The Alzheimer's Association Guidance for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders
The Alzheimer's Association Guidance for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD) offers clinicians a practical, evidence-informed framework for the early identification, diagnosis and management of Alzheimer’s disease and related dementias (ADRD). Designed to support both primary care providers and specialists, this guidance and its accompanying decision tools promote consistent, patient-centered evaluation and care planning grounded in the latest clinical evidence.
Background
Developed through a modified Delphi process and an extensive review of 7,374 publications, of which 133 met inclusion criteria, the DETeCD-ADRD Guidance provides comprehensive, expert-vetted recommendations to support clinicians in accurately assessing cognitive function, identifying cognitive-behavioral syndromes, and determining the underlying causes of ADRD.
This guidance seeks to improve early diagnosis, facilitate shared decision-making between patients and care partners, and enhance overall care planning by promoting standardized evaluation, testing and disclosure practices. The framework is designed for use across diverse clinical settings and includes tailored tools to meet the needs of both primary care providers and specialty clinicians.
Key Recommendations
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Structured Evaluation Process:
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Assess the patient's cognitive functional status, cognitive-behavioral syndrome and likely underlying brain disease.
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Utilize evidence-supported evaluation methods to characterize, diagnose and disclose findings to the patient and care partner.
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Patient-Centered Care:
- Develop optimal care plans that maximize the quality of life for the patient and the care partner.
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Implementation in Practice Settings:
- If clinicians adopt this guideline and health care systems provide adequate resources, outcomes should improve in most patients across various practice settings.
DETeCD-ADRD Tools for Clinicians
The Alzheimer’s Association has developed two complementary decision guides based on the DETeCD-ADRD clinical practice guideline to support clinicians in the diagnostic evaluation, testing, counseling, and disclosure process for suspected Alzheimer’s disease and related dementias.
Primary Care Decision Guide
This tool helps primary care clinicians by serving as a practical checklist to:
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Evaluate cognitive symptoms and functional status in patients presenting with suspected cognitive impairment.
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Inform recommendations for brain health promotion and risk factor management.
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Identify when referral to specialty care is appropriate, especially in cases of early onset, atypical features or rapidly progressing symptoms.
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Guide initial counseling and shared decision-making with patients and care partners.
Primary care providers should use this guide as a structured framework for early detection and to ensure timely, appropriate referral for further evaluation when needed.
Specialist Decision Guide
This tool supports neurologists, geriatricians, geriatric psychiatrists and other specialty clinicians in:
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Performing comprehensive cognitive-functional assessments.
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Evaluating detailed cognitive-behavioral syndromes and underlying conditions.
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Ordering and interpreting diagnostic testing, including laboratory panels and brain imaging.
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Leading disclosure conversations with patients and care partners about diagnosis and prognosis.
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Developing individualized care plans and coordinating referrals for advanced evaluation or therapy.
Specialists use this guide to deliver in-depth diagnostic evaluation and management aligned with the latest evidence and best practices.
When and How to Use the Decision Guides
Start with the Primary Care Guide for initial patient evaluation in any clinical setting where cognitive concerns are raised. Use it to triage patients, address modifiable risk factors and determine the need for specialist referral.
Use the Specialist Guide when managing patients referred from primary care or other settings, especially for complex cases, atypical presentations or when detailed diagnostic workup is required.
Both guides follow a three-step diagnostic formulation framework: assessing cognitive functional status, characterizing cognitive-behavioral syndrome, and establishing an etiological diagnosis.
Clinicians should integrate these tools into the clinical workflow to support consistent, evidence-informed evaluation, improve communication with patients and families, and facilitate shared decision-making.
Contact Us
Questions or feedback about the updated Appropriate Use Criteria for Amyloid and Tau PET can be directed to:
Christopher Weber, Ph.D.
Senior Director, Global Science Initiatives
cweber@alz.org
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