships, should not be dismissed as normal aging without an evaluation.
  • The evaluation should include a detailed history from the patient and his/her partner, investigation for all possible causes, a diagnosis, a full disclosure to the patient and a management plan.
  • Management should include education about the condition, planning, treatment and support.

An evaluation of possible Alzheimer’s disease or another dementia can start at your annual wellness visit. If the findings indicate cognitive problems, consider asking to be referred to a specialist for a comprehensive diagnostic evaluation—a geriatric psychiatrist, a neurologist, a neuropsychologist or a physician working at an Alzheimer’s disease center.

Seeing such a professional is key because brain changes can be subtle, and other conditions such as normal cognitive decline, a sleep disorder, depression or a reaction to a medication need to be ruled out. A specialist will go beyond memory loss to look for a pattern of changes over time. He/she might also order a brain imaging study to make a diagnosis. Figuring out what’s going on with your cognition is a little like the game Wheel of Fortune, says geriatric psychiatrist Marc E. Agronin, MD—you need to keep getting letters until you get the whole word.

You can find more information about diagnosis, a help line, and services in your area at the Alzheimer’s Association website.

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