Making a diagnosis of dementia in the early stages can be a clinical challenge.

The insidious and variable emergence of dementia symptoms makes recognition of the syndrome problematic, particularly in the primary care setting, with the often limited time available for consultation (Iliffe S, 2009)

In addition, physicians need to be wary of patients' ability to hide their symptoms. In the early stages of dementia, accommodation to or denial of changes in cognition, functional ability, mood, or behavior are common coping strategies (Woods RT, 2003).

As the person's denial strengthens, the concerns of the family become more pressing, with the physician often caught in between and faced with apparently irreconcilable needs.

 

The proposed diagnostic criteria move away from the traditional 2-step approach of first identifying dementia according to degree of functional disability and then specifying its cause (Dubois D, 2007).

Instead, they aim to define the clinical, biochemical, structural, and metabolic presence of AD at the earliest stages before full-blown dementia.

These new criteria are centered on a clinical core of early and significant episodic memory impairment.

They stipulate that there also must be at least one or more abnormal biomarkers among structural neuroimaging with magnetic resonance imaging, molecular neuroimaging with PET, and CSF analysis of β-amyloid or τ proteins (Dubois D, 2007).

For example, a decrease in the β-amyloid (1–42) peptide and an increase in the τ and phospho-τ proteins may be the earliest signs of AD (Dubois B, 2009).

These criteria represent a cultural shift requiring a more biologically focused workup than previous approaches, and their timeliness is highlighted by the development of drugs that are directed at altering pathogenesis, particularly at the production and clearance of β-amyloid.