Dementia & Alzheimer disease
Also known as: AD · Alzheimer's · cognitive impairment · MCI
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The Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD)
Alzheimer's Association · 2025 · 2025 (specialty care executive summary)
An evidence-based US clinical practice guideline describing a structured, stepwise process for evaluating a patient with cognitive, behavioural or functional symptoms that could reflect Alzheimer's disease or a related dementia, and for testing, disclosing and counselling on the result. Companion executive summaries were issued for primary care and for specialty care, alongside a review of validated assessment instruments. Published in Alzheimer's & Dementia in 2025.
- Built from a review of 7,374 publications, of which 133 met inclusion criteria, by a multidisciplinary expert workgroup. source
- Describes a structured multi-element evaluation process covering cognitive functional status, cognitive-behavioural syndrome, and likely underlying disease. source
- Issued in parallel versions tailored to primary care and to specialty care settings. source
A European Academy of Neurology guideline on medical management issues in dementia
European Academy of Neurology (EAN) · 2020
An EAN guideline addressing recurring medical management questions that arise in caring for people already diagnosed with dementia, rather than diagnosis itself. Topics include structured medical follow-up, management of vascular risk factors, recognition and treatment of pain, use of antipsychotic drugs, and epilepsy in dementia. Developed with systematic reviews and GRADE, and published in the European Journal of Neurology in 2020.
US vs EU key differences
- Scope differs fundamentally: the 2025 Alzheimer's Association DETeCD-ADRD guideline is about diagnostic evaluation, testing and disclosure, while the 2020 EAN guideline explicitly covers post-diagnosis medical management and does not address diagnosis or disclosure. source
- The US guideline structures the workup by care setting, defining tiered assessments for primary care, specialty care and subspecialty care, built around characterising cognitive-functional status, identifying the cognitive-behavioural syndrome and determining the likely underlying brain disease, followed by clear and compassionate disclosure. source
- The European guideline answers management questions the US document does not touch: systematic vascular risk factor management in mild-to-moderate dementia, anticoagulation for coexisting atrial fibrillation (weak recommendation), restriction of antipsychotics to severe agitation or aggression after non-pharmacological measures fail, and preference for levetiracetam or lamotrigine when treating seizures. source
- Version currency differs by five years: the European guidance dates to 2020 and therefore predates the US 2025 document's treatment of contemporary diagnostic testing pathways. source
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