Low Prevalence of Mixed Dementia in a Cohort of 2,000 Elderly Patients in a Memory Clinic Setting

Claus, J. J.; Staekenborg, Salka S.; Roorda, Jelmen J.; Stevens, Martijn; Herderschêe, D.; Maarschalkerweerd, Willy van; Schuurmans, Lilly; Tielkes, Caroline E.M.; Koster, Pieter; Bavinck, Chris; Scheltens, Philip

doi:10.3233/jad-150796

Cited by 26 publications

(24 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Various studies have advocated a synergistic effect of SVD and AD pathology on cognitive decline, while other studies have shown that SVD in AD was related to age and vascular risk factors, comparable to individuals without AD (Kester et al, 2014; Mortamais et al, 2014; Spies et al, 2014; Benedictus et al, 2015; Claus et al, 2015; Prins and Scheltens, 2015). Yet, in all these studies the diagnostic value of WMH for separating AD from controls has not been addressed.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, in addition to measures of atrophy, it is common practice to estimate the extent of small vessel disease (SVD), such as white matter hyperintensities (WMH) in the diagnostic workup (van der Flier et al, 2004; Kester et al, 2014). A recent CT study showed an unexpected low percentage of WMH in elderly patients (Claus et al, 2015). It has been suggested that WMH may predict progression in the MCI stage, but other studies have found no such effect (Prins et al, 2013; Mortamais et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

MRI Visual Ratings of Brain Atrophy and White Matter Hyperintensities across the Spectrum of Cognitive Decline Are Differently Affected by Age and Diagnosis

Rhodius-Meester

Benedictus

Wattjes

et al. 2017

Front. Aging Neurosci.

Self Cite

View full text Add to dashboard Cite

Aim: To assess the associations of age and diagnosis with visual ratings of medial temporal lobe atrophy (MTA), parietal atrophy (PA), global cortical atrophy (GCA), and white matter hyperintensities (WMH) and to investigate their clinical value in a large memory clinic cohort.Methods: We included 2,934 patients (age 67 ± 9 years; 1,391 [47%] female; MMSE 24 ± 5) from the Amsterdam Dementia Cohort (1,347 dementia due to Alzheimer's disease [AD]; 681 mild cognitive impairment [MCI]; 906 controls with subjective cognitive decline). We analyzed the effect of age, APOE e4 and diagnosis on visual ratings using linear regression analyses. Subsequently, we compared diagnostic and predictive value in three age-groups (<65 years, 65–75 years, and >75 years).Results: Linear regression analyses showed main effects of age and diagnosis and an interaction age*diagnosis for MTA, PA, and GCA. For MTA the interaction effect indicated steeper age effects in MCI and AD than in controls. PA and GCA increased with age in MCI and controls, while AD patients have a high score, regardless of age. For WMH we found a main effect of age, but not of diagnosis. For MTA, GCA and PA, diagnostic value was best in patients <65 years (optimal cut-off: ≥1). PA and GCA only discriminated in patients <65 years and MTA in patients <75 years. WMH did not discriminate at all. Taking into account APOE did not affect the identified optimal cut-offs. When we used these scales to predict progression in MCI using Cox proportional hazard models, only MTA (cut-off ≥2) had any predictive value, restricted to patients >75 years.Conclusion: Visual ratings of atrophy and WMH were differently affected by age and diagnosis, requiring an age-specific approach in clinical practice. Their diagnostic value seems strongest in younger patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

MRI Visual Ratings of Brain Atrophy and White Matter Hyperintensities across the Spectrum of Cognitive Decline Are Differently Affected by Age and Diagnosis

Rhodius-Meester

Benedictus

Wattjes

et al. 2017

Front. Aging Neurosci.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Each patient received the same diagnostic work-up in one day, resulting in a total of close to 350 patients per year. This resulted in a consecutive series of 2,000 patients in a period of 6 years, from April 2009 to April 2015 (for a summary of the study population and procedures see Claus et al [16]). All patients diagnosed with AD (832) or SCI (333) were included in the current study.…”

