Table 4.

Twenty final Grade A and B recommendations included after three rounds in the Delphi consensus

Statement number	Statement	Strength	Consistency
1	Each Region must have a Diagnostic, Therapeutic and Assistance Pathway (PDTA) for dementia in accordance with the indications of the National Dementia Plan	A	II
2	It is desirable that the General Practitioner (GP) applies risk maps to implement prevention policies and intercept suspected patients	B	III
3	In the suspicion of cognitive deficits, the GP must perform a screening test (e.g. GP-Cog) before selecting patients to be referred to the CDCD	B	III
4	It is necessary to integrate the CDCDs of the territory and those of the hospital in order to respond to different needs and phases of dementia according to their specificities	B	II
5	It is necessary to integrate the non-CDCD care phases into a network of integrated services (territorial specialists, day centers, social and health services), especially with regard to the advanced and or complex stages of the disease on the basis of what is described in the regional PDTAs	A	II
6	The current organization of the CDCD does not allow the biological diagnosis of Alzheimer's disease to be carried out uniformly throughout the country	B	III
7	In order to allow all patients to have access to biological diagnosis, the CDCD network, based on their different functions, must be organized at district level (hub and spoke model)	B	III
8	To obtain a biological diagnosis, CSF testing provides more clinically useful pathology information than amyloid PET	B	II
9	It is appropriate to request investigations for a biological diagnosis of AD in those people considered best candidates for DMTs, on the basis of the prescriptive restrictions provided by the authority in Countries where these treatments are licensed	B	III
10	The use of plasma biomarkers can be implemented as a preliminary investigation to optimize screenings aimed at selecting subjects to undergo more invasive or expensive investigations for the NHS	B	III
11	In order to proceed with the correct prescription, administration and monitoring of DMTs, it is necessary to reorganize and strengthen the day hospitals, radiology services with specific focus on the personnel training	A	III
12	The prescription of disease-modifying drugs must be under the responsibility of CDCDs	B	II
13	The administration of DMTs can also be carried out by specialized hospitals as long as they are able to guarantee safety in the administration and clinical-radiological monitoring	B	III
14	It is necessary that CDCDs, which are infusion centers for DMTs, are also able to perform clinical-radiological monitoring	B	II
15	CDCD identified as infusion Centers must have specific characteristics (possibility of access to Emergency Department H/24 h a day, facilitated contact with the reference specialist)	B	III
16	PDTAs are essential for the organization of health and social care for people with neurocognitive disorders and for proper management	B	III
17	Patient care cannot be linked only to the CDCD but must be organized at a local level involving GPs, neurology and territorial geriatricians, day centers, Alzheimer’s café networks, Community Hospitals and nursing homes	A	III
18	Patients/caregivers associations play an important supporting role in the social-welfare process	B	III
19	AIFA note 85 can be abolished by ensuring that patients are taken care of by CDCDs for the appropriate diagnostic care pathways	B	II
20	Telemedicine should be used in CDCDs for follow-up visits, follow-up cognitive assessments, for therapeutic adjustments, and for speech and cognitive rehabilitation/stimulation	B	III

Legend: CDCD: Centers for cognitive decline and dementia; DMTs: disease modifying treatments; AIFA: Italian Regulatory Drugs Agency