The adherence of memory clinics to consensus recommendations for dementia diagnosis: A multicentric study in Italy

INTRODUCTION: Quantitative evaluations of how recommendations influence clinical practice are limited. This study assessed changes in the diagnostic pathways after the 2020 Italian Intersocietal Consensus Recommendations (IICR) for biomarker-based dementia diagnosis. METHODS: Medical charts of new patients referred to three Italian memory clinics were reviewed for 2018 and 2019 (pre-IICR) and 2022 and 2023 (post-IICR). Sociodemographic and clinical data were extracted. Adherence to IICR was measured using an adherence index (AI, range 0-5). Deviations from recommended pathways were analyzed. RESULTS: We analyzed 601 pathways in pre-IICR and 434 in post-IICR. Biomarker-based diagnoses increased from 23% to 41% post-IICR, with a significant redistribution of diagnostic categories and greater biomarker use. The AI increased modestly (2.09 ± 1.04 to 2.28 ± 1.04; p = 0.04), driven by improved neuropsychological assessment and biomarker selection (p < 0.001). Deviation analyses showed that adherence remained heterogeneous, with reduced biomarker use in older patients. DISCUSSION: Diagnostic practices partially aligned with IICR, reflecting a progressive shift toward standardized, biologically informed dementia diagnosis in Italian expert centers.