Practice parameter: Diagnosis of dementia (an evidence-based review)

Abstract

Article 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.

Structural grey matter changes in the substantia innominata in Alzheimer's disease and dementia with Lewy bodies: a DARTEL‐VBM study

“…Firstly, despite following a previously reported protocol (Choi et al ., 2012; George et al ., 2011; Shin et al ., 2012), these findings should still be considered tentative, given the relatively small size, proximity and subsequent methodological challenges surrounding the automated GM segmentation of the SI and of similar structures from MR images. Secondly, there were no pathologically confirmed diagnoses, although the applied clinical diagnostic criteria were associated with high diagnostic specificity (Ferman et al ., 2011; Knopman et al ., 2001). Lastly, although the examination of a significant omnibus effect across groups, followed by appropriate post hoc tests, would have allowed a more systematic approach to the group analyses, this approach is potentially too conservative, and where focal changes between different types of dementia and healthy ageing are often relatively small, potentially important findings can be overlooked.…”

Current and future uses of neuroimaging for cognitively impaired patients

“…The most recent American Academy of Neurology Practice Parameter guidelines recommended structural neuroimaging with either a non-contrast CT or MRI scan in the initial assessment of patients with dementia. 24 Functional imaging technologies provide information about brain structure, but their spatial resolution is lower than with CT or MRI. The added value of functional scanning is the information provided on cerebral blood flow or glucose metabolism, even when structural deficits are not present, which can assist the physician in the diagnosis and differential diagnosis of dementia.…”

Grid Infrastructures for Computational Neuroscience: The neuGRID Example

“…In the late 1990s, the traditional exclusionary approach was abandoned in favor of the inclusive approach [4,5]. Rapid advances in neuroimaging technologies such as PET, single photon emission CT, MR spectroscopy, diffusion tensor imaging and functional MRI have offered new vision into the pathophysiology of Alzheimer's desease (AD) [6] and, consequently, increasingly new powerful data-analysis methods have been developed [7].…”

“…In the late 1990s, the traditional exclusionary approach was abandoned in favor of the inclusive approach [4,5]. Rapid advances in neuroimaging technologies such as PET, single photon emission CT, MR spectroscopy, diffusion tensor imaging and functional MRI have offered new vision into the pathophysiology of Alzheimer's desease (AD) [6] and, consequently, increasingly new powerful data-analysis methods have been developed [7].Since the beginning of the 21st Century, the development of innovative techniques for region-of-interest-based volumetry, automated voxel-based morphometry, cortical thickness measurement, basal forebrain volumetry and multivariate statistics have emerged [7][8][9] and those measurements most feasible and accurate have started to be used in clinical settings. The availability to the neuroimaging community of large prospective image data repositories has led to the development of web-based interfaces to access data and online image analysis tools to assess longitudinal brain changes [10][11][12][13].…”