Expert Guidance on Diagnosing and Managing Cognitive Impairment in Alzheimer’s Disease in the UAE – A Seven-Step Framework

The diagnosis and management of Cognitive Impairment (CI) and Alzheimer’s Disease (AD) pose a growing global health challenge. While international guidelines exist, their local implementation in the United Arab Emirates (UAE) is often limited by unique cultural factors and specific healthcare resource constraints. To address this gap, a task force of UAE neurologists and collaborators was convened to develop evidence-based position statements/recommendations to guide the diagnosis and management of AD, including the use of amyloid-targeting therapies (ATTs), in the UAE clinical setting.

A seven-step framework for diagnosing and managing CI in the UAE was developed, with consensus achieved on all statements. This framework integrates global best practices with essential, region-specific guidance for the patient journey.

Step 1: When to Suspect Cognitive Impairment

Healthcare providers must be vigilant for early, subtle signs of CI, including memory loss, executive dysfunction, and behavioral changes. Due to cultural norms like multigenerational households in the UAE, the concerns raised by care partners are especially crucial and should be carefully considered, particularly in individuals over 65. Early suspicion is vital, as emerging disease-modifying therapies, such as Amyloid-Targeting Therapies (ATTs), are most effective when initiated early in the disease course.

Step 2: Clinical Confirmation of CI

Patients with suspected CI should undergo a comprehensive clinical assessment led by a neurologist, psychiatrist, or geriatrician. This baseline evaluation requires a detailed history and, critically, a neuropsychological evaluation tailored to the patient’s language and cognitive profile, ensuring the tools are culturally and linguistically appropriate. The assessment must also include high-quality Magnetic Resonance Imaging (MRI) and routine blood tests to exclude reversible causes of cognitive decline, such as hypothyroidism or vitamin deficiencies.

Step 3: Laboratory Confirmation of AD

To secure an accurate AD diagnosis, especially in patients with mild CI or dementia who may be eligible for ATTs, the use of biomarkers is strongly recommended. The framework strongly advocates for utilizing amyloid Positron Emission Tomography (PET) in the UAE to confirm the diagnosis and monitor progression. Cerebrospinal Fluid (CSF) analysis is recommended as an alternative for suspected AD cases.

Step 4: Patient and Care Partner Education

Addressing the enduring stigma associated with AD in the UAE is a priority. The framework recommends enhancing public awareness, expanding education, and strengthening patient advocacy groups to provide essential support. Education is considered the cornerstone of management.

Step 5: Lifestyle Interventions and Cognitive Rehabilitation

Management necessitates a holistic approach that includes actively addressing modifiable risk factors in the early stages to improve brain health and slow disease progression. Non-pharmacological interventions are essential components across all stages, including cognitive stimulation and rehabilitation, physical activity, social engagement, and improving sleep hygiene and stress management.

Step 6: Current Treatment Options

ATTs represent a significant advancement for patients in the early stages of AD. Physicians must evaluate the risks and benefits of these treatments, offering them at the earliest appropriate time point with informed consent and thorough patient and care partner education on expectations and side effects. For moderate-to-severe AD, the focus shifts to a patient-centered approach on symptom management, ensuring comfort, dignity, and optimal quality of life.

Step 7: Evaluation of Treatment Response and Adjusting Management

Given the chronic and progressive nature of AD, regular assessments every 3–6 months are essential to evaluate treatment response, progression, and to make necessary therapeutic adjustments. Neurologists should be the main responsible healthcare professionals, especially for patients on ATTs. The framework strongly recommends establishing a multidisciplinary memory service—involving neurologists, psychiatrists, psychologists, and occupational therapists—to manage complex comorbidities and provide comprehensive care plans.

By combining international standards with local cultural sensitivities, the model ensures a holistic approach that integrates appropriate pharmacological treatment with lifestyle interventions, continuous monitoring, and vital support for both patients and their care partners, tailored to the evolving stage of the disease.

Reference Source
Alsaadi, T., Almadani, A., AlRukn, S. et al. Expert Guidance on Cognitive Impairment in Alzheimer’s Disease: A Practical Seven-Step Approach from the United Arab Emirates. Neurol Ther (2025). [doi.org/10.1007/s40120-025-00833-8]