Role of psychiatrists in the diagnosis and management of alzheimer’s disease “revisited”: A review and clinical opinion

The number of people diagnosed with Alzheimer’s disease (AD) is expected to increase substantially in the near future. In the recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the terminology related to AD has shifted from “dementia” to major or mild “neurocognitive disorder”, emphasizing the cognitive impairment that occurs relatively early in the disease process. The concept of “mild neurocognitive disorder” or “mild cognitive impairment” promotes early detection and diagnosis of AD, particularly by psychiatrists, who often consult the DSM-5. This narrative review describes the current and future role of psychiatrists in the diagnosis and management of AD, focusing on the DSM-5 criteria for mild and major neurocognitive disorder. We summarize some of the key instruments used to assess cognition and the neuropsychiatric and behavioral symptoms that often accompany early AD, neuroimaging diagnostic tools, and newly available AD-specific biomarkers that enhance the ability of clinicians to diagnose early AD. We also briefly describe current and emerging pharmacological treatments for AD that target amyloid and tau and that may modify disease progression. Finally, we provide our clinical opinion on the future role of psychiatrists in AD, the education and training necessary to fulfil this role, interactions between psychiatrists and other specialists as part of a multidisciplinary team, and the potential for routine screening of cognitive function among elderly people.