Dementia Care Practice

Background: The increasing population of older adults and growing number of disease-modifying therapies for Alzheimer's disease (AD) highlight the need for timely differential diagnosis of neurodegenerative disorders despite high referral volumes. This study aimed to develop and pilot a brief neuropsychological battery to evaluate cognitive functioning in adults with suspected AD and improve service delivery by reducing the time between referral and diagnosis.

Methods: Patients were referred to the "early AD pathway" by their neurologist or geriatrician after an initial evaluation in an outpatient multidisciplinary dementia clinic. Eligible patients scored 18-25/30 on a brief cognitive screening measure (Montreal Cognitive Assessment [MoCA]), had an amnestic clinical presentation, and were thought to have mild cognitive impairment (MCI) or mild dementia. The "early AD pathway" involved chart review, a brief clinical interview, and an abbreviated clinical test battery based on the NACC Uniform Data Set (UDS) Version 3 neuropsychological battery. Patients were provided feedback shortly after the assessment, and referring providers followed up with patients to discuss additional neurodiagnostic workup and/or possible treatments. Nine patients referred for the "early AD pathway" pilot were compared to general memory/cognitive referrals seen by the neuropsychology clinic during fall 2023 (n = 95). Retrospective data collection included demographic characteristics and relevant clinical information, including the time between referral and evaluation, MoCA total score, and post-evaluation diagnosis. Non-parametric analyses were used to compare the "early AD pathway" patients to those undergoing traditional clinic procedures.

Results: Preliminary results indicated significantly reduced wait times compared to traditional neuropsychological referrals (M_diff = 155.17 days, p<.001) and successful identification of individuals with MCI or mild dementia. Moreover, 8/9 participants had an amnestic cognitive profile, suggesting high sensitivity for identifying a likely neurodegenerative process (i.e., suspected AD) in this pathway. Importantly, this pilot sample was small and racially homogenous, indicating the need for broader recruitment going forward.

Conclusions: This pilot study demonstrated preliminary evidence for how to optimize neuropsychological service delivery to guide patients efficiently through an early AD identification process in a multidisciplinary clinic. This will be increasingly important as service demands and the number of pharmacological treatments increase over time.