Early Cognitive Decline / Anti-Amyloid Pre-Referral Pathway

Educational pathway

Select the clinical state to begin

This follows the workflow presented in the lecture. It does not diagnose Alzheimer disease or determine treatment eligibility.

1. Is objective cognitive decline established?

Subjective concern only — no objective deficit demonstrated Yes — objective decline demonstrated clinically / on testing

2. Functional stage

Independent in key IADLs → MCI-level functional stage Some IADL loss → mild / very mild dementia range Major dependence / requires extensive caregiving

3. Clinical Alzheimer phenotype

Progressive syndrome clinically suspicious for Alzheimer disease Atypical but AD-compatible phenotype (e.g. logopenic PPA) Strong alternate explanation / reversible contributor present

4. Basic workup / treatment-risk flags

Brain MRI completed Major cerebrovascular disease / substantial microbleed burden Therapeutic anticoagulation / blood thinner APOE ε4 homozygous MoCA below ~13 (local UPMC practice point from lecture) Basic reversible-cause labs reviewed (including TSH / B12)

5. Biomarker status

No Alzheimer biomarker yet Blood biomarker positive Blood biomarker negative Blood biomarker intermediate / indeterminate Amyloid PET or CSF confirms Alzheimer pathology Amyloid PET or CSF negative for Alzheimer pathology

6. Blood-test confounders / interpretation

Chronic kidney disease Medication that may impair cognition (lecture example: topiramate)

Educational tool derived from the July 2026 Primary Care Educational Session transcript. It reflects the speaker's framing and UPMC practice examples, not a substitute for current prescribing information, specialist assessment, or local treatment protocols.

Alzheimer's Disease — Practical Update

Primary Care Educational Session • July 2026

⚠ Lecture-based aid — verify current protocols.

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