Early Recognition of Alzheimer's Disease: What Is Consensual? What Is Controversial? What Is Practical?

Alzheimer’s disease is often unrecognized or misdiagnosed in its early stages. Despite the lack ofcurative treatments, there are compelling reasons why early recognition of Alzheimer’s disease mayoffer substantial benefits. Early evaluation and diagnosis may offer opportunities to enhance patientsafety, allow families to plan for the future, provide family education and support, and initiate the besttreatment before more substantial neuronal loss occurs. Barriers to early diagnosis include failure offamily or physicians to recognize the existence or importance of cognitive/functional changes and/ormisperceptions regarding diagnostic requirements and treatment capabilities. There is consensus thathigh diagnostic accuracy can be achieved clinically, even by nonspecialists, using established criteriaand practice parameters. Population-based screening programs for the elderly, genetic testing, yield ofroutine neuroimaging studies, and the diagnostic value of certain molecular markers remain controversial.This review highlights practical issues related to the initial clinical evaluation and differentialdiagnosis of Alzheimer’s disease.