Presentation (CTI)

OBJECTIVES: PREDICTOM is an IHI-funded European research project addressing delays between early cognitive symptoms and definitive dementia diagnosis. It aims to shorten this timeline by developing and implementing an integrated biomarker screening platform that can bring innovative diagnostics to the point of care. Many European countries have national guidelines for assessing suspected cognitive impairment, but with little emphasis and guidance on the role of primary care. Understanding current diagnostic pathways is essential for assessing where novel technologies may add value. We reviewed clinical guidelines for people presenting in primary care with suspected mild cognitive impairment (MCI) or dementia, examining their structure, content, key gaps, and similarities or differences in recommended non-specialist diagnostic steps across Europe.
METHODS: We identified guidelines from a relevant 2023 systematic review and updated its search. We included national European clinical practice guidelines covering screening or diagnosis of MCI, dementia, or Alzheimer’s disease in community or primary care. We extracted screening and diagnostic recommendations, summarised them narratively by diagnostic context and assessment type, and grouped them thematically to identify patterns across guidelines.
RESULTS: We included 13 guidelines from 12 countries, published between 2006 and 2024. No guideline recommended population-level screening, and all recommended multidimensional assessment. However, guidance varied substantially and showed limitations in scope, clarity, and operational utility, including little direction on: the order and timing of investigations, thresholds for concern, interpretation of borderline findings, risk factors, and referral criteria.
CONCLUSIONS: These limitations are particularly important in the context of rapidly evolving diagnostic innovation. Emerging tools, including blood-based biomarkers, digital cognitive and risk assessment tools are key innovations that have the potential to transform the early identification of cognitive impairment leading to AD and other dementias. There is scope to optimise European guidelines to accommodate these emerging diagnostic modalities at the point of initial clinical contact.