Difference between revisions of "Alzheimer dementia"

(References)
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'''Diagnostics'''
 
'''Diagnostics'''
  
Clinical criteria for Alzheimer’s dementia 41
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Clinical criteria for Alzheimer’s dementia (McKhann et al, 2011)
  
 
1) ''Probable Alzheimer’s disease dementia (core clinical criteria)''
 
1) ''Probable Alzheimer’s disease dementia (core clinical criteria)''
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[[Amnestic (most typical) variant]]
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'''Variants''' There are four common clinical presentations in Alzheimer's disease (Salardini 2019)
  
[[Visual variant (posterior cortical atrophy)]]
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- [[Amnestic (most typical) variant]]
  
[[Logopenic variant primary progressive aphasia]]
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- [[Visual variant (posterior cortical atrophy)]]
  
[[Executive variant or frontal AD]]
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- [[Logopenic variant primary progressive aphasia]]
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- [[Executive variant or frontal AD]]
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 +
 
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'''Autosomal dominant Alzheimer disease''': ''PSEN1, PSEN 2,'' and ''APP'' genes are known autosomal dominant genes in AD - see [[Genetics of Alzheimer disease]] subsection
  
 
[[Early vs late-onset AD]]
 
[[Early vs late-onset AD]]
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McKhann, G. M. et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 7, 263–269 (2011). https://pubmed.ncbi.nlm.nih.gov/21514250/
 
McKhann, G. M. et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 7, 263–269 (2011). https://pubmed.ncbi.nlm.nih.gov/21514250/
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Salardini, A. An Overview of Primary Dementias as Clinicopathological Entities. Semin. Neurol. 39, 153–166 (2019). https://pubmed.ncbi.nlm.nih.gov/30925609/

Revision as of 09:56, 12 June 2021

Diagnostics

Clinical criteria for Alzheimer’s dementia (McKhann et al, 2011)

1) Probable Alzheimer’s disease dementia (core clinical criteria)

a. Insidious onset over months to years
b. Clear-cut history of worsening cognition by report or observation
c. Initial and most prominent cognitive deficits on history and examination are one of the following:
i. Amnestic presentation: impairment in learning and recall
ii. Non-amnestic presentation
1. Language presentation: word-finding difficulties, deficits in other domains should be present
2. Visuospatial presentation: spatial cognition-object agnosia, facial recognition, simultagnosia, and alexia, deficits in other domains should be present
3. Executive dysfunction: impaired reasoning, judgment and problem solving, deficits in other domains should be present
d. There is no evidence of
i. Stroke temporally related to the onset of cognitive symptoms or presence of extensive infarcts or severe white matter hyperintensity burden
ii. Core features of DLB other than dementia itself
iii. Prominent features of bvFTD
iv. Prominent features of semantic or non-fluent / agrammatic PPA
v. Other active neurological disease, medical comorbidity, or use of medications with effects on cognition


2) Probable AD dementia with documented decline: core clinical criteria + evidence of decline on subsequent evaluation based on informants, formal neuropsychological evaluation, or standardized mental status examinations


3) Probable AD dementia in a carrier of a causative AD genetic mutation: core clinical criteria + presence of APP, PSEN1, or PSEN2 mutations


4) Probable AD dementia with evidence of AD pathophysiological process meets core clinical criteria + biomarker data

a. High probability: amyloid PET or CSF + positive CSF tau, FDG-PET, or structural MRI
b. Intermediate probability:
i. unavailable, conflicting, or indeterminate amyloid PET or CSF + positive CSF tau, FDG-PET, or structural MRI
ii. positive amyloid PET or CSF + unavailable, conflicting, or indeterminate CSF tau, FDG-PET, or structural MRI
c. Uninformative: unavailable, conflicting, or indeterminate amyloid PET or CSF + unavailable, conflicting, or indeterminate CSF tau, FDG-PET, or structural MRI


5) Possible AD:

a. Atypical: meets core clinical criteria for AD but either has a sudden onset or demonstrates insufficient historical detail or objective cognitive documentation or progressive decline
b. Etiologically mixed presentation meets criteria for AD but has evidence of
i. Stroke
ii. Features of DLB other than dementia
iii. Evidence of another neurological disease or medical condition with effects on cognition


6) Possible AD dementia with evidence of AD pathophysiological process: atypical clinical presentation plus the following biomarker data:

a. High probability: positive amyloid PET or CSF + positive CSF tau, FDG-PET, or structural MRI
b. Intermediate probability
c. Uninformative: unavailable, conflicting, or indeterminate amyloid PET or CSF + unavailable, conflicting, or indeterminate CSF tau, FDG-PET, or structural MRI


Variants There are four common clinical presentations in Alzheimer's disease (Salardini 2019)

- Amnestic (most typical) variant

- Visual variant (posterior cortical atrophy)

- Logopenic variant primary progressive aphasia

- Executive variant or frontal AD


Autosomal dominant Alzheimer disease: PSEN1, PSEN 2, and APP genes are known autosomal dominant genes in AD - see Genetics of Alzheimer disease subsection

Early vs late-onset AD

Management


References

McKhann, G. M. et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 7, 263–269 (2011). https://pubmed.ncbi.nlm.nih.gov/21514250/

Salardini, A. An Overview of Primary Dementias as Clinicopathological Entities. Semin. Neurol. 39, 153–166 (2019). https://pubmed.ncbi.nlm.nih.gov/30925609/