201
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Abstract
The prevalence of Alzheimer's disease (AD) and dementia continues to rise. However, a significant number of patients are undiagnosed or untreated. Given the complexities of detecting cognitive impairment and the early signs of AD, this review discusses how advances in brain imaging can help assist in improving overall management. Imaging techniques and surrogate markers may provide unique opportunities to diagnose accurately AD in presymptomatic stages with practical consequences for patients, caregivers, and physicians. The possible outcomes for using imaging and surrogate markers as adjuncts to clinical examination and as screening tools for AD, as well as tangible and intangible advantages to early diagnosis and treatment, will be discussed. The specific value of using advanced serial imaging in patients with a genetic disposition to AD will be evaluated. If neurons can be protected from neurodegenerative damage in early stages, this may preserve patient cognition, function, and quality of life, and may confer considerable societal healthcare benefits.
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Affiliation(s)
- Gary W Small
- Neuropsychiatric Institute, University of California-Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024, USA.
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202
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Tang BNT, Minoshima S, George J, Robert A, Swine C, Laloux P, Borght TV. Diagnosis of suspected Alzheimer's disease is improved by automated analysis of regional cerebral blood flow. Eur J Nucl Med Mol Imaging 2004; 31:1487-94. [PMID: 15232656 DOI: 10.1007/s00259-004-1597-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 05/11/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE Accurate diagnosis of Alzheimer's disease (AD), the most common form of dementia, remains difficult. In order to assess whether fully automated stereotactic surface projection (3D-SSP) presentation contributes to the diagnosis of AD by single-photon emission computed tomography (SPECT), we investigated the diagnostic accuracy of transaxial display with and without 3D-SSP analysis as well as the correlation between cerebral perfusion in different cortical areas and the mini mental score (MMS). METHODS Seventy-two patients referred because of cognitive impairment were included in the study. According to the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer's disease and Related Disorders Association (ADRDA) criteria, 27 patients were diagnosed as having probable AD while 45 were classified as non-AD patients. 3D-SSP was used to quantify the regional cerebral blood flow (rCBF) acquired from SPECT imaging. RESULTS Compared with the transaxial section presentation alone, 3D-SSP presentation improved the area under the receiver operating curve (p<0.05) as well as intra-observer (k=0.73 vs 0.88) and inter-observer (k=0.50 vs 0.84) reproducibility. Upon normalisation of regional to thalamic activity, multiple regression analysis revealed a strong correlation between the MMS and rCBF in the right parietal cortex (p=0.002). CONCLUSION Addition of 3D-SSP to the transaxial section display of ECD-SPECT studies improves the reproducibility and the diagnostic performance in respect of AD in patients with cognitive impairment and provides a valid tool for assessment of the severity of cortical perfusion abnormalities in such patients.
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Affiliation(s)
- Bich-Ngoc-Thanh Tang
- Department of Nuclear Medicine, Mont-Godinne University Hospital, UCL-Université Catholique de Louvain, Yvoir, Belgium.
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203
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Mok W, Chow TW, Zheng L, Mack WJ, Miller C. Clinicopathological concordance of dementia diagnoses by community versus tertiary care clinicians. Am J Alzheimers Dis Other Demen 2004; 19:161-5. [PMID: 15214202 PMCID: PMC1626585 DOI: 10.1177/153331750401900309] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subjects enrolled in the Autopsy Program at the University of Southern California Alzheimer's Disease Research Center may receive clinical diagnoses from primary care providers in the community or from specialists in neurology. We reviewed the autopsy concordance rates for 463 subjects for diagnoses made by both groups of clinicians. Seventy-seven percent of the sample met neuropathological criteria for Alzheimer's disease (AD). The overall diagnostic accuracy for this sample was 81 percent. Neurologists assessed 200 of the subjects (43 percent). The diagnostic accuracy for any clinical diagnosis among the non-neurologists was 84 percent, and 78 percent (p = 0.07) among neurologists. For AD, non-neurologists had a diagnostic concordance rate of 91 percent and neurologists 87 percent. Where neuropathological AD was missed, non-neurologists had failed to detect any cognitive impairment; neurologists had diagnosed Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). Erroneous clinical diagnoses of AD missed dementia with Lewy bodies (DLB) or AD concurrent with Parkinson's disease (PD). Our findings identify specific foci for improving clinical diagnosis of dementia among all physicians managing dementia.
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Affiliation(s)
- W Mok
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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204
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Zamrini E, De Santi S, Tolar M. Imaging is superior to cognitive testing for early diagnosis of Alzheimer’s disease. Neurobiol Aging 2004; 25:685-91. [PMID: 15172748 DOI: 10.1016/j.neurobiolaging.2004.02.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Revised: 02/16/2004] [Accepted: 02/18/2004] [Indexed: 11/18/2022]
Abstract
Alzheimer's disease (AD) starts at a molecular level possibly decades earlier than could be detected by neuropsychological tests (NPTs). Neuropathological and neuroimaging data suggest that amyloid accumulation precedes the clinical onset of AD. Disease-modifying agents would have to be used early to alter the course of AD. Therefore, preclinical diagnosis is necessary. Structural and functional neuroimaging are superior for detection of the earliest stages of AD. Magnetic resonance imaging (MRI) and positron emission tomography (PET) techniques, including amyloid visualization, will have therapeutic importance for prevention as well as intervention as further refinements of current imaging techniques and biochemical markers occur. Neuropsychological tests measure the effect of pathology for an individual based upon norms obtained from an artificial population-often white and relatively highly educated. Unless serial NPTs are performed, the individual is compared to a population to which they may not conform. Neuroimaging can provide objective measures of preclinical disease state and, when measured serially, rate of change. Such information can be used in prevention trials.
