Toward a Sequential Strategy for Diagnosing Neurocognitive Disorders: A Consensus from the “Act On Dementia” European Joint Action

Article type: Review Article

Authors: Krolak-Salmon, Pierre^{a; b; c; *} | Maillet, Audrey^b | Vanacore, Nicola^d | Selbaek, Geir^e | Rejdak, Konrad^f | Traykov, Latchezar^g | Politis, Antonios^h | Georges, Jeanⁱ | Borson, Soo^j | Leperre-Desplanques, Armelle^{a; b}

Affiliations: [a] Clinical and Research Memory Centre of Lyon, Civil Hospices of Lyon, INSERM U1028, UMR CNRS 5292, Lyon, France | [b] Claude Bernard University, Lyon I, Lyon, France | [c] French Federation of Clinical and Research Memory Centre of Lyon, Lyon, France | [d] National Centre for Disease Prevention and Health Promotion, National Institute of Health, Roma, Italy | [e] Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, T–nsberg, Norway | [f] Medical University of Lublin, Lublin, Poland | [g] Bulgarian Society of Dementia, Sofia, Bulgaria | [h] Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece | [i] Alzheimer Europe Association, Luxembourg-Ville, Luxembourg | [j] University of Washington School of Medicine, Seattle, Washington, and Dementia Care Research and Consulting, Palm Springs, CA, USA

Correspondence: [*] Correspondence to: Pr. Pierre Krolak-Salmon, Clinical and Research Memory Centre of Lyon, Civil Hospices of Lyon, INSERM U1028, UMR CNRS 5292, Lyon, France. Tel.: +33 4 72 43 20 50; Fax: +33 4 72 43 20 54; E-mail: pierre.krolak-salmon@chu-lyon.fr.

Abstract: Neurocognitive disorders causing progressive cognitive, functional, and behavioral impairment remain underdiagnosed. The needs for a timely diagnosis are now widely acknowledged since person-centered care helps to preserve life quality and prevent crises. One powerful barrier to detection in primary care is the lack of an easy-to-follow stepwise approach, grounded in evidence and consistent with high-quality specialty practice. To help fill this gap, the current European Joint Action proposes a graduated diagnosis strategy tailored to the patients’ needs and wills, clarifying appropriate components for primary and specialty care. This strategy considers a first evaluation in primary care that may detect a neurocognitive disorder, that would lead to a second evaluation step allowing etiological diagnosis hypotheses performed mostly by the specialist. A third evaluation stage considering some biological, electrophysiological, or neuroimaging complementary techniques would be proposed to atypical cases or patients willing to consider access to research.

Keywords: Alzheimer’s disease, detection, diagnosis, general practitioner, memory, neurocognitive disorder

DOI: 10.3233/JAD-190461

Journal: Journal of Alzheimer's Disease, vol. 72, no. 2, pp. 363-372, 2019