The Clinical Diagnosis of Alzheimer's Disease

Wade, John; Mirsen, Thomas R.; Hachinski, Vladimir; Fisman, Michael; Lau, Catherine; Merskey, Harold

doi:10.1001/archneur.1987.00520130016010

Cited by 264 publications

(92 citation statements)

References 13 publications

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“…Despite established clinical diagnostic criteria for AD, 9 a clinical diagnosis of AD often differs from neuropathologic findings. [10][11][12][13] Many studies have focused on the influence of Lewy body pathology in the clinical phenotype of AD within consistent results. 8,1418 There is controversy as to whether there are differences in parkinsonian features, 8,14,16,19,20 cognitive deficits, 16,17,[19][20][21] cognitive decline, 8,14 and the presence of visual hallucinations 8,17,18,20,22 between AD with Lewy bodies and AD without Lewy bodies (eTable in the Supplement).…”

Section: Main Outcomes and Measures-clinical And Neuropsychiatric Tesmentioning

confidence: 99%

P1‐206: Clinical features of Alzheimer disease with and without lewy bodies

Chung

Babulal

Monsell

et al. 2015

Alzheimer's & Dementia

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edu).Role of the Funder/Sponsor: The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.Supplemental content at jamaneurology.com Author Contributions: Dr Morris had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Conflict of Interest Disclosures:Dr Morris has participated or is currently participating in clinical trials of antidementia drugs sponsored by the following companies and studies: Janssen Immunotherapy, Pfizer, Eli Lilly/Avid Radiopharmaceuticals, the SNIFF (Study of Nasal Insulin to Fight Forgetfulness) study, and the A4 (Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease) trial. Dr Morris has served as a consultant for Lilly USA, ISIS Pharmaceuticals, and the Charles Dana Foundation. He receives research support from Eli Lilly/Avid Radiopharmaceuticals and is funded by National Institutes of Health grants P50AG005681, P01AG003991, P01AG026276, and U19AG032438.Additional Information: The NACC database is funded by NIA/National Institutes of Health grant U01 AG016976. The NACC data were obtained from the NIA-funded AD centers (grants P30 AG019610 [PI Eric Reiman, MD] EXPOSURES-Standardized neuropathologic assessment and then brain autopsy after death. HHS Public Access MAIN OUTCOMES AND MEASURES-Clinical and neuropsychiatric test scores.RESULTS-The mean (SD) age at death was statistically significantly younger for participants who had AD with Lewy bodies (77.9 [9.5] years) than for participants who had AD without Lewy bodies (80.2 [11.1] years) (P = .01). The mean (SD) age at onset of dementia symptoms was also younger for participants who had AD with Lewy bodies (70.0 [9.9] years) than for participants who had AD without Lewy bodies (72.2 [12.3] years) (P = .03). More men than women had AD with Lewy bodies (P = .01). The frequency of having at least 1 APOE ε4 allele was higher for participants who had AD with Lewy bodies than for participants who had AD without Lewy bodies (P = .03). CONCLUSIONS AND RELEVANCE-Participants with both AD and Lewy body pathology have a clinical phenotype that may be distinguished from AD alone. The frequency of Lewy bodies in AD and the association of Lewy bodies with the APOE ε4 allele suggest potential common mechanisms for AD and Lewy body pathologies.The 2 neuropathological hallmarks of Alzheimer disease (AD) are the extracellular Aβ plaques and the intracellular neurofibrillary tangles, of which the latter is composed of hyperphosphorylated tau protein. 1 Lewy bodies are intraneuronal cytoplasmic inclusions comprising aggregates of α-synuclein 2,3 and are readily detected by immunohistochemistry using anti-α-synuclein antibodies. In up to 50% of cases of sporadic late-onset AD, comorbid Lewy bodies are found. 2 Lewy bodies are frequent in the setting of moderate-tosevere levels of A...