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Affiliation(s)
- Edward Zamrini
- Department of Neurology, 454 Sparks Center, 1720 7th Avenue South, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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205
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Abstract
Extensive PET imaging research on AD has been conducted since PET scanners became available in the early 1980s. PET imaging using FDG, now commercially available, can detect early metabolic changes in AD and differential metabolic features of various dementing disorders. Image analysis techniques have also advanced in the field of functional brain imaging and permit accurate and consistent scan interpretation. PET studies that involve autopsy-confirmed cases suggest that the PET diagnosis of AD is no worse or may even be better than clinical diagnosis. Limited prospective studies demonstrated the effects of PET imaging in dementia management, which precludes the approval of FDG PET for more widespread, reimbursable use. Further evidence for the efficacy of PET imaging through well-organized clinical studies, as well as continuing efforts in technologic development and basic research to characterize functional alterations in dementing disorders in living patients, are equally important to achieve the goal of better dementia care.
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Affiliation(s)
- Satoshi Minoshima
- Departments of Radiology and Bioengineering, University of Washington, 1959 North East Pacific Street, Seattle, WA 98195-6004, USA.
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206
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Gao FQ, Black SE, Leibovitch FS, Callen DJ, Rockel CP, Szalai JP. Linear width of the medial temporal lobe can discriminate Alzheimer’s disease from normal aging: the Sunnybrook Dementia Study. Neurobiol Aging 2004; 25:441-8. [PMID: 15013564 DOI: 10.1016/s0197-4580(03)00121-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2002] [Revised: 02/27/2003] [Accepted: 05/28/2003] [Indexed: 11/26/2022]
Abstract
To discriminate Alzheimer's disease (AD) from healthy controls, the thinnest medial temporal lobe (tMTL) width on 3D-MRI was measured according to a newly developed method at the inter-collicular sulcus (ICS) level with scans aligned to the long axis of the hippocampus in 22 mild, 27 moderate probable AD patients and 41 healthy controls. For comparison, MTL width replicating the technique of Jobst et al. (jMTL) as well as hippocampal and parahippocampal volumes, were also measured. Using logistic regression taking into account age, sex, and education, tMTL width classified mild AD from controls with a sensitivity of 86%, specificity of 95% and accuracy of 92%. Similar values were obtained for moderate or total AD group versus controls. By comparison, jMTL width was only useful in distinguishing moderate AD from controls, and volumetric measures were equally sensitive in classifying mild and moderate AD in our sample. This quick, reliable, and standardized measurement of tMTL can be helpful in differentiating even mild AD from controls with reasonable accuracy.
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Affiliation(s)
- F Q Gao
- Cognitive Neurology Unit, Neuroscience Research Program, Sunnybrook and Women's College Health Sciences Center, University of Toronto, A421-2075 Bayview Avenue, Toronto, Ont., Canada M4N 3M5
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207
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Abstract
The importance of the autopsy in neurodegenerative disease is often not appreciated. Yet clinical diagnosis of neurodegenerative disease is relatively inaccurate, many neurodegenerative diseases are inherited or are associated with specific genetic risk factors, and several non-transmissible neurodegenerative diseases may be confused clinically with prion diseases. In all these cases, the autopsy is the only practical way in which brain tissue can be obtained for diagnosis. The pathologist should ensure that consent by the next-of-kin to post mortem examination is based on clear information as to the nature, scope and limitations of the autopsy, and that any constraints on retaining brain and other tissues are documented. The autopsy should be preceded by a careful review of the clinical notes and ante mortem studies, and consideration of the possible and likely pathological processes. This may suggest the need to retain fixed or frozen samples of cerebrospinal fluid, skeletal muscle, peripheral nerve and other tissues in addition to brain and spinal cord. Ideally, the brain should be fixed intact for 2-3 weeks before it is sliced and blocks are taken. If the period of fixation is limited to a few days only, it is best to slice the brain whilst it is fresh and to allow the diagnostically relevant slices to fix flat; after about 3 days the fixed slices can be sliced further, examined macroscopically and sampled. Even if consent is limited to the retention of only a few tissue samples for histology, a reasonably confident diagnosis can still usually be made, provided that the sampling is careful and systematic. The selection of blocks or brain and spinal cord for histology should be based on internationally accepted guidelines for the pathological diagnosis of different types of neurodegenerative disease, where such guidelines are available. Illustrations are provided to indicate which regions of the brain are critical to establishing a diagnosis in the main categories of neurodegenerative disease. When difficulties arise in the pathological diagnosis of neurodegenerative disease, inadequate post mortem sampling or rapid processing of poorly fixed brain tissue is usually to blame.
