Alzheimer's Disease: Clinical Best Practices

Purpose and scope of this document

Alzheimer’s disease affects over 5.8 million Americans of all ages in 2020. Approximately 400,000 of them are Texans. Alzheimer’s disease is the sixth leading cause of death in the U.S. and has an economic burden of $305 billion annually. Texas ranks fourth in the number of Alzheimer’s disease cases and second in the number of Alzheimer’s disease deaths. In 2019, there were an estimated 16 million unpaid caregivers in the U.S., most of whom were family members. In Texas, approximately 1.45 million unpaid caregivers provided care to Texans with Alzheimer’s disease in 2019. This equates to an estimated 1.65 billion hours of unpaid care at a cost of approximately $21.6 billion per year. Alzheimer’s disease exacts an enormous toll on individuals, families, the healthcare system, and American businesses. It is a serious problem affecting many aspects of our society. Until Alzheimer’s disease can be prevented or cured, the impact of this disease will only continue to intensify. 

Currently there is no treatment available to slow or stop deterioration of brain cells in Alzheimer’s disease.  Five drugs are currently approved that temporarily slow worsening symp­toms for on average, six to 12 months, and for about half of the individuals who take them. Despite current lack of disease-modifying therapies, studies consistently show that active medical management of Alzheimer’s disease can significantly improve quality of life through all disease stages for individuals and their caregivers.  Active management includes appropriate use of available treatment options, effec­tive integration of coexisting conditions into the treatment plan, and use of supportive services such as counseling, activity and support groups, and adult day center pro­grams.  

Most older adults—including people with Alzheimer's disease —receive their medical care from Primary Care Practitioners (PCPs) (Callahan et al., 2006), who may lack the information and other resources needed to treat this growing and demanding population (Reuben, Roth, Kamberg, & Wenger, 2003).  These guidelines were developed specifically for health care professionals in diagnosing and treating individuals with Alzheimer's disease, as appropriate medical management and treatment of this disease is imperative.  These guidelines were developed to promote best practices for recognizing, diagnosing, and providing treatment to individuals with Alzheimer’s disease or a related dementia. These guidelines are broad enough in scope that they can be used by primary healthcare professionals, including physicians, nurse practitioners, physician assistants, social workers, nurses, and other professionals providing primary care to patients with Alzheimer’s disease and their families. Recommendations for manage­ment of associated neuropsychiatric symptoms and coexisting medical condi­tions often seen in persons with Alzheim­er’s disease are included in these guidelines. Patients with Alzheimer’s dis­ease often need concomitant medication for treatment of diverse central nervous system disorders associated with progressive brain dysfunction (Cacabe­los). Suggestions for easily administered and scored appraisal tools are incorporated when possible, as well as diagnostic and treatment pearls.

These guidelines also present best practices on the diagnosis and treatment of mild cognitive impairment (MCI), which can affect memory and other cognitive areas, but much less severe than Alzheimer’s disease or other dementias.  Information on the relationship between MCI and Alzheimer’s disease is also presented.

These guidelines were developed and peer-reviewed by a group of Alzheimer’s disease experts working to meet the Disease Management objectives of the 2010-2015 Texas State Plan on Alzheimer’s Disease. These groups include the Texas Council on Alzheimer’s Disease and Related Disorders, the Alzheimer’s Disease Program at the Texas Department of State Health Services, and many dedicated volunteers of the Texas Alzheimer’s Disease Partnership.  

Click Here to download Clinical Best Practices for the Early Detection, Diagnosis, and Pharmaceutical and Non-Pharmaceutical Treatment of Persons with Alzheimer’s Disease

Last updated July 2, 2020