Assessment of Suspected Dementia

Abstract

At the Second Canadian Consensus Conference on Dementia (CCCD) (February, 1998), a group of neurologists, geriatricians, and psychiatrists met to consider guidelines for evaluation of dementia in Canada. This review paper formed a background paper for their discussion of dementia diagnosis. These experts from across the country concluded that diagnosis of suspected dementia cases continued to rest on skilled clinical assessment. Mental status exam, preferably in some quantifiable form, has become an essential part of the assessment. Selected laboratory tests are advisable in all cases (CBC, TSH, electrolytes, calcium, and glucose), but the CCCD continued to advise that CT scanning was mandatory only in selected cases where clinical findings pointed to another possibility besides Alzheimer’s disease. The growing list of other diagnostic measures with potential usefulness in diagnosis of Alzheimer’s disease or dementia in general was reviewed, but the evidence was judged as insufficient to support routine use of these tests by physicians. As new treatments for Alzheimer’s disease become available, neurologists face new diagnostic challenges - differentiating Mild Cognitive Impairment, Frontotemporal dementias and Mixed dementias, and Lewy Body Dementia. Guidelines to aid in differential diagnosis are presented.

Suppression of Glial HO-1 Activitiy as a Potential Neurotherapeutic Intervention in AD

“…AD is the most common agingrelated neurodegenerative disorder, afflicting 5-10% of North Americans over age 65 and 30-40% by the end of ninth decade [2]. Current pharmacotherapy, including acetylcholinesterase inhibitors, NMDA receptor antagonists and neuropsychiatric medications, temporarily ameliorate the symptoms of AD.…”

Astroglial heme oxygenase-1 and the origin of corpora amylacea in aging and degenerating neural tissues

“…Mild cognitive impairment (MCI) refers to persons exhibiting cognitive dysfunction (often memory loss) that does not meet clinical criteria for AD or another dementing illness. Subjects with MCI often manifest hallmark neuropathological features of AD at autopsy and about half of persons with MCI will develop AD within an ensuing 5-year period (Chertkow, et al, 2001). …”

MRI in Dementia

“…This notion is supported by the observation that MTR in the hippocampus was found to be decreased in Alzheimer's disease patients 39 and by the detection of MTR changes in gray and white matter in mild cognitive impairment subjects who did not yet show notable brain volume change. 40 MTR changes therefore might precede gross regional atrophy. 41 An additional future application for magnetic transfer imaging could be the detection of microglia surrounding neuritic plaques in Alzheimer's disease, as suggested by a 3-T MRI study.…”