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Affiliation(s)
- S Love
- Department of Neuropathology, Institute of Clinical Neuroscience, Frenchay Hospital, Bristol, UK.
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208
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Christensen DD. Practical Principles for the Management of Alzheimer's Disease. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2004; 4:63-69. [PMID: 15014746 PMCID: PMC181227 DOI: 10.4088/pcc.v04n0204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2002] [Accepted: 06/13/2002] [Indexed: 10/20/2022]
Abstract
Alzheimer's disease is a complex disorder that is particularly challenging to treat and manage. Early recognition of Alzheimer's disease is the first step toward providing patients with optimal therapy and the best opportunity for treatment response. Subsequently, physicians will need to address issues that emerge as the disease inevitably progresses. As the number of elderly patients with Alzheimer's disease increases, it becomes increasingly important for the primary care physician-usually the first line of patient contact-to diagnose Alzheimer's disease early, and initiate and manage appropriate long-term cholinesterase inhibitor therapy, which has been shown to provide significant benefits to Alzheimer's disease patients. In this article, discussions of individual patients illustrate commonly encountered situations in the primary care setting.
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209
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Knopman DS, Boeve BF, Petersen RC. Essentials of the proper diagnoses of mild cognitive impairment, dementia, and major subtypes of dementia. Mayo Clin Proc 2003; 78:1290-308. [PMID: 14531488 DOI: 10.4065/78.10.1290] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Loss of cognitive function in the elderly population is a common condition encountered in general medical practice. Diagnostic criteria and approaches have become more refined and explicit in the past several years. Precise diagnosis is feasible clinically. In this article, the precursor state and major subtypes of dementia are considered. Mild cognitive impairment is the term given to patients with cognitive impairment that is detectable by clinical criteria but does not produce impairment in daily functioning. When daily functioning is impaired as a result of cognitive decline, dementia is the appropriate syndromic label. Specific causes of dementia tend to have distinctive clinical presentations: the anterograde amnesic syndrome of Alzheimer disease; the syndrome of dementia with cerebrovascular disease; the syndrome of Lewy body dementia with its distinctive constellation of extrapyramidal features, disordered arousal, and dementia; the behavioral-cognitive syndrome of frontotemporal dementia; the primary progressive aphasias; and the rapidly progressive dementias. Because dementia syndromes have distinctive natural histories, precise diagnosis leads to a better understanding of prognosis. As new treatments become available for Alzheimer disease, the most common of the dementias, accurate diagnosis allows the appropriate patients to receive treatment.
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Affiliation(s)
- David S Knopman
- Department of Neurology and Alzheimer's Disease Research Center, Mayo Clinic, Rochester Minn 55905, USA
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210
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Hampel H, Goernitz A, Buerger K. Advances in the development of biomarkers for Alzheimer's disease: from CSF total tau and Abeta(1-42) proteins to phosphorylated tau protein. Brain Res Bull 2003; 61:243-53. [PMID: 12909294 DOI: 10.1016/s0361-9230(03)00087-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Advances have been made to establish biological markers of Alzheimer's disease (AD). Measurement of total tau (t-tau) and beta-amyloid(1-42) (Abeta(1-42)) in the cerebrospinal fluid (CSF) seems useful to discriminate early and incipient AD from age-associated memory-impairment, depression, and some secondary dementias. New immunoassays to detect different phosphorylated tau epitopes (p-tau) have recently been developed. P-tau phosphorylated at threonine 231 (p-tau(231)) showed improvements compared to t-tau in the early detection of AD in subjects with mild cognitive impairment. As p-tau(231) declined during the course of AD, it may have potential to track disease progression. Additionally, p-tau(231) improved differential diagnosis between AD, frontotemporal dementia, and geriatric major depression. P-tau phosphorylated at threonine 181 improved diagnostic accuracy between AD and dementia with Lewy bodies. P-tau phosphorylated at serine 199 demonstrated high discriminative power between AD and non-Alzheimer's dementia. P-tau phosphorylated at serine 306/serine 404 improved differential diagnosis between AD and vascular dementia. A comparative study of the different p-tau epitopes is currently under way. In summary, first clinical multi-center studies suggest that measurement of phosphorylated tau proteins may significantly improve early and differential diagnosis and may come close to fulfilling proposed criteria of a biological marker for AD.
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Affiliation(s)
- Harald Hampel
- Department of Psychiatry, Alzheimer Memorial Center and Geriatric Psychiatry Branch, Ludwig-Maximilian University, D-80336 Munich, Germany.
