E1 – New Appropriate Use Criteria in Diagnosing Alzheimer’s Disease

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We explore the value of the newly released Alzheimer’s Association appropriate use criteria for lumbar puncture and cerebral spinal fluid (CSF) testing in the diagnosis of Alzheimer’s disease. We kick off this series with Dr. Maria Carillo, the Alzheimer Association’s Chief Science Officer and Dr. Jim Hendrix, Director of Global Science Initiatives.
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“Alzheimer’s is often diagnosed with a pencil-paper test, which is a good way to determine if somebody has dementia. But it’s not always easy to understand if they have Alzheimer’s disease or another form of dementia.” Dr. Jim Hendrix


Guest Speaker
Dr. Maria Carillo , Chief Science Officer, Alzheimer's Association
Guest Speaker
Dr. Jim Hendrix , Director of Global Science Initiatives, Alzheimer's Association

This interview was originally published as a podcast. The audio is no longer available, but you can read the transcript below. For updates on our newly released content, visit our Insight Subscription page.

Explore Other Interviews in This Series

E2 – CSF Clinical Diagnosis’ Used to Inform Guidance on Detecting Alzheimer’s Disease

E3 – New Appropriate Use Criteria Increases Likelihood of Accurate Diagnosis for Alzheimer’s Disease


Judit Illes: Hello and welcome to Avalere’s podcast. My name is Judit Illes and I serve as Senior Manager in our Center for Healthcare Transformation. This is the first in a series of three discussions about the newly released Alzheimer’s Association appropriate use criteria for lumbar puncture and cerebral spinal fluid (CFS) testing in diagnosing Alzheimer’s disease. As some of our listeners may know, for the past year, we at Avalere have had the pleasure of supporting the Association in facilitating a truly international workgroup of experts to develop these evidence-based criteria that will hopefully help advance the field.

For this discussion, I’m honored to be joined by the Association’s Chief Science Officer, Dr. Maria Carillo, and Dr. Jim Hendrix, Director of Global Science Initiatives.

Maria, let me start with you. Take us to the beginning of what lead to this publication. Why did the Association feel it was important to embark on this project?

Dr. Maria Carillo: So, the Alzheimer’s Association embarked on AUC for CFS because we know that CSF assays for lumbar puncture for Alzheimer’s disease are coming online and there’s already one approved in the United States. There will be more coming in the coming months and we want to make sure that healthcare professionals and people that we support, people that are affected by Alzheimer’s disease or memory loss and their families, know about this tool and technology and know how it could be useful within a clinical work op and how it could be useful to inform them of what’s happening with their loved one.

We think that medical professionals need to be aware of this because it’s going to be a very new tool that’s going to hit the market, and already has, but I think will be even more disseminated in the coming 6-12 months. The Alzheimer’s Association firmly believes that an early and accurate diagnosis is critical to ensure quality healthcare and treatment, and potentially even make recommendations to people to participate in clinical trials. So, we, as advocates for patients and families, are very excited about being able to provide AUC for CSF.

Judit: Jim, let me turn to you. We know that there aren’t any effective treatments for Alzheimer’s. So, what is the incentive for people to get an early diagnosis?

Jim: Well, I think that there are treatments that are available that help many people. But, the real initiative is designed to give people an early, accurate diagnosis because we know if people don’t get that diagnosis, they don’t get the proper care and support that they need and that can lead to bad health outcomes. We know people who get an early and accurate diagnosis are better treated, they have better outcomes, and they avoid hospitalizations and emergency room visits. You know, for example, if you’re somebody who has dementia, you’re living alone and you also have Type II diabetes and you forget to take your insulin, you’re going to end up in an emergency room. Well, why are you in the emergency room? Well, you’re going to be treated for diabetes, but you’re actually there because you have untreated dementia, and we hope that this type of technology will help reduce those sorts of bad health outcomes in the future.

Judit: So that’s interesting. I feel like often we don’t hear about the kinds of outcomes you’re discussing. But turning it back to these AUC, how is this going to advance the fields or practitioner’s ability to do early diagnosis? Who should use it?

Jim: So, this AUC is around a specific new technology, it’s relatively new, and it’s not been widely used, particularly in the United States. But, we’re seeing this new technology improving, and the Alzheimer’s Association felt it was time that we provided this guidance for physicians on the types of patients that should get this technology, when would be appropriate to use it, and for which patients it would be inappropriate to use it. We thought that this was really important guidance for the physician community.

Judit: Bringing it down to the level of the patient now, what is the direct impact that the dissemination of these criteria could have on the quality of care for the individual patient as well as their families and caregivers?

Jim: Well, I think it provides a better understanding of the types of disease that somebody has. Alzheimer’s is often diagnosed with a pencil-paper test and this is a good way to determine if somebody has dementia, but it’s not always easy to understand if they have Alzheimer’s disease or another form of dementia. The CSF test can help with that and by understanding the type of disease that somebody has, that also can give the patient and the caregiver a sense of the trajectory of the disease. So, if you know you have say Alzheimer’s disease, maybe you and your loved one decide that it’s time to do that big vacation that you’ve been planning for and you shouldn’t wait any longer. It’s time to maybe plan for how you would like to live the remainder of your life and give your family that kind of guidance and peace of mind. Those are just some of the things that can be provided. And also just making sure that the individual with Alzheimer’s disease, they can make plans for their future while they’re still able to make those plans. So, we’re actually empowering for patients to get the diagnosis early.

Judit: Great. Thank you. I think this is an extremely important context that you’ve set for our listeners on the podcast today and please tune in for our other two companion podcasts on these AUC, one featuring our workgroup chair, Dr. Les Shaw, and the other, Dr. Steve Salloway, a workgroup member, who will provide further perspectives on how these important criteria can change diagnosis in the field. Thank you.

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