Neuropathologically Confirmed Alzheimer's Disease: Clinical Diagnoses in 394 Cases

Abstract

In the absence of pathognomonic clinical features, the clinical diagnosis of Alzheimer's disease (AD) remains one of exclusion of other dementias. We investigated the clinical diagnoses among 394 neuropathologically confirmed AD cases in a dementia brain bank. Most patients were correctly diagnosed as AD (348 or 88%). Among the misdiagnosed patients, AD was mistaken for a primary depressive disorder in 14, multi-infarct dementia in 13, Parkinson's disease in nine, and alcoholic dementia in four. The number of misdiagnosed AD patients did not differ between physician specialties but was greater among AD patients with agitation, depression, paranoia, or delusions. This retrospective study suggests that the diagnostic sensitivity for AD is high among a cross-section of practicing physicians and that an important factor in mistaking AD for another illness is unfamiliarity with the potential psychiatric symptoms of AD.

Performance Characteristics of Amyloid PET with Florbetapir F 18 in Patients with Alzheimer's Disease and Cognitively Normal Subjects

“…Despi te the introduction of standardized criteria for the clinical diagnosis of Alzheimer's disease (AD) (1,2), a degree of uncertainty nevertheless commonly persists (3). The consequence of this uncertainty is reflected in the misdiagnosis rate documented in postmortem studies (4)(5)(6)(7)(8). With the anticipated development of pathologically targeted treatments and the goal of treating during the earliest symptomatic stage, there is a growing consensus regarding the advantage of incorporating valid biomarkers of AD pathology in the assessment of individuals with late-life cognitive impairment.…”

Is Brain Banking of Psychiatric Cases Valuable for Neurobiological Research?

“…Late-onset psychiatric symptoms such as depression, hallucinations and delusions are common even in patients at the early stages of Lewy body dementia, Alzheimer’s disease, Progressive Supranuclear Palsy and Corticobasal Degeneration,129–132 and may lead to misdiagnosed cases in a brain bank 133. International standard criteria should be followed regarding clinical and neuropathological diagnosis of these dementias 129,134.…”