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211
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Abstract
Current clinical criteria (DSM-IIIR and NINCDS-ADRDA) for the diagnosis of dementia and AD are reliable; however, these criteria remain to be validated by clinicians of different levels of expertise at different clinical settings. Structural neuroimaging has an important role in initial evaluation of dementia for ruling out potentially treatable causes. Although CT is the appropriate choice when brain tumors, subdural hematoma, or normal pressure hydrocephalus is suspected, MR imaging is more sensitive to the white-matter changes in vascular dementia. The diagnostic accuracy of PET, SPECT, 1H MRS, and MR volumetry of the hippocampus for distinguishing patients with AD from healthy elderly individuals is comparable to the accuracy of a pathologically confirmed clinical diagnosis. Sensitivity of PET for distinguishing patients with dementia with Lewy bodies from AD, however, is higher than that of clinical evaluation; similarly, SPECT and 1H MRS may be adjuncts to clinical evaluation for distinguishing patients with frontotemporal dementia from those with AD. Neuroimaging is valuable in predicting future development of AD in patients with MCI and in carriers of the ApoE epsilon 4 allele who are at a higher risk of developing AD than are cognitively normal elderly individuals. Quantitative MR techniques (e.g., MR volumetry, DWI, magnetization transfer MR imaging, and 1H MRS) and PET are sensitive to the structural and functional changes in the brains of patients with MCI, and hippocampal volumes on MR imaging are associated with future development of AD in these individuals. PET is also sensitive to the regional metabolic decline in the brains of carriers of the ApoE epsilon 4 allele. The longitudinal decrease of whole brain and hippocampal volumes on MR imaging, NAA levels on 1H MRS, cerebral glucose metabolism on PET, and cerebral blood flow on SPECT are associated with rate of cognitive decline in patients with AD. These neuroimaging markers may be useful for monitoring symptomatic progression in groups of patients with AD for drug trials. Furthermore, antemortem MR-based hippocampal volumes correlate with the pathologic stage of AD, and the rate of hippocampal volume loss on MR imaging correlates with clinical disease progression in the cognitive continuum from normal aging to MCI and to AD. Hence, as an in vivo correlate of pathologic involvement, structural imaging measures are potential surrogate markers for disease progression in patients with established AD and in patients with prodromal AD, who will benefit most from disease-modifying therapies underway.
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Affiliation(s)
- Kejal Kantarci
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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212
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Abstract
Lewy bodies were originally described in isolated brainstem nuclei in persons with Parkinson's disease. They have since been recognized as a widespread and common neuropathologic finding in individuals with dementia. Dementia with Lewy bodies (DLB) is the preferred term for the dementia syndrome associated with Lewy bodies. Although DLB is acknowledged as the second most common degenerative dementia, trailing only Alzheimer's disease, its ranking with respect to vascular dementia remains controversial. Large, community-based studies of DLB with postmortem confirmation are lacking. Available data suggest that DLB is more common than pure vascular dementia but not more common than any vascular contribution to dementia.
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Affiliation(s)
- Judith L Heidebrink
- Department of Neurology, University of Michigan, and Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
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213
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Bonner LT, Tsuang DW, Cherrier MM, Eugenio CJ, Du JQ, Steinbart EJ, Limprasert P, La Spada AR, Seltzer B, Bird TD, Leverenz JB. Familial dementia with Lewy bodies with an atypical clinical presentation. J Geriatr Psychiatry Neurol 2003; 16:59-64. [PMID: 12641375 PMCID: PMC1482838 DOI: 10.1177/0891988702250585] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report a case of a 64-year-old male with Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) pathology at autopsy who did not manifest the core symptoms of DLB until very late in his clinical course. His initial presentation of early executive and language dysfunction suggested a cortical dementia similar to frontotemporal lobar degeneration (FTLD). Core symptoms of DLB including dementia, hallucination, and parkinsonian symptoms were not apparent until late in the course of his illness. Autopsy revealed both brainstem and cortical Lewy bodies and AD pathology. Family history revealed 7 relatives with a history of dementia including 4 with possible or probable DLB. This case is unique because of the FTLD-like presentation, positive family history of dementia, and autopsy confirmation of DLB.
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Affiliation(s)
- Lauren T. Bonner
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Debby W. Tsuang
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Monique M. Cherrier
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Charisma J. Eugenio
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Jennifer Q. Du
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Ellen J. Steinbart
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Pornprot Limprasert
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Albert R. La Spada
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Benjamin Seltzer
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - Thomas D. Bird
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
| | - James B. Leverenz
- From the Department of Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC) (Drs. Bonner, Tsuang, Eugenio, Du, and Leverenz); Parkinson’s Disease Research, Education, and Clinical Center (Dr. Leverenz); and Geriatric Research, Education and Clinical Centers (Dr. Bird and Ms. Steinbart), University of Washington, Seattle; Departments of Laboratory Medicine (Drs. Limprasert and La Spada), Neurology (Drs. La Spada, Bird, and Leverenz), Psychiatry and Behavioral Sciences (Drs. Bonner, Tsuang, Cherrier, and Leverenz), and Medicine (Medical Genetics) (Drs. Bird and La Spada), University of Washington, Seattle; and Tulane University School of Medicine, Department of Psychiatry and Neurology and the Department of Veterans Affairs South Central MIRECC (Dr. Seltzer), New Orleans, Louisiana
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214
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Abstract
Early diagnosis and treatment of Alzheimer's disease, a chronic, debilitating disease, can delay cognitive, functional, and behavioral declines in afflicted patients. Here, learn how to diagnose and manage the disease with the latest pharmacologic approaches. Early diagnosis and treatment, coupled with caregiver support, can delay nursing home placement, improving patient well-being.