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Section: Main Outcomes and Measures-clinical And Neuropsychiatric Tesmentioning

confidence: 99%

P1‐206: Clinical features of Alzheimer disease with and without lewy bodies

Chung

Babulal

Monsell

et al. 2015

Alzheimer's & Dementia

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“…[8][9][10] When standardized clinical diagnostic criteria are used, interrater reliability 6 and consistency of diagnosis between the initial visit and 1-year follow-up is high (95% in Forette 11 ). There are 13 studies, 3 Class I 12-14 and 10 Class II, 9,[15][16][17][18][19][20][21][22] that have addressed the diagnostic accuracy of the clinical diagnosis of AD using neuropathologic confirmation as the "gold standard." Both the DSM-IIIR "Dementia of the Alzheimer type" (DAT) and the NINCDS-ADRDA "probable" AD definitions achieved either good sensitivity (average across cited studies = 81%, range 49 to 100%) for AD at the expense of specificity (average across cited studies = 70%, range 47 to 100%) or vice versa in the majority of the cited studies.…”

Section: Are Current Diagnostic Criteria Able To Establish a Diagnosimentioning

confidence: 99%

“…Only one Class I study 12 reported the sensitivity (43%) and specificity (95%) of a published criteria, NINDS-AIREN, for VAD. Four Class II studies with patient samples drawn from referral cohorts [15][16][17]27,28 reported sensitivity and specificity of the diagnosis of vascular dementia with any criteria. With one exception, their results had the same diagnostic accuracy as the population-based studies, with low sensitivity (average across 5 studies = 50%, range 20 to 89%) but higher specificity (average across 5 studies = 87%, range 64 to 98%) for the HIS, DSM-IIIR, NINDS-AIREN, or California clinical criteria.…”

Section: Vascular Dementia (Vad)mentioning

confidence: 99%

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

et al. 2001

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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.

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“…Insbesondere ist in der Syst-Eur-Studie auch anzuzweifeln, ob eine zuverlässige Differenzialdiagnose zwischen AD und VD gelungen ist. Auf Grund der starken Überschnei-dungen der beiden Entitäten sind sowohl CCT als auch Hachinski-Score hierzu nur sehr bedingt geeignet [39,85]. An der HO-PE-Studie ist u. a. die Art der Präsentati-on der Ergebnisse bemängelt worden, wodurch die klinischen Effekte überschätzt [84].…”

Section: Kritische Beurteilung Der Studienergebnisseunclassified

Arterielle Hypertonie und Demenz

Scheid

Voigt

2005

Nervenarzt

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Die arterielle Hypertonie ist unabhän-gig von ihrer Genese als wichtigster beeinflussbarer Risikofaktor für den Schlaganfall etabliert. Ätiologisch werden 26-49% aller Schlaganfälle auf eine arterielle Hypertonie (AH) zurückgeführt [24]. Über die Konstruktion einer einfachen ätiopa-thogenetischen Reihe AH -Schlaganfall -vaskuläre Demenz (VD) ist die AH mit dem Syndrom Demenz verknüpft. Die Demenzinzidenz nach Schlaganfall wird in der Literatur mit 6-33% angegeben [52,59]. Für den Oberbegriff VD ist eine Reihe spezifischerer Unterteilungen vorgenommen worden. Román et al. unterscheiden eine zerebrale Makroangiopathie+Demenz mit Unterkategorien "multi-infarct" und "strategic-infarct dementia" von einer zerebralen Mikroangiopathie+Demenz mit Unterkategorien "subkortikal ischämisch" und "kortikal subkortikal". Weitere Kategorien sind "ischämisch hypoperfusive VD" und "hämorrhagische VD" [7]. Ein aktueller klinisch-pragmatisch orientierter Ansatz schlägt die Unterscheidung von 3 Typen vor: "post-stroke dementia", subkortikale VD und Alzheimer+VD [86]. Als verbindender Überbegriff dient der Terminus "vascular cognitive impairment" [30,59].Aber auch für die häufigere degenerative Demenz, die Alzheimer-Demenz (AD), wird die AH zunehmend als Risikofaktor diskutiert [0, 72, 75, 79]

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The Clinical Diagnosis of Alzheimer's Disease

Cited by 264 publications

References 13 publications

P1‐206: Clinical features of Alzheimer disease with and without lewy bodies

P1‐206: Clinical features of Alzheimer disease with and without lewy bodies

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

Arterielle Hypertonie und Demenz

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