EFNS guidelines for the diagnosis and management of Alzheimer’s disease

Abstract

Background and objectives: In 2008 a task force was set up to develop a revision of the European Federation of the Neurological Societies (EFNS) guideline for the diagnosis and management of AlzheimerÕs disease (AD) and other disorders associated with dementia, published in early 2007. The aim of this revised international guideline was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with AD. Mild cognitive impairment and nonAlzheimer dementias are not included in this guideline. Methods: The task force working group reviewed evidence from original research articles, meta-analysis, and systematic reviews, published before May 2009. The evidence was classified and consensus recommendations graded (A, B, or C) according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. Results: The recommendations for clinical diagnosis, blood tests, neuropsychology, neuroimaging, electroencephalography, cerebrospinal fluid (CSF) analysis, genetic testing, disclosure of diagnosis, treatment of AD, behavioural and psychological symptoms in dementia, legal issues, counselling and support for caregivers were all revised as compared with the previous EFNS guideline. Conclusion: A number of new recommendations and good practice points are made, namely in CSF, neuropsychology, neuroimaging and reviewing non-evidence based therapies. The assessment, interpretation, and treatment of symptoms, disability, needs, and caregiver stress during the course of AD require the contribution of many different professionals. These professionals should adhere to these guideline to improve the diagnosis and management of AD. Objectives

The use of biomarkers for the etiologic diagnosis of MCI in Europe: An EADC survey

“…This apparent contradiction can be explained by structural imaging being regarded as mandatory at least once in the assessment of patients with cognitive impairment, with the aim to exclude intracranial pathology [16,17]. Moreover, MR is widely available and non-invasive, and thus practical.…”

HSV1 in Alzheimer’s disease: Myth or reality?

“…suggest several additional criteria for AD diagnosis: defining the impact of cognitive decline on activities of daily living, inclusion of information on past medical history, assessing comorbidity (e.g., depression, cardiovascular and pulmonary diseases, infections, sleep disturbances), and electroencephalography measurements [6]. [7] that is based on the discovery that a mutation in APP gene was able to induce AD in familial cases of the disease [8].…”

Functional neuroimaging for dementia: commissioning and evaluating a service

“…2 European guidelines state that FDG-PET is particularly useful in differentiating AD from FTD with more than 95% specificity in young onset dementia. 3 NICE also recommends that functional neuroimaging with DaTscan should be used to help establish diagnosis in those with suspected dementia with Lewy bodies (DLB) if the diagnosis is in doubt. 2 European guidelines attribute around 85% sensitivity and specificity to DaTscans for differentiating AD from DLB.…”

“…2 European guidelines attribute around 85% sensitivity and specificity to DaTscans for differentiating AD from DLB. 3 This article describes how we developed a business case for a pilot investment proposal leading to recurrent funding for 40 FDG-PET/CT and five DaTscans per year; the protocol for the service evaluation; and data from the first two years of operation. Functional neuroimaging that uses a radio-active ligand to assess glucose metabolism in brain tissue.…”