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215
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Abstract
Vascular dementia (VaD) is increasingly recognised to reflect an outmoded concept in that it identifies cases too late for preventive therapy to have an opportunity to prevent the development of dementia and uses a cognitive paradigm inappropriately based on Alzheimer's disease. A replacement is urgently required and a new concept, that of vascular cognitive impairment (VCI), has been proposed to meet this need. It is imperative that criteria for VCI are developed on the basis of knowledge and data rather than supposition and assumption, as was the case for VaD. This review details the state of knowledge that we have now reached concerning the fundamental points of severity and cognitive paradigm and also covers a number of other imaging-related essential points embracing atrophy, leukoaraiosis, infarct volume and infarct location. Finally, the increasingly important concept of mixed dementia (co-existent Alzheimer's disease and VCI) is discussed.
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Affiliation(s)
- J V Bowler
- Royal Free Hospital, Pond Street, NW3 2QG London, UK.
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216
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Abstract
The prevalence of hypertension is estimated to approach 50% in individuals above age 70. The consequences of hypertension include cerebrovascular disease, coronary heart disease, and general atherosclerosis. Several recent studies suggest that there may be an association also between hypertension and Alzheimer's disease (AD). This review will examine the evidence for this association and possible pathways between hypertension, Alzheimer encephalopathy, and clinical dementia.
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Affiliation(s)
- Ingmar Skoog
- Institute of Clinical Neuroscience, Section of Psychiatry, Sahlgrenska University Hospital, Göteborg University, SE-413 45 Göteborg, Sweden.
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217
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Robinson SR, Bishop GM. Abeta as a bioflocculant: implications for the amyloid hypothesis of Alzheimer's disease. Neurobiol Aging 2002; 23:1051-72. [PMID: 12470802 DOI: 10.1016/s0197-4580(01)00342-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Research into Alzheimer's disease (AD) has been guided by the view that deposits of fibrillar amyloid-beta peptide (Abeta) are neurotoxic and are largely responsible for the neurodegeneration that accompanies the disease. This 'amyloid hypothesis' has claimed support from a wide range of molecular, genetic and animal studies. We critically review these observations and highlight inconsistencies between the predictions of the amyloid hypothesis and the published data. We show that the data provide equal support for a 'bioflocculant hypothesis', which posits that Abeta is normally produced to bind neurotoxic solutes (such as metal ions), while the precipitation of Abeta into plaques may be an efficient means of presenting these toxins to phagocytes. We conclude that if the deposition of Abeta represents a physiological response to injury then therapeutic treatments aimed at reducing the availability of Abeta may hasten the disease process and associated cognitive decline in AD.
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Affiliation(s)
- Stephen R Robinson
- Department of Psychology, Monash University, Clayton, Vic. 3800, Australia.
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218
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Barker WW, Luis CA, Kashuba A, Luis M, Harwood DG, Loewenstein D, Waters C, Jimison P, Shepherd E, Sevush S, Graff-Radford N, Newland D, Todd M, Miller B, Gold M, Heilman K, Doty L, Goodman I, Robinson B, Pearl G, Dickson D, Duara R. Relative frequencies of Alzheimer disease, Lewy body, vascular and frontotemporal dementia, and hippocampal sclerosis in the State of Florida Brain Bank. Alzheimer Dis Assoc Disord 2002; 16:203-12. [PMID: 12468894 DOI: 10.1097/00002093-200210000-00001] [Citation(s) in RCA: 464] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alzheimer disease (AD) is the most common dementing illness in the elderly, but there is equivocal evidence regarding the frequency of other disorders such as Lewy body disease (LBD), vascular dementia (VaD), frontotemporal dementia (FTD), and hippocampal sclerosis (HS). This ambiguity may be related to factors such as the age and gender of subjects with dementia. Therefore, the objective of this study was to calculate the relative frequencies of AD, LBD, VaD, FTD, and HS among 382 subjects with dementia from the State of Florida Brain Bank and to study the effect of age and gender on these frequencies. AD was the most frequent pathologic finding (77%), followed by LBD (26%), VaD (18%), HS (13%), and FTD (5%). Mixed pathology was common: Concomitant AD was present in 66% of LBD patients, 77% of VaD patients, and 66% of HS patients. The relative frequency of VaD increased with age, whereas the relative frequencies of FTD and LBD declined with age. Males were overrepresented among those with LBD, whereas females were overrepresented among AD subjects with onset age over 70 years. These estimates of the a priori probabilities of dementing disorders have implications for clinicians and researchers.
