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The Differential Diagnosis and Treatment of Mild Cognitive Impairment and Alzheimer Disease
Overview
Navigating the associated differential diagnosis in AD is essential as various causes of cognitive impairment require different treatment strategies.
Learning Objectives
After completing this educational activity, you should be able to:
- Diagnose patients with mild cognitive impairment or mild Alzheimer dementia
- Facilitate prompt treatment initiation for patients with mild cognitive impairment or mild Alzheimer dementia
Target Audience
Clinicians in neurology, psychiatry, and primary care settings
Abstract
Identifying patients at risk for developing mild cognitive impairment (MCI) and Alzheimer disease (AD) remains challenging in clinical practice, even as scientific understanding of dementia advances generally. That said, successfully navigating the associated differential diagnosis in AD is essential, as various causes of cognitive impairment require different treatment strategies. In recent years, the armamentarium in AD has expanded with regulatory approval of a disease-modifying therapy – aducanumab – and may be shifting away from symptomatic treatments such as cholinesterase inhibitors and memantine. Concurrently, the role of biomarkers in AD is increasing, and these entities may soon play a greater role in determining patient eligibility for prophylactic interventions and the likelihood of disease progression. As the standard of care progresses, clinicians should educate patients and their care providers on the implications of these advances and reinforce lifestyle changes that can delay or prevent the onset of disease in those at risk of AD. In doing so, care providers can deliver the best care possible.
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Support Statement
Supported by an educational grant from Biogen MA Inc.
Learning Objective
After completing this educational activity, you should be able to:
- Diagnose patients with mild cognitive impairment or mild Alzheimer dementia
- Facilitate prompt treatment initiation for patients with mild cognitive impairment or mild Alzheimer dementia
Release, Review, and Expiration Dates
This CME activity was published in December 2022 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2023. The latest review of this material was September 2022.
Statement of Need and Purpose
A diagnosis of Alzheimer disease (AD) occurs in many cases when patients have already reached the moderate to severe stages in the AD continuum. This diagnostic delay while patients have mild cognitive impairment (MCI) or mild dementia reduces the opportunity to intervene with symptomatic therapy or potentially disease-modifying therapy. When a diagnosis is made, clinicians are not effectively communicating with patients and care partners regarding the illness and next steps. Although guidelines recommend that symptomatic therapy should be initiated upon diagnosis, prompt treatment initiation does not occur in a substantial number of patients newly diagnosed with AD. Clinicians need education about the rationale for early identification of MCI and mild AD dementia and about recommended methods for diagnosis. They also need guidance for sharing the diagnosis along with education on next steps for patients and their care partners, including support services. Finally, education is needed about facilitating treatment initiation.
Unlabeled and Investigational Usage
The faculty of this educational activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been advised to disclose to the audience any reference to an unlabeled or investigational use.
No endorsement of unapproved products or uses is made or implied by coverage of these products or uses.
Please refer to the official prescribing information for each product for discussion of approved indicators, contraindications and warnings.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
© Copyright 2022 Physicians Postgraduate Press, Inc.
Faculty Affiliation
Allan Anderson, MD
Banner Alzheimer’s Institute
Tucson, AZ
Matthew Malone, DO
Banner Alzheimer’s Institute
Tucson, AZ
Financial Disclosure
The CME Institute adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME). Any individuals in a position to control the content of a continuing education activity, including faculty, content developers, reviewers, staff, and others, are required to disclose to learners the presence or absence of any relevant financial relationships with an ACCME-defined ineligible company within the preceding 24 months of the activity. The ACCME defines an “ineligible company” as one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
The CME Institute has mitigated all relevant conflicts of interest prior to the commencement of the activity. None of the individuals involved in the content have relevant financial relationships with ineligible companies except the following:
Dr Anderson has served on the speakers/advisory boards for Biogen.
Dr Malone has no financial disclosures.
____
Marlene P. Freeman, MD
Editor in Chief
Boston, Massachusetts
Dr Freeman has received research funding from JayMac and Sage; has been a member of the Independent Data Safety and Monitoring Committee for Janssen (Johnson & Johnson), Novartis, and Neurocrine; and has served on advisory boards for Eliem and Sage. As an employee of Massachusetts General Hospital (MGH), Dr Freeman works with the MGH National Pregnancy Registry, which receives funding from Alkermes, Aurobindo, AuroMedics, Johnson & Johnson/Janssen, Otsuka, Sage, Sunovion, Supernus, and Teva, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. Dr Freeman has also received royalties through MGH for the Massachusetts General Hospital Female Reproductive Lifecycle and Hormones Questionnaire.
None of the other planners, reviewers, and CME Institute staff for this educational activity have relevant financial relationships with ineligible companies to disclose. All relevant financial relationships have been mitigated.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
Available Credit
- 0.50 AMA PRA Category 1 Credit™
- 0.50 Participation