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

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Explore the value of the newly released Alzheimer’s Association appropriate use criteria for lumbar puncture and cerebral spinal fluid testing in the diagnosis of Alzheimer’s disease with guest presenter Dr. Steven Salloway, Director of Neurology and the Memory and Aging Program at Butler Hospital.
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“The rate of misdiagnosis is somewhere between 20-30%, even in expert hands.” Dr. Steven Solloway

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

E1 – New Appropriate Use Criteria in Diagnosing Alzheimer’s Disease
E2 – CSF Clinical Diagnosis’ Used to Inform Guidance on Detecting Alzheimer’s Disease


Dr. Steven Salloway: Welcome to the third of three podcasts to accompany the release of the new appropriate use criteria for cerebral spinal fluid testing(CSF) for the diagnosis of Alzheimer’s disease. Developed by an expert workgroup convened by the Alzheimer’s Association with technical support from Avalere Health. My name is Dr. Steven Salloway and I serve as Director of Neurology and the Memory and Aging Program at Butler Hospital and I am a professor of neurology and psychiatry at the Brown Medical School in Providence, Rhode Island. In this session, I want to share my perspective as a clinician on the value of this document for specialists and how it may positively affect how clinicians are able to diagnose Alzheimer’s disease.

An accurate diagnosis forms the foundation for excellent medical care. Many conditions mimic Alzheimer’s disease. Some of the favorable prognosis and the rate of misdiagnosis is somewhere between 20-30%, even in expert hands. There have been improvements in CSF assays for amyloid and tau, which increase the diagnostic accuracy and change treatment. What’s new in this document is that CSF testing is found to be appropriate and recommended for use in the diagnosis of patients with mild cognitive impairment before dementia. We are also recommending use of CSF testing for AD with typical age of onset to improve diagnosis and treatment, and we further recommend that it is appropriate to use CSF testing for people with subjective cognitive decline who still test in the normal cognitive range, but where the patient, family, and clinician perceive that there has been a cognitive decline and the patient is felt to be at an increased risk for Alzheimer’s disease.

Diagnosing Alzheimer’s in earlier stages give patients and families the opportunity to make important decisions and plan ahead with this additional information and also to take advantage of treatments, including clinical trials to slow memory loss. It is important that expert clinicians become familiar with these recommendations and take the lead in implementing them. Patients are concerned about the safety of undergoing lumbar puncture and they rely on their physician for guidance and reassurance.

Thank you for listening.

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