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Affiliation(s)
- Warren W Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
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219
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Goethals I, Van De Wiele C, Slosman D, Dierckx R. Brain SPET perfusion in early Alzheimer’s disease: where to look? Eur J Nucl Med Mol Imaging 2002; 29:975-8. [PMID: 12296285 DOI: 10.1007/s00259-002-0872-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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220
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Abstract
The prevalence of dementia dramatically increases during ageing, and this puts a serious strain on the optimism brought by the continuous increase in life expectancy observed in most industrialised countries. Diseases that produce dementia are numerous, and the cognitive deficit results from lesions of various regions and from different mechanisms. This modulates the possible prediction, prevention and cure of dementia. Emphasis is put on the necessity of, and prerequisite for, efficient research in the field of dementia. Three paradigmatic dementing disorders are reviewed. Subacute spongiform encephalopathies (prion diseases) constitute a biological enigma and a public health concern. In Alzheimer's disease and vascular or mixed dementia, the clinical diagnosis is still imperfect, and this hinders research. Distinguishing and accurately identifying the various types of dementia is essential for understanding their mechanism and for developing efficient therapeutic strategies, preventive and curative. For such objectives, the study of human brain tissue will remain mandatory until non-invasive markers and additional models are available. Ethical reasons banish the use of cerebral biopsy and favour the promotion of autopsy.
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Affiliation(s)
- Jean-Jacques Hauw
- Université Paris-6, Académie de médecine, Raymond-Escourolle Neuropathology Laboratory, centre hospitalo-universitaire Pitié-Salpêtrière, Paris, France.
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221
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Abstract
VaD is the second most common cause of dementia in the elderly after AD. VaD is defined as the loss of cognitive function resulting from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions as a result of CVD and cardiovascular pathologic changes. Diagnosis requires (1) cognitive loss (often predominantly subcortical), (2) vascular brain lesions demonstrated by imaging, and (3) exclusion of other causes of dementia, such as AD. VaD is excluded by brain imaging showing no evidence of vascular lesions. VaD may be caused by multiple strokes (MID or poststroke dementia) but also by single strategic strokes, multiple lacunes, and hypoperfusive lesions such as border zone infarcts and ischemic periventricular leukoencephalopathy (Binswanger's disease). Primary and secondary prevention of stroke and cardiovascular disease decreases the burden of VaD. Genetic advice is needed in patients with familial forms, such as CADASIL. Treatment involves control of risk factors (i.e., hypertension, diabetes, smoking, hyperfibrinogenemia, hyperhomocystinemia, orthostatic hypotension, cardiac arrhythmias). Anticholinergic medications used for AD are also useful in VaD, and atypical antipsychotic agents and antidepressants (e.g., selective serotonin reuptake inhibitors) may be required in some patients.
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Affiliation(s)
- Gustavo C Román
- Department of Medicine/Neurology, University of Texas Health Science Center, Audie L. Murphy Memorial Veterans Hospital, 7703 Floyd Curl Drive, San Antonio, TX 78284-7883, USA.
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222
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Stevens T, Livingston G, Kitchen G, Manela M, Walker Z, Katona C. Islington study of dementia subtypes in the community. Br J Psychiatry 2002; 180:270-6. [PMID: 11872521 DOI: 10.1192/bjp.180.3.270] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Epidemiological studies of dementia subtypes have revealed widely varying distribution rates. There are almost no published community prevalence data for dementia with Lewy bodies (DLB) or the frontal lobe dementias (FLD). AIMS To identify the distribution of dementia subtypes in a representative community population of older people. METHOD People aged > or = 65 years in randomised enumeration districts in Islington, north London, were screened using a reliable and valid questionnaire. People screened as having dementia were assessed in detail and diagnoses were made according to standard diagnostic criteria. RESULTS Of 1085 people interviewed, 107 (9.86%) met screening criteria for dementia. Diagnoses were made for 72 people (67.3%). Distribution of subtypes varied according to the criteria used; the best-validated criteria yielding: Alzheimer's disease 31.3%; vascular dementia 21.9%; DLB 10.9%; and FLD 7.8%. CONCLUSIONS Alzheimer's disease is confirmed as the most common cause of dementia in older people, followed by vascular dementia. However, DLB and FLD occur sufficiently often to be seen frequently in clinical practice and should be incorporated into future editions of standard diagnostic criteria.
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Affiliation(s)
- Tim Stevens
- Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, UK.
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223
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Affiliation(s)
- W Jagust
- Department of Neurology, University of California, Davis, 95817, Sacramento, CA, USA
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224
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Kitabayashi Y, Ueda H, Narumoto J, Nakamura K, Kita H, Fukui K. Qualitative analyses of clock drawings in Alzheimer's disease and vascular dementia. Psychiatry Clin Neurosci 2001; 55:485-91. [PMID: 11555344 DOI: 10.1046/j.1440-1819.2001.00894.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although quantitative analyses of clock drawings (CD) have achieved widespread clinical use as a cognitive screening, little is known about the qualitative profiles of CD in Alzheimer's disease (AD) and vascular dementia (VD). To address this issue, the present study examined the significance of qualitative analyses of CD in AD and VD. Sixty-seven AD patients, 44 VD patients and eight controls underwent a clock drawing test and took the Mini-Mental State Examinations (MMSE). In the dementia groups, quantitative scores significantly decreased compared with controls and were significantly correlated with MMSE scores. Qualitative analysis demonstrated that in AD patients qualitative error patterns were stable and independent of severity. In contrast, in VD patients the frequency of graphic difficulties and conceptual deficit increased, while the frequency of spatial and/or planning deficit decreased, as severity worsened. In mild dementia groups the frequency of spatial and/or planning deficit was significantly higher in VD. In moderate dementia groups, the frequency of graphic difficulties was significantly higher in VD and the difference in the frequency of spatial and/or planning deficit seen in mild dementia disappeared. The present study suggests that qualitative analyses of clock drawings could demonstrate the neuropsychological profiles of AD and VD and their differences between these dementias.
