Question of the week
Early detection of Alzheimer’s and dementia is more critical than ever as new treatment options show greater effectiveness in the earliest stages of disease.
With advanced therapies now available to slow progression, primary care providers play an increasingly vital role in identifying mild cognitive impairment early. On Healthcasts, clinicians recently discussed how they approach cognitive screening, referrals, and emerging biomarker tests like p-Tau217.
Have you adjusted your screening protocols for Alzheimer’s and dementia to support early detection? Log in or sign up to share your approach and view the consensus summary.
Questions for consult
1. Has your screening process changed, given the importance of early detection for these treatment options to be effective, and if so, what are you doing to screen your patients early and get them appropriate referrals for a neurology consult?
2. Are you checking a p-Tau217 if a patient presents with cognitive impairment or screening indicates mild cognitive impairment?
Comments
Key takeaways about the early detection of Alzheimer’s and dementia:
- Family input matters for early detection
Clinicians emphasize listening to family members when screening for cognitive decline. Subtle changes often go unnoticed by patients but are clear to those close to them. - Screening is common, but approaches vary
Most clinicians use tools like MMSE and begin screening around age 65. While many refer patients to neurology after a basic workup, others initiate therapies or safety planning with families. - Biomarker testing adoption is slow
Testing for p-Tau217 remains rare. Many clinicians defer this to neurology due to insurance uncertainty and unclear guidelines, though some incorporate tau protein testing alongside labs for reversible causes.
Internal Medicine
"1. I am paying more attention to family members these days than before. Often, if a patient complains of memory loss, it's not dementia, but medication or nutritional-related. Family members are really the key, as they can point out subtleties that are red flags.
2. I do not, but leave this to the neurology consult."
Nurse Practitioner
"1. We do the MMSE, and we also refer appropriately and/or start on medication appropriately while working with the patient/family to ensure patients are safe to be at home in their own environments
2. Yes, we have done that at times after a discussion with patients/family."
Internal Medicine
"1. I have always routinely screened for dementia, and some cognitively impaired patients have agreed to imaging, some agreed to referral to a memory center, some to referral to neurology, and some to oral therapies, but none have ever acquiesced to referral to a study or infusion therapy after presentation of risks and benefits.
2. I have not yet started checking this and defer to neurology at this stage."
Internal Medicine
"1. I screen all patients starting at age 65 years annually for dementia with the standard MinoCog screen and refer appropriate cases to Neurology after basic workup, which includes labs and CT/MRI brain.
2. I have not started checking for p-Tau217, and I am not certain if insurance would cover this test. I would defer this test to Neurology until more clarity regarding coverage."
Internal Medicine
"1. I perform the MMSE and order tau protein. Also, I check for reversible causes, then refer.
2. Yes, in addition to B12, TSH, and RPR."
Would you check for p-Tau217 in a patient with cognitive impairment? Share your opinion and read other practitioners' comments on the full post on Healthcasts.
