Using the 4Cs of Primary Care to Ensure Timely Diagnosis of Alzheimer Disease

BACKGROUND: Disease-modifying treatment is available for patients diagnosed with early symptomatic Alzheimer disease [AD, mild cognitive impairment (MCI), and mild dementia]. Recognition and diagnosis of MCI and dementia occur every day in the primary care setting, but diagnostic challenges and delays are common. Over 90% of MCI cases are missed, and more than half of AD diagnoses occur when the disease is in the moderate or advanced stage, when crises and emergencies are more likely to occur. DISCUSSION: Diagnostic delays limit opportunities to organize and implement proactive, comprehensive patient care and treatment and to prepare individuals and caregivers for the long-term implications of progressive dementia. With the advent of new diagnostic methods, including blood-based biomarkers, AD can now be diagnosed with greater precision and ease at a lower cost. Given the expected increase in prevalence of AD in the next 2 decades and the growing shortage of geriatricians and memory disorders specialists, the role of the PCP in diagnosing AD will be of even greater importance. However, many PCPs do not feel confident or equipped to recognize and diagnose patients with early symptomatic AD. To empower PCPs as key participants in diagnosis, we propose an approach aligned with the fundamental strengths of primary care, codified in the 4Cs (first contact, comprehensiveness, coordination, and continuity of care). CONCLUSION: Using the 4Cs framework, PCPs can increase the rate of timely diagnosis of symptomatic AD and be afforded more time to provide comprehensive care, using proactive rather than reactive management strategies throughout the diagnostic process.