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Affiliation(s)
- Y Kitabayashi
- Department of Psychiatry, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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225
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Abstract
Alzheimer's disease is the most frequent form of dementia and it is estimated that its prevalence will quadruple by the year 2050. In the past decade, a number of important new developments have provided insight in the pathogenesis, improved diagnosis and allowed therapy of dementia. Several new mutations in the amyloid protein precursor gene, presenilin-1 and -2 genes and the influence of the apolipoprotein E gene isotypes on the disease phenotype have been described. The role of secretases in the generation of amyloid in senile plaques has been determined and this may provide important new therapeutic approaches in the future. The role of vascular lesions in the development of dementia and relationship with the Lewy body variant of Alzheimer's disease have been refined. Acetylcholine is deficient in Alzheimer's disease and can be supplemented in part by treatment with acetylcholinesterase inhibitors. Recently, surprising results of vaccination with amyloid in a transgenic mouse model have opened a completely new perspective in the prevention and treatment of Alzheimer's disease.
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226
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Abstract
The discovery of widely distributed Lewy bodies (LBs) in the brains of patients with dementia has stimulated much clinical and pathologic inquiry. This clinico-pathologic syndrome is now referred to as dementia with Lewy bodies (DLB). Diagnostic criteria for DLB proposed at a workshop in 1995 are receiving detailed scrutiny. The criteria are complex to apply, and appear to have high specificity, but variable sensitivity. Neuropathologic studies have been aided by the development of probes against alpha-synuclein, a key component of LBs. Widespread LBs in limbic or cortical areas contribute to dementia. Pharmacologic management of cognitive and behavioral symptoms in patients with DLB is being explored. There is evidence that cholinesterase inhibitors may have beneficial effects.
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Affiliation(s)
- D Galasko
- Department of Neurology, Veterans Affairs Medical Center, 127, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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227
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Kammoun S, Gold G, Bouras C, Giannakopoulos P, McGee W, Herrmann F, Michel JP. Immediate causes of death of demented and non-demented elderly. ACTA NEUROLOGICA SCANDINAVICA. SUPPLEMENTUM 2001; 176:96-9. [PMID: 11261812 DOI: 10.1034/j.1600-0404.2000.00314.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the immediate causes of death, in autopsied demented and non-demented elderly. DESIGN Retrospective clinicopathologic correlations. SETTING Acute and intermediate care geriatric hospital. PARTICIPANTS 342 hospitalized demented and non-demented elderly (mean age 84.94 +/- 6.9 years) who underwent consecutive postmortem examinations: 120 demented patients with either vascular dementia (VaD, n = 34), mixed dementia (MD, n = 65) or Alzheimer's disease (AD, n=21) neuropathologically confirmed and 222 nondemented elderly. RESULTS Primary causes of death were similar in both demented and non-demented patients; the commonest were cardiovascular disease and bronchopneumonia. Cardiac causes of death and especially cardiac failure were more frequent in VaD than in AD or MD (respectively P = 0.027 and 0.005). Dementia was an underlying but never a primary cause of death. CONCLUSIONS Immediate causes of death are similar in elderly demented and non-demented patients.
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Affiliation(s)
- S Kammoun
- Department of Geriatrics, Geneva University Hospitals, Switzerland
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228
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Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, Small GW, Miller B, Stevens JC. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1143-53. [PMID: 11342678 DOI: 10.1212/wnl.56.9.1143] [Citation(s) in RCA: 920] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To update the 1994 practice parameter for the diagnosis of dementia in the elderly. BACKGROUND The AAN previously published a practice parameter on dementia in 1994. New research and clinical developments warrant an update of some aspects of diagnosis. METHODS Studies published in English from 1985 through 1999 were identified that addressed four questions: 1) Are the current criteria for the diagnosis of dementia reliable? 2) Are the current diagnostic criteria able to establish a diagnosis for the prevalent dementias in the elderly? 3) Do laboratory tests improve the accuracy of the clinical diagnosis of dementing illness? 4) What comorbidities should be evaluated in elderly patients undergoing an initial assessment for dementia? RECOMMENDATIONS Based on evidence in the literature, the following recommendations are made. 1) The DSM-III-R definition of dementia is reliable and should be used (Guideline). 2) The National Institute of Neurologic, Communicative Disorders and Stroke--AD and Related Disorders Association (NINCDS-ADRDA) or the Diagnostic and Statistical Manual, 3rd edition, revised (DSM-IIIR) diagnostic criteria for AD and clinical criteria for Creutzfeldt--Jakob disease (CJD) have sufficient reliability and validity and should be used (Guideline). Diagnostic criteria for vascular dementia, dementia with Lewy bodies, and frontotemporal dementia may be of use in clinical practice (Option) but have imperfect reliability and validity. 3) Structural neuroimaging with either a noncontrast CT or MR scan in the initial evaluation of patients with dementia is appropriate. Because of insufficient data on validity, no other imaging procedure is recommended (Guideline). There are currently no genetic markers recommended for routine diagnostic purposes (Guideline). The CSF 14-3-3 protein is useful for confirming or rejecting the diagnosis of CJD (Guideline). 4) Screening for depression, B(12) deficiency, and hypothyroidism should be performed (Guideline). Screening for syphilis in patients with dementia is not justified unless clinical suspicion for neurosyphilis is present (Guideline). CONCLUSIONS Diagnostic criteria for dementia have improved since the 1994 practice parameter. Further research is needed to improve clinical definitions of dementia and its subtypes, as well as to determine the utility of various instruments of neuroimaging, biomarkers, and genetic testing in increasing diagnostic accuracy.
