Practical Guidelines for the Recognition and Diagnosis of Dementia

Center of Excellence for Brain Aging, New York University Langone School of Medicine, New York, NY 10016, USA.
The Journal of the American Board of Family Medicine (Impact Factor: 1.98). 05/2012; 25(3):367-82. DOI: 10.3122/jabfm.2012.03.100181
Source: PubMed


To date, user-friendly, practical guidelines for dementia have not been available for busy family physicians. However, the growing number of patients with dementia means that primary care physicians will have an increasingly important role in the diagnosis and subsequent management of dementia. This article provides practical guidance for the recognition and diagnosis of dementia and is aimed at family physicians, who are usually the first clinicians to whom patients present with dementia symptoms. Because Alzheimer disease (AD) is the most common form of dementia, this condition is the main focus of this article. We review the pathophysiology of AD and discuss recommended diagnostic protocols and the importance of early diagnosis. An AD diagnostic algorithm is provided, with clearly defined steps for screening and diagnosing AD and assessing daily functioning, behavioral symptoms, and caregiver status.

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    • "For example, using longitudinal data from the National Alzheimer's Coordination Center's (NACC) research database, Beach et al. reported that the sensitivity of current clinical diagnostic criteria for AD ranged from 71% to 87% and specificity from 44% to 71%, suggesting substantial rates of AD misdiagnosis among patients with cognitive impairment [11]. This highlights that although clinical evaluation can reliably detect the presence of cognitive impairment , additional testing may be necessary to accurately diagnose the cause of the impairment [9]. Prognosis, treatment, and patient management can vary depending on the underlying cause of dementia. "
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    ABSTRACT: Recent developments in diagnostic technology can support earlier, more accurate diagnosis of non-Alzheimer's disease (AD) dementias. To evaluate potential economic benefits of early rule-out of AD, annual medical resource use and costs for Medicare beneficiaries potentially misdiagnosed with AD before their diagnosis of vascular dementia (VD) or Parkinson's disease (PD) were compared with those of similar patients never diagnosed with AD. Study findings indicate that patients with prior AD diagnosis use substantially more medical services every year until their VD/PD diagnosis, resulting in incremental annual medical costs of approximately $9500-$14,000. However, after their corrected diagnosis, medical costs converge with those of patients never diagnosed with AD. The observed correlation between timing of correct diagnosis and subsequent reversal in excess costs is strongly suggestive of the role of misdiagnosis of AD-rather than AD comorbidity-in this patient population. Our findings suggest potential benefits from earlier, accurate diagnosis. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
    Alzheimer's & dementia: the journal of the Alzheimer's Association 07/2015; 11(8). DOI:10.1016/j.jalz.2015.06.1889 · 12.41 Impact Factor
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    • "Even though a definitive diagnosis of AD can only be made by means of brain tissue post-mortem assessment, scientific advances have made it possible for early detection of abnormalities, e.g., cognitive decline, memory deficits and behavioral problems (Millard et al. 2011; Woods et al. 2003; Santacruz & Swagerty 2001). This is made possible by use of biological markers to detect biochemical changes in the cerebrospinal fluid (CSF), presence of filamentous aggregates of misfolded Aβ, tau and α-synuclein; and presence of neurotrophins such as cocaine-and amphetamine-regulated transcript (CART) (Forlenza et al. 2010; Trojanowski & Hampel 2011; Mao 2012; Galvin & Sadowsky 2012). A current study, however, has pointed out that the assessment of levels of Aβ in plasma and CSF may not be entirelly specific for AD (Verbeek et al. 2009). "
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    ABSTRACT: Diseases involving the nervous system drastically change lives of victims and commonly increase dependency on others. This paper focuses on senile dementia from both the neuroscientific and Islamic perspectives, with special emphasis on the integration of ideas between the two different disciplines. This would enable effective implementation of strategies to address issues involving this disease across different cultures, especially among the world-wide Muslim communities. In addition, certain incongruence ideas on similar issues can be understood better. The former perspective is molded according to conventional modern science, while the latter on the analysis of various texts including the holy Qur'an, sunnah [sayings and actions of the Islamic prophet, Muhammad (pbuh)] and writings of Islamic scholars. Emphasis is particularly given on causes, symptoms, treatments and prevention of dementia.
    Journal of Religion and Health 07/2015; DOI:10.1007/s10943-015-0079-5 · 1.02 Impact Factor
    • "Recently, research interest has developed in detecting dementia in the primary health care setting. Though it has been estimated that around 39% of individuals afflicted with dementia seek care at specialty clinics (Galvin & Sadowsky, 2012), this percentage generally represents individuals with more advanced dementia. Most persons with mild to moderate dementia initially present to primary care physicians, often for seemingly unrelated problems , are often missed and remain undiagnosed. "
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    ABSTRACT: Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance. A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs. At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis. The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.
    Aging and Mental Health 05/2015; DOI:10.1080/13607863.2015.1043620 · 1.75 Impact Factor
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