The Decreasing Prevalence of Reversible Dementias

Clarfield, A. Mark

doi:10.1001/archinte.163.18.2219

Cited by 251 publications

(127 citation statements)

References 116 publications

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“…Unlike most other types of dementia, AD is characterised by primary memory deficit and progressive memory loss over the course of the disease. While memory clinics in developed countries have reported prevalence rates of 50 -62% for AD and 7 -20% for vascular dementia (VaD), 22 our audit showed an AD prevalence of 44%, compared with 36% in a Brazilian memory clinic. 23 Our high prevalence of VaD (28%) and mixed dementia (15%) suggests a high prevalence of stroke and attendant risk factors that may be inadequately managed.…”

Section: Clinical Diagnosescontrasting

confidence: 55%

Profile and management of patients at a memory clinic

Kalula

Ferreira

Thomas³

et al. 2010

S Afr Med J

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Section: Clinical Diagnosescontrasting

confidence: 55%

Profile and management of patients at a memory clinic

Kalula

Ferreira

Thomas³

et al. 2010

S Afr Med J

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“…The most common dementia-related disorders are AD (55-70%), cerebrovascular dementia (15-25%), Lewy body disease and Parkinson's disease (10-15%), frontal lobe dementia (5-10%), and traumatic brain injury (Ͻ5%) (2). A comprehensive multifactorial evaluation including clinical assessment, laboratory testing, and imaging is typically used to diagnose ADRD.…”

mentioning

confidence: 99%

Methods to improve the detection of mild cognitive impairment

Shankle

Romney

Hara

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

134

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We examined whether the performance of the National Institute of Aging's Consortium to Establish a Registry for Alzheimer's Disease's 10-word list (CWL), part of the consortium's neuropsychological battery, can be improved for detecting Alzheimer's disease and related disorders early. We focused on mild cognitive impairment (MCI) and mild dementia because these stages often go undetected, and their detection is important for treatment. Using standardized diagnostic criteria combined with history, physical examination, and cognitive, laboratory, and neuroimaging studies, we staged 471 community-dwelling subjects for dementia severity by using the Clinical Dementia Rating Scale. We then used correspondence analysis (CA) to derive a weighted score for each subject from their item responses over the three immediate-and one delayed-recall trials of the CWL. These CA-weighted scores were used with logistic regression to predict each subject's probability of impairment, and receiver operating characteristic analysis was used to measure accuracy. For MCI vs. normal, accuracy was 97% [confidence interval (C.I.) 97-98%], sensitivity was 94% (C.I. 93-95%), and specificity was 89% (C.I. 88 -91%). For MCI͞mild dementia vs. normal, accuracy was 98% (C.I. 98 -99%), sensitivity was 96% (C.I. 95-97%), and specificity was 91% (C.I. 89 -93%). MCI sensitivity was 12% higher (without lowering specificity) than that obtained with the delayed-recall total score (the standard method for CWL interpretation). Optimal positive and negative predictive values were 100% and at least 96.6%. These results show that CA-weighted scores can significantly improve early detection of Alzheimer's disease and related disorders.

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“…53 The traditionally quoted figure of a 20 % prevalence has been mostly abandoned. 54 A new look at an old problem shows that true reversibility is rare (1 %) 55 and uncommon in older patients with cognitive decline who fulfil the proposed criteria for primary degenerative dementia.…”

Section: Infectionsmentioning

confidence: 99%

How Reversible are ‘˜Reversible Dementias’?

Ioannidis¹,

Karacostas²

2011

European Neurological Review

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Reversible dementias comprise different groups of disorders of variable aetiologies, such as structural brain lesions or metabolic, infectious, toxic, autoimmune, paraneoplastic and psychiatric disorders. When patients present with cognitive symptoms, especially in the younger age groups, the first thought of the attending neurologist should be to try to identify an underlying treatable cause. The incidence of degenerative dementia rises with older age and its symptoms progressively become more evident and typical; in such cases, a differential diagnosis is limited and the chance of uncovering a treatable disorder is minimal. However, although uncommon, treatable dementias or dementia-like symptoms do exist. Future studies with better design and methodology, as well as longer observation periods and larger patient populations, are needed to clarify the controversial issues concerning the epidemiology and accurate diagnosis of, and treatment possibilities for, reversible dementias. KeywordsReversible dementia, classification, differential diagnosis, treatment, review 1 It is estimated that the number of people with dementia will increase dramatically over the next few decades, 2 presenting a tremendous burden for patients, spouses and other family carers, and society. Consideration of the differential diagnosis of dementia is a complex process, and accurate diagnosis is challenging. Primary degenerative dementias result from irreversible aetiologies, such as beta-amyloid deposition, inclusion of Lewy bodies, taupathies or other dysfunctional proteins, whereas reversible dementias are secondary to other treatable conditions. When patients present with cognitive symptoms, especially in the younger age groups, the first thought of the attending neurologist should be to try to to identify an underlying treatable cause. Reversible dementias comprise different groups of variable aetiologies, such as structural brain lesions or metabolic, infectious, toxic, autoimmune, paraneoplastic and psychiatric disorders. 3 The aim of this article is first to define these treatable conditions and second to explore how reversible they really are according to data from the literature. 4,5 Traditional and New Approach to ReversibilityBetween the 1980s and early 1990s, most studies estimated the prevalence of reversible dementias to be almost 20 %, introducing aetiologies such as normal pressure hydrocephalus (NPH), structural brain abnormalities, depression, hypothyroidism and vitamin B12 deficiency. 6,7 However, many of these studies were lacking strict criteria, adequate follow-up and solid methodology. 8In recent years, neurologists have taken a new approach to reversibility.It seems that good history evaluation, clinical examination accompanied by certain psychometric tests and appropriate laboratory work-up should be considered for every patient with cognitive symptoms. 9The incidence of degenerative dementia rises with older age and its symptoms progressively become more evident and typical; in such cases, the differenti...

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The Decreasing Prevalence of Reversible Dementias

Cited by 251 publications

References 116 publications

Profile and management of patients at a memory clinic

Profile and management of patients at a memory clinic

Methods to improve the detection of mild cognitive impairment

How Reversible are ‘˜Reversible Dementias’?

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