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Affiliation(s)
- D S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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229
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Abstract
Approximately 20% to 40% of dementia is caused by diseases other than Alzheimer's disease. This article reviews the major categories of non-Alzheimer dementia, including dementia associated with cerebrovascular disease, dementia associated with extrapyramidal features, and the frontotemporal dementias. Dementia associated with cerebrovascular disease is a heterogeneous condition the importance of which is often misunderstood. Dementia with Lewy bodies, the most common of the dementias associated with extrapyramidal disease, is becoming better recognized for its unique management issues. At least some of the frontotemporal dementias, which in this article encompass the progressive aphasias, have mutations in the tau gene that account for some of the phenotypic variations.
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Affiliation(s)
- D S Knopman
- Department of Neurology, Mayo Medical School, Rochester, Minnesota, USA
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230
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Reed BR, Eberling JL, Mungas D, Weiner MW, Jagust WJ. Memory failure has different mechanisms in subcortical stroke and Alzheimer's disease. Ann Neurol 2001. [DOI: 10.1002/1531-8249(200009)48:3<275::aid-ana1>3.0.co;2-c] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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231
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Beck C, Cody M, Souder E, Zhang M, Small GW. Dementia diagnostic guidelines: methodologies, results, and implementation costs. J Am Geriatr Soc 2000; 48:1195-203. [PMID: 11037004 DOI: 10.1111/j.1532-5415.2000.tb02590.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To facilitate the diagnostic process for dementia. Five guidelines and four consensus statements on specific diagnostic recommendations, specialist referral recommendations, and costs of recommended diagnostic procedures were compared and summarized. DATA SOURCES AND SELECTION A MEDLINE search from 1984 to 1999 and queries to experts yielded 14 guidelines and consensus statements that addressed the diagnosis of dementia. Only nine documents which had national or international scopes were reviewed. METHODS Comparisons were made on the specific diagnostic criteria for patient history, clinical examination, functional assessment, laboratory tests, neuroimaging, and other diagnostic tests, as well as specialist referral recommendations and costs for the recommended diagnostic procedures. The first three authors reviewed independently each document and completed a table on specific recommendations in each document. To settle disagreements about specific recommendations, they discussed them until they reached a consensus. To interpret the intent of vague statements, they used their best judgment. RESULTS The documents differed in content, recommendations, and development methodology. They were based on either expert opinion or scientific evidence, or both. Although the nine documents were nearly unanimous in several recommendations, including assessing the presenting problem, taking a medical history, conducting physical and neurological examinations, and assessing the patient's mental and cognitive status, considerable differences in recommendations were common. Such differences led to large differentials in the estimated costs (range, $190 to $2,001) for recommended diagnostic assessments. CONCLUSIONS A systematic approach to diagnostic recommendations for dementia may induce greater consistency among guidelines and consensus statements. The current approach leads to considerable variability in recommendations and estimated costs.
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Affiliation(s)
- C Beck
- College of Medicine, University of Arkansas for Medical Sciences, the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Health Care System, University of California at Los Angeles, USA
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232
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233
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Abstract
AbstractFunctional neuroimaging is playing an increasing role in psychiatry and has moved from academic isolation into clinical practice. This review examines the basis for the use of Single Photon Emission Computed Tomography, the most widely available functional modality, in the two important areas of dementia and parkinsonism. Its contribution to the diagnosis and management of patients is discussed and its likely impact in clinical trials indicated. As functional imaging moves closer to those most able to utilise its power its impact in these and other areas of psychiatry and neurology will increase further.
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234
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Shadlen MF, Larson EB, Yukawa M. The epidemiology of Alzheimer's disease and vascular dementia in Japanese and African-American populations: the search for etiological clues. Neurobiol Aging 2000; 21:171-81. [PMID: 10867202 DOI: 10.1016/s0197-4580(00)00115-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M F Shadlen
- Department of Medicine, Harborview Medical Center, School of Pharmacy, University of Washington, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499, USA.
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