Episode notes
Part one of a two-part approach series on dementia, covering diagnosis. Built on Curbsiders episode 511 with Halima Amjad, the Alzheimer's Association's first clinical practice guideline on blood-based biomarkers, and a JAGS review on detecting Alzheimer neuropathology in chronic kidney disease. The organizing question is whether a primary care clinician should be ordering the new blood tests, and three credible sources disagree: the podcast says recent FDA clearances make primary care an appropriate setting, the Alzheimer's Association guideline explicitly declines to address primary care and restricts its recommendations to specialized settings, and the geriatrics literature says the tests should not be implemented anywhere without validation in kidney disease. It covers functional impairment as the line between mild cognitive impairment and dementia, cognitive testing and collateral history, alternative screeners for patients with little schooling or tested in a second language (education-adjusted MoCA cutoffs, MoCA-Basic, the RUDAS and its 2026 meta-analysis, the SLUMS and the limits of its education adjustment, the Mini-Cog as a first-step screen at Medicare Annual Wellness Visits and why a negative result is less reassuring than a negative PHQ-2, the AD8 informant questionnaire, and the Spanish-developed Fototest and Prueba Cognitiva de Leganés), what the MRI is for, the biomarkers themselves and the performance thresholds the guideline sets, why kidney disease produces false positives, the sarcopenia trap that hides kidney disease behind a normal creatinine, and why a positive amyloid result in an eighty-year-old means less than it sounds.