# Alzheimer's Disease - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Alzheimer Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499922/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PD01.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text ALZHEIMER'S DISEASE Sources: Alzheimer Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499922/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PD01.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Memory loss is the most common first symptom of Alzheimer disease [memory loss] - In early-onset disease diagnosed before 60, roughly a quarter first present with impaired judgment and visuospatial difficulty rather than memory loss - Trouble managing finances, shopping, meal preparation, or housekeeping reflects declining instrumental daily function - Caregivers often describe a gradual shift in memory, thinking, behavior, or daily function - One atypical variant brings progressive visual difficulty with problems in object and space perception, calculation, and reading, while memory stays relatively intact early on - Another variant starts with worsening language difficulty while memory is preserved early on - A less common variant shows impaired planning and executive function out of proportion to memory loss [memory loss] - In advanced disease the patient can stop talking and stop responding to being spoken to, eventually becoming bed-bound SIGNS - what you find (3) - The neurological exam is usually normal apart from loss of smell [loss of smell] - Unlike Alzheimer disease, loss of smell is not typically seen in vascular cognitive impairment or depression [loss of smell] - Advanced disease can bring focal findings such as apraxia, aphasia, frontal release signs, and primitive reflexes [slurred speech] TESTS (12) - Bedside screening with the MMSE, or preferably the MOCA, is part of the standard cognitive workup - The MOCA outperforms the MMSE for picking up mild cognitive impairment - The Mini-Cog, combining a clock-drawing task with three-item recall, is another primary-care screening test - Mini-Cog scores are not meaningfully skewed by a patient's education level - Basic bloodwork such as CBC, metabolic panel, TSH, and B12 is drawn to exclude other reversible causes, not because it shows AD-specific changes - A brain CT can show cerebral atrophy and third-ventricle widening, but these findings are nonspecific - MRI can show entorhinal cortex atrophy followed by medial temporal or hippocampal atrophy - Volumetric MRI can show hippocampal shrinkage, a characteristic feature linked to memory decline - EEG is usually normal in AD and is not a useful diagnostic tool, though it may show generalized slowing - FDG-PET can reveal metabolic impairment in the hippocampi in early or preclinical disease - CSF testing shows a drop in amyloid-beta 42 alongside a rise in phosphorylated and total tau - Genetic testing is not part of routine workup but is considered for families with rare early- onset disease IF NOT THIS - what else fits (10) - Depression-related pseudodementia needs to be excluded - Dementia with Lewy bodies is a key differential; watch for fluctuating cognition, visual hallucinations, and parkinsonism - Vascular dementia belongs on the differential list - Frontotemporal dementia mimics AD but visuospatial skills tend to stay intact, a useful discriminator - Dialysis dementia, a neurologic complication of chronic dialysis treatment, is another consideration - Vitamin B12 deficiency is a reversible cause that should be ruled out - Thyroid dysfunction can mimic cognitive decline and needs excluding - Polypharmacy is weighed as a possible contributing or mimicking factor - Alcohol or drug misuse is considered among the mimicking causes - Normal age-related memory change is distinguished from true dementia Source StatPearls "Alzheimer Disease" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult The most common cause of dementia, with insidious memory loss and progressive cognitive decline; a GP recognises the pattern, arranges basic work-up to exclude reversible causes, and refers to neurology/psychiatry for formal diagnosis and initiation of a cholinesterase inhibitor or memantine, continuing prescriptions once established. - Refer, with advice Peds Adult-only condition - paediatric section not applicable Source No dose - referral pathway, no medicine given in primary care Why The most common cause of dementia, with insidious memory loss and progressive cognitive decline; a GP recognises the pattern, arranges basic work-up to exclude reversible causes, and refers to neurology/psychiatry for formal diagnosis and initiation of a cholinesterase inhibitor or memantine, continuing prescriptions once established. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Rapid (weeks to months) cognitive decline is atypical for Alzheimer's and needs urgent work-up for another cause. Refer also for new focal neurological signs, or depression that mimics or coexists with dementia. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)