Section: Methodsmentioning

confidence: 99%

Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer’s disease: Validation in a large memory clinic population

et al. 2017

Self Cite

View full text Add to dashboard Cite

ObjectiveTo provide age-specific medial temporal lobe atrophy (MTA) cut-off scores for routine clinical practice as marker for Alzheimer’s disease (AD).MethodsPatients with AD (n = 832, mean age 81.8 years) were compared with patients with subjective cognitive impairment (n = 333, mean age 71.8 years) in a large single-centre memory clinic. Mean of right and left MTA scores was determined with visual rating (Scheltens scale) using CT (0, no atrophy to 4, severe atrophy). Relationships between age and MTA scores were analysed with regression analysis. For various MTA cut-off scores, decade-specific sensitivity and specificity and area under the curve (AUC) values, computed with receiver operator characteristic curves, were determined.ResultsMTA strongly increased with age in both groups to a similar degree. Optimal MTA cut-off values for the age ranges <65, 65–74, 75–84 and ≥85 were: ≥1.0, ≥1.5, ≥ 2.0 and ≥2.0. Corresponding values of sensitivity and specificity were 83.3% and 86.4%; 73.7% and 84.6%; 73.7% and 76.2%; and 84.0% and 62.5%.ConclusionFrom this large unique memory clinic cohort we suggest decade-specific MTA cut-off scores for clinical use. After age 85 years, however, the practical usefulness of the MTA cut-off is limited.Key Points• We suggest decade-specific MTA cut-off scores for AD. • MTA cut-off after the age of 85 years has limited use. • CT is feasible and accurate for visual MTA rating.

show abstract

“…Additionally, we performed a direct comparison between the converting MCI groups using ANCOVA with age as a covariate (age and education for neuropsychological tests) to investigate if differences seen between the converting and stable MCI groups could also be detected between the converting MCI groups. Finally, we produced Kaplan-Meier curves to illustrate differences in survival between MCI patients with pathological or non-pathological values of selected markers based on the cut-off values derived from the dementia groups and control group (for A␤ 42 /T-tau ratio we used AD/controls, for WMC volume we used SVD/controls comparisons) The cut-off values from were then applied to the MCI-AD/MCI-MCI group etc. All analyses were performed using IBM SPSS software (version 19.0).…”

Section: Variable Selection and Cut-off Scoresmentioning

confidence: 99%

“…Several studies have examined differential diagnostics in dementia patients using biomarkers and cognitive testing [6]. Pathological levels of the cerebrospinal fluid (CSF) markers amyloid-␤ (A␤) 42 , total-tau (T-tau), and phosphorylated tau (P-tau) are typical for AD but deviation from normal levels may also be seen in SVD [7]. Although markers such as neurofilament light protein and CSF/serum albumin ratio have been examined, there are currently no reliable disease-specific CSF markers for SVD [8].…”

Section: Introductionmentioning

confidence: 99%

Characteristic Biomarker and Cognitive Profile in Incipient Mixed Dementia

Eckerström

Göthlin

et al. 2020

JAD

View full text Add to dashboard Cite

Background: Research has shown that mixed dementia is more common than previously believed but little is known of its early stages. Objective: To examine if incipient mixed dementia can be differentiated from incipient Alzheimer's disease (AD) and subcortical ischemic vascular dementia (SVD) using neuropsychological tests, cerebrospinal fluid (CSF) markers, and magnetic resonance imaging markers. Methods: We included 493 patients and controls from the Gothenburg MCI study and used the dementia groups for marker selection (CSF total-tau (T-tau), phospho-tau (P-tau), and amyloid-␤ 42 (A␤ 42 ), 11 neuropsychological tests, and 92 regional brain volumes) and to obtain cut-off values which were then applied to the MCI groups. Results: Incipient mixed dementia was best differentiated from incipient AD by the Word fluency F-A-S test and the Trail making test A. CSF T-tau, P-tau, and A␤ 42 differentiated incipient mixed dementia from incipient SVD. Conclusion: Incipient mixed dementia is characterized by an AD-like biomarker profile and an SVD-like cognitive profile. Incipient mixed dementia can be separated from incipient AD and incipient SVD using CSF markers and cognitive testing.

show abstract

Low Prevalence of Mixed Dementia in a Cohort of 2,000 Elderly Patients in a Memory Clinic Setting

Abstract: We found a low prevalence of mixed dementia. Furthermore, severe WML in AD was largely explained by age rather than effect of disease.

Cited by 26 publications

References 41 publications

MRI Visual Ratings of Brain Atrophy and White Matter Hyperintensities across the Spectrum of Cognitive Decline Are Differently Affected by Age and Diagnosis

MRI Visual Ratings of Brain Atrophy and White Matter Hyperintensities across the Spectrum of Cognitive Decline Are Differently Affected by Age and Diagnosis

Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer’s disease: Validation in a large memory clinic population

Characteristic Biomarker and Cognitive Profile in Incipient Mixed Dementia

Contact Info

Product

Resources

About