ALZHEIMER’S disease and related dementia often first present in primary care, emergency medicine, or general neurology settings, where clinicians must distinguish chronic cognitive decline from acute or subacute delirium. The review emphasized that memory loss may begin with subjective concerns raised by the patient before progressing to objective cognitive impairment, mild cognitive impairment, and ultimately dementia that interferes with daily functioning.
Alzheimer’s disease remains the most common cause of dementia, but clinicians must also consider vascular dementia, Lewy body dementia, and frontotemporal dementia. Vascular dementia may follow cerebrovascular events, Lewy body dementia is associated with movement disorders, sleep disturbance, balance problems, and visual hallucinations, and frontotemporal dementia may begin with personality or behavioral change.
Biomarkers and Imaging Are Changing Dementia Evaluation
The review highlighted a shifting diagnostic pathway that begins with clinical suspicion and exclusion of alternative causes of altered mental status. Standard laboratory evaluation may include complete blood count, comprehensive metabolic profile, liver function tests, coagulation studies, and targeted infectious, endocrine, inflammatory, hepatic, toxicology, and heavy metal screening when appropriate.
Imaging remains central to Alzheimer’s disease evaluation. Computed tomography can help exclude hemorrhage, while MRI may better assess ischemia, infection, malignancy, atrophy, and amyloid-related imaging abnormalities. Amyloid PET imaging and tau PET imaging remain important diagnostic standards, alongside cerebrospinal fluid biomarkers, including beta amyloid and phosphorylated tau.
Blood-based biomarkers may expand access to Alzheimer’s disease diagnosis, particularly where PET imaging or specialty dementia care is limited. Tests assessing amyloid beta 42/40, phosphorylated tau, glial fibrillary acidic protein, and neurofilament light chain may help support diagnosis in patients with high pretest probability, but the review cautioned that these are not general screening tools.
Acute Care Teams Must Recognize Treatment Risks
As amyloid-modifying therapy becomes more widely used, acute care clinicians need to recognize amyloid-related imaging abnormalities, including edema and hemorrhage. This awareness is especially important when patients present with acute neurologic symptoms, require anticoagulation, or are being considered for thrombolytic therapy.
The review stressed that patients receiving amyloid-modifying therapy, or those with cerebral amyloid angiopathy, may face heightened hemorrhage concerns during acute stroke treatment. Specialty consultation may be warranted to weigh systemic thrombolysis against alternatives such as mechanical clot retrieval.
The authors concluded that dementia care should prioritize primary care screening, equitable access to blood-based biomarker testing, appropriate imaging, and timely specialty referral. As Alzheimer’s disease diagnosis continues to evolve, acute and primary care clinicians will play an increasingly important role in identifying high-risk patients and guiding them through the diagnostic pathway.
Reference
Vukmir BV. Alzheimer’s disease and related dementia: evaluation, diagnosis and acute care management. Front Neurol. 2026;17:1743770.
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