The 2026 recommendations of the Federation of Memory Centers (FCM) for the diagnosis of Alzheimer’s disease propose an updated and operational framework to support professionals involved in identification, guidance, diagnosis and notification. This new version reminds us that early diagnosis remains a clinical-biological approach, based on clinical and neuropsychological evaluation and the reasoned use of biomarkers. It also specifies the place of MRI, CSF, blood pTau217, FDG-PET, amyloid PET and Tau PET.
These recommendations for the diagnosis of Alzheimer’s disease* propose a structured approach to diagnosis, integrating in particular:
– identification of early and atypical forms of the disease;
– the connection between primary care, local Memory consultations, Territorial Memory consultations and CMRR;
– the role of additional examinations, in particular MRI, neuropsychological assessment, CSF, FDG-PET and amyloid PET;
– the progressive integration of blood biomarkers, in particular pTau217;
– the importance of diagnostic notification and post-disclosure support, for patients and their caregivers.
The recommendations also emphasize on the importance of identification in primary care, graduated orientation towards Memory consultations, taking into account non-amnestic or behavioral formsand post-announcement support. They do not only modify certain technical points of the diagnosis. They offer a more structured to think about the patient journey : from initial identification to announcement, including orientation, multidisciplinary evaluation, biomarkers and support. For Memory Center professionals, they can be used common support to harmonize practicesstrengthen links with primary care, secure indications for additional examinations and prepare for future developments.
In detail, what recommendations does the working group make for the diagnosis?
The working group proposes to use the symptomatic clinical stages linked to Alzheimer’s disease as recently defined by the Alzheimer’s Association Working Group
Minor neurocognitive disorders:
– impaired/abnormal cognitive performance based on objective and standardized cognitive tests;
– evidence of decline from baseline, documented by interview of the person or informant (e.g., partner) or by change in change in cognitive tests or behavioral assessments;
– ability to perform activities of daily living independently. Note that cognitive difficulties may have a functional impact that is only detectable on complex activities of daily life, that is to say, they may take more time or be less effective, while still remaining accomplished, according to the patient’s declarations and/or corroborated by the informant;
– stage 3 of the classification Alzheimer’s Association.
Major neurocognitive disorders with mild functional impairment (mild stage):
– progressive cognitive decline and slight functional change in instrumental activities of daily living (ADLs) (meal preparation, household chores, use of means of transportation, administrative/financial management, management of medication treatments, etc.) and not affecting basic ADLs (washing, dressing, transfers, eating prepared meals);
– stage 4 of the classification Alzheimer’s Association.
Major neurocognitive disorders with moderate functional impairment (moderate stage):
– progressive cognitive decline and moderate functional change in basic ADLs requiring assistance;
– stage 5 of the classification Alzheimer’s Association.
Major neurocognitive disorders with severe functional impairment (severe stage)
– progressive cognitive decline and severe functional change with dependence for basic ADLs
– stage 6 of the classification Alzheimer’s Association.
Some reminders also from the working group
– The evaluation of the progressive clinical stage can be complex in the early stages of the disease and requires the expertise of doctors trained in Memory consultation.
– Certain clinical situations can lead to an overestimation of the cognitive deficit in the case of primary language impairment, for example, or an underestimate of the cognitive deficit in the case of executive impairment.
– Depression is a differential diagnosis which can present itself with a complaint or cognitive disorders and can influence executive functions in particular. Its diagnosis is important because it is a curable condition but sometimes linked to an authentic neurodegenerative disease, justifying follow-up.
– In current clinical practice, the progressive stages of the disease can be assessed through detailed questioning by evaluating the impact on autonomy in daily life (activities of daily living, instrumental activities), dependence on aids or the notion of behavioral modifications.
– Questioning a close family informant who spends at least several hours per week alongside the patient appears particularly important to assess the progressive stage of the disease.
– In a clinical research context, the administration of the CDR scale allows a more detailed assessment of the progressive stage of Alzheimer’s disease.
For the working group, early diagnosis makes it possible to plan long-term care, allocate resources
resources proactively and to better anticipate future health care and community support needs. In the current state of knowledge, systematic screening in the general population
of Alzheimer’s disease is however not indicated. On the other hand, these recommendations could change in the future if effective preventive therapies become available..
The challenge now is to bring these recommendations to life in the teams : read them, discuss them, integrate them into local protocols, and use them as a basis for dialogue between general practitioners, specialists, neuropsychologists, speech therapists, nurses, psychologists, social workers and course coordinators.
*Recommendations developed in partnership with the SF3PA – French-speaking Society of Psychogeriatrics and Psychiatry of the Elderly, the SFGG (French Society of Geriatrics and Gerontology), the SFMN French Society of Nuclear Medicine and the French Society of Clinical Biology (SFBC).
• Recommendations for the diagnosis of Alzheimer’s disease, Federation of Memory Centers, June 2026 (PDF)
