An image depicting a man living with Alzheimer's disease
An image depicting a man living with Alzheimer's disease

Act NOW at first signs of MCI due to AD

Early diagnosis is critical1

It may now be possible to slow progression of cognitive decline due to AD, but early detection is key. The time between MCI and later stages is limited, making early detection and referral to a specialist critical.1

Consistent screening is essential

Cognitive screening for patients aged 65 years and older, at the annual wellness visit, is key to detecting MCI due to AD and planning an appropriate treatment path.1

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Age 65+

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Annual wellness visits

Only 2.4%

of Medicare beneficiaries eventually diagnosed with AD or a related disorder received a cognitive assessment during an annual wellness visit, highlighting the need for consistent screening and identification of early-stage patients2

Annual visit screening tips

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Detecting MCI due to AD

Relying on informal observation alone may not be sufficient. However, specifically asking patients 65 years and older about changes in memory, language, and the ability to complete routine tasks may help guide your decision to administer a cognitive test.1

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What cognitive test should you use?

Although no single test is recognized as the “gold standard” for detection of cognitive impairment, a validated and sensitive test could be a trigger for further patient evaluation.3

Tests sensitive to MCI and mild AD* include:

MoCA=Montreal Cognitive Assessment4

  • Designed based on tools commonly used in cognitive screening, with the raw score adjusted for education
  • 30 questions covering 8 domains
  • Score range: 0 to 30: >26=normal

Administration time: ~10 minutes

Administrator: MoCA is designed to be administered to patients by qualified HCPs

Mini-Cog©=Quick Screening for Early Dementia Detection3,5

  • Easy to administer to non-English speakers
  • Less biased by low education and literacy than other tools
  • Score range: 0 to 5: 0-2=higher likelihood of cognitive impairment, 3-5=lower likelihood of dementia

Administration time: 2-4 minutes

Administrator: Mini-Cog© is designed to be administered to patients by qualified HCPs

AD8=8-item Interview to Differentiate Aging and Dementia6

  • Rates change in cognition and function
  • Phone or in-person administration
  • Score range: 0 to 8: 0 or 1=not demented. 2-8=demented

Administration time: ~3 minutes

Administrator: AD8 is designed to be administered to a care partner by qualified health care providers (HCPs)

SLUMS=Saint Louis University Mental Status Examination7

  • Educational bias is minimized
  • Scoring similar to the MMSE® with additional tasks
  • Score range: 0 to 30: 1-20=dementia, 21-26=MNCD, 27-30=normal

Administration time: ~7 minutes

Administrator: SLUMS is designed to be administered to patients by qualified HCPs

MMSE=Mini-Mental State Examination; MNCD=mild neurocognitive disorder.

*This is not a comprehensive list of tools for assessing cognitive function and is not intended to recommend any particular tool.

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Utilize information about patient office visits

Office staff can offer valuable observations of cognitive and functional changes in patients seen over time. Family members and care partners can provide relevant information about the presence of a change in cognition.1

Catching MCI due to AD early, may offer an opportunity for intervention.1

Act Early Act Now
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Note and assess MCI

Understand the signs of MCI

Patients in the MCI due to AD stage still perform activities of daily living independently, though may experience mild but detectable impacts on more complex activities of daily life.1 These patients will show evidence of cognitive decline from baseline and test abnormally or impaired by objective cognitive tests.3

Through direct observation and discussion with patients and care partners, make note of any of the following common symptoms of early cognitive decline1:

  • Frequent poor judgment and decision making
  • Inability to manage finances
  • Losing track of time or the current season 
  • Difficulty having a conversation 
  • Losing items and being unable to backtrack or locate them

Changes in memory, language, and the ability to complete routine tasks may help guide your decision to administer a cognitive test.

Evaluate and rule out other causes of MCI

MCI can be caused by several reasons, but more than 60% of cases are due to AD. Before testing for Aβ pathology, rule out the following1,7,8:

  • Vitamin B12 deficiency
  • Thyroid diseases
  • Tumors
  • Evidence of small or large strokes
  • Damage from severe head trauma
  • Fluid buildup in the brain
  • Medications/comorbidities
  • Psychiatric disorders
  • Sleeping issues
  • Hearing problems
  • Alcohol or drug abuse
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Order a cognitive workup

Perform screening for MCI

While no test represents the benchmark for MCI validation, the following neurocognitive tools* are sensitive to MCI due to AD and mild AD dementia, and may aid in early identification:

  • MoCA=Montreal Cognitive Assessment4
  • Mini-Cog©=Quick Screening for Early Dementia Detection3,5
  • AD8=8-item Informant Interview to Differentiate Aging and Dementia6
  • SLUMS=Saint Louis University Mental Status Examination7

*This is not a comprehensive list of tools for assessing cognitive function and is not intended to recommend any particular tool.

Consider screening for amyloid beta pathology with a new blood biomarker (BBM) test. Aβ is a biomarker of AD that accumulates years before late-stage symptoms appear. Aβ concentration may be measured via BBMs in symptomatic individuals and may aid in the collection of evidence to triage a patient to a specialist.1,9

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Weigh results and refer

Refer patient to a specialist if evidence suggests need for further testing

BBM tests measure ratio of Aβ42 and Aβ40 and assesses levels of Aβ in a patient’s plasma. In addition to Aβ, some tests also measure phosphorylated tau proteins in plasma with high accuracy and correlate with AD pathology. These test results can indicate the need for further evaluation to verify an AD diagnosis.9

New care pathways are emerging to help identify appropriate patients for therapies that may slow progression of disease, but time is of the essence. Current treatment options include1:

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Symptom management medications

Aid in memory loss by relieving symptoms caused by AD.1

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Anti-amyloid treatments

An emerging class that reduces Aβ in the brain, an underlying cause of AD, with potential to slow progression of disease.1

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