Alzheimer's disease physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
When a doctor or physician has been notified, and AD is suspected, the diagnosis is usually further supported by behavioral assessments and [[cognitive tests]], often followed by a [[neuroimaging|brain scan]] if available. | When a doctor or physician has been notified, and AD is suspected, the diagnosis is usually further supported by behavioral assessments and [[cognitive tests]], often followed by a [[neuroimaging|brain scan]] if available. | ||
==Neurologic== | ==Neurologic== | ||
Revision as of 16:11, 16 August 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
When a doctor or physician has been notified, and AD is suspected, the diagnosis is usually further supported by behavioral assessments and cognitive tests, often followed by a brain scan if available.
Neurologic
Dementia is a clinical condition rather than an exact diagnosis. Alzheimer's disease is usually diagnosed clinically, using the patient history, collateral history from relatives, and clinical observations, based on the presence of characteristic neurological and neuropsychological features and the absence of alternative conditions.[1][2] Advanced medical imaging with CT or MRI, and with SPECT or PET may also be used to help to diagnose the subtype of dementia and exclude other cerebral pathology.[3] Neuropsychological evaluation including memory testing and assessment of intellectual functioning can further characterize the dementia.[4] Medical organizations have created diagnostic criteria to ease and standardize the process for practicing physicians. Sometimes the diagnosis can be confirmed on autopsy when brain material is available and can be examined histologically and histochemically.[5]
Diagnostic criteria
The diagnostic criteria for Alzheimer of the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) are among the most commonly used criteria for diagnosing AD.[6] These criteria require that the presence of cognitive impairment and a suspected dementia syndrome be confirmed by neuropsychological testing for a clinical diagnosis of possible or probable AD, while they require histopathologic confirmation (microscopic examination of brain tissue) for the definitive diagnosis. They have shown good reliability and validity.[7] They specify as well eight cognitive domains that may be impaired in AD (i.e., memory, language, perceptual skills, attention, constructive abilities, orientation, problem solving and functional abilities). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria published by the American Psychiatric Association are similar to the NINCDS-ADRDA Alzheimer's Criteria.[8][9]
Diagnostic tools
Neuropsychological screening tests such as the Mini mental state examination (MMSE) are widely used to evaluate the cognitive impairments needed for diagnosis, but more comprehensive batteries are necessary for high reliability by this method, especially in the earliest stages of the disease.[10][11] The neurological examination in early AD is often normal independent of cognitive impairment, but is key for diagnosis of the other dementing disorders. Therefore, neurological examination is crucial in the differential diagnosis of Alzheimer's disease and other dementias.[4] In addition, interviews with family members are also utilised in the assessment of the disease. Caregivers can supply important information on the daily living abilities, as well how the patient's mental function has changed over time. [12] This is especially important since a patient with AD is commonly unaware of his or her own deficits (anosognosia).[13] Many times families also have difficulties in the detection of initial dementia symptoms and in adequately communicating them to a physician.[14] Finally, supplemental testing may provide extra information on features of the disease, or may rule out other diagnoses. Examples are blood tests, which can identify other causes for dementia different than AD,[4] which may even be reversible.[15] psychological tests for depression are also important, as depression can both co-occur with AD or even be at the origin of the patient's cognitive impairment.[16][17]
References
- ↑ Mendez MF (2006). "The accurate diagnosis of early-onset dementia". International Journal of Psychiatry Medicine. 36 (4): 401–412. PMID 17407994.
- ↑ Klafki HW, Staufenbiel M, Kornhuber J, Wiltfang J (2006). "Therapeutic approaches to Alzheimer's disease". Brain. 129 (Pt 11): 2840–2855. doi:10.1093/brain/awl280. PMID 17018549.
- ↑
"Dementia: Quick reference guide" (PDF). National Institute for Health and Clinical Excellence. 2006. ISBN 1-84629-312-X. Retrieved 2008-02-22. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 4.2 Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, Scheltens P, Tariska P, Winblad B (2007). "Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline". European Journal of Neurology. 14 (1): e1–26. doi:10.1111/j.1468-1331.2006.01605.x. PMID 17222085.
- ↑ McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984). "Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease". Neurology. 34 (7): 939–44. PMID 6610841.
- ↑ Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, Delacourte A, Galasko D, Gauthier S, Jicha G, Meguro K, O'brien J, Pasquier F, Robert P, Rossor M, Salloway S, Stern Y, Visser PJ, Scheltens P (2007). "Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria". Lancet Neurology. 6 (8): 734–746. doi:10.1016/S1474-4422(07)70178-3. PMID 17616482.
- ↑ Blacker D, Albert MS, Bassett SS, Go RC, Harrell LE, Folstein MF (1994). "Reliability and validity of NINCDS-ADRDA criteria for Alzheimer's disease. The National Institute of Mental Health Genetics Initiative". Archives of Neurology. 51 (12): 1198–1204. PMID 7986174.
- ↑ American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental disorders, 4th Edition Text Revision. Washington DC.
- ↑ Ito N (1996). "Clinical aspects of dementia". Hokkaido Igaku Zasshi (in Japanese). 71 (3): 315–320. PMID 8752526.
- ↑ Tombaugh TN, McIntyre NJ (1992). "The mini-mental state examination: a comprehensive review". J Am Geriatr Soc. 40 (9): 922–935. PMID 1512391.
- ↑ Pasquier F (1999). "Early diagnosis of dementia: neuropsychology". J. Neurol. 246 (1): 6–15. PMID 9987708.
- ↑ Harvey PD, Moriarty PJ, Kleinman L, Coyne K, Sadowsky CH, Chen M, Mirski DF (2005). "The validation of a caregiver assessment of dementia: the Dementia Severity Scale". Alzheimer Disease and Associated Disorders. 19 (4): 186–194. PMID 16327345.
- ↑ Antoine C, Antoine P, Guermonprez P, Frigard B (2004). "Awareness of deficits and anosognosia in Alzheimer's disease". Encephale (in French). 30 (6): 570–577. PMID 15738860.
- ↑ Cruz VT, Pais J, Teixeira A, Nunes B (2004). "The initial symptoms of Alzheimer disease: caregiver perception". Acta Med Port (in Portuguese). 17 (6): 435–444. PMID 16197855.
- ↑ Clarfield AM (2003). "The decreasing prevalence of reversible dementias: an updated meta-analysis". Arch. Intern. Med. 163 (18): 2219–29. doi:10.1001/archinte.163.18.2219. PMID 14557220.
- ↑ Geldmacher DS, Whitehouse PJ (1997). "Differential diagnosis of Alzheimer's disease". Neurology. 48 (5 Suppl 6): S2–9. PMID 9153154.
- ↑ Potter GG, Steffens DC (2007). "Contribution of depression to cognitive impairment and dementia in older adults". Neurologist. 13 (3): 105–117. doi:10.1097/01.nrl.0000252947.15389.a9. PMID 17495754.