O'Brien Kyra, Largent Emily A, Karlawish Jason
Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Alzheimers Dement. 2025 Jan;21(1):e14200. doi: 10.1002/alz.14200. Epub 2024 Dec 30.
A comprehensive evaluation for cognitive impairment should culminate with the communication of the diagnosis to patients and their care partners. This diagnostic disclosure sets the stage for subsequent care. Diagnostic disclosure for individuals with cognitive impairment due to Alzheimer's disease (AD) or AD-related dementias (ADRD) is particularly nuanced and requires a conscientious approach. Clinicians must assess patients' understanding and appreciation of symptoms, goals for the evaluation, and desire for information. Because AD/ADRD can impact patients' perceptions of their symptoms, it is recommended to include an informant or care partner for this assessment and for future care. Here, we provide guidance for addressing the complexities of AD/ADRD diagnostic disclosure to build clinicians' confidence in communicating diagnostic findings and a plan of care. HIGHLIGHTS: Diagnostic disclosure is a key part of the evaluation of cognitive impairment. The disclosure process begins at the moment a cognitive evaluation is initiated. Care partners must be included in the cognitive evaluation and diagnostic disclosure. Clinicians should use patient-centered communication for evaluation and disclosure.
对认知障碍的全面评估应以向患者及其护理伙伴传达诊断结果作为结束。这种诊断结果的披露为后续护理奠定了基础。对于因阿尔茨海默病（AD）或AD相关痴呆症（ADRD）导致认知障碍的个体，诊断结果的披露尤为微妙，需要采取审慎的方法。临床医生必须评估患者对症状的理解和认知、评估目标以及对信息的需求。由于AD/ADRD会影响患者对自身症状的认知，因此建议在此次评估及后续护理中纳入知情人或护理伙伴。在此，我们提供应对AD/ADRD诊断结果披露复杂性的指导，以增强临床医生传达诊断结果和护理计划的信心。要点：诊断结果披露是认知障碍评估的关键部分。披露过程从启动认知评估的那一刻就开始了。护理伙伴必须参与认知评估和诊断结果披露。临床医生应采用以患者为中心的沟通方式进行评估和披露。
