👴 Geriatric Mental Health

🔬 2025 Alzheimer's Biomarker Guidelines

Alzheimer's Association Clinical Practice Guideline (July 2025): First guidelines endorsing blood-based biomarkers as part of diagnostic workup in specialty settings.

Key Recommendations

• Plasma p-tau217 validated as highly accurate for AD pathology detection
• Two-tier approach: screening (tier 1) vs confirmatory (tier 2)
• Restricted to memory care/specialty settings—primary care application pending
• AGS recommends caution: evidence quality graded as "low" or "conditional"

💊 Anticholinergic Cognitive Burden Scale

Score	Risk	Examples
1	Possible	Trazodone, ranitidine
2	Moderate	Carbamazepine, cyclobenzaprine
3	Definite/Severe	Amitriptyline, paroxetine, oxybutynin

Clinical Threshold: Total score ≥3 significantly associated with cognitive impairment, falls, and mortality. Target deprescribing Score 3 agents.