A Guide to the Diagnosis and Assessment of Alzheimer’s Disease
DEFINITION OF THE DEMENTIA SYNDROME
The characteristic clinical feature of dementia is the presence of cognitive decline sufficient to cause functional impairment. Criteria for dementia are defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM IV). When dementia has been confirmed, the differential diagnosis can begin. The onset of progressive dementia is usually insidious. The first signs are forgetfulness, personality change, changes in the capacity to carry out the ordinary tasks of daily living, and repetitive behavior.
In addition, delusions and paranoid or antisocial behavior may be experienced in more advanced dementia. The exact clinical symptoms vary between patients and the duration of the illness may be long or short, taking from months (e.g. Creutzfeld-Jakob disease) to years (average 9 years in AD). Dementia has diverse etiologies. One challenge is to make a correct differential diagnosis.
Differentiating Alzheimer’s disease from other forms of dementia
* Differentiate dementia from normal aging, depression and delirium and effects of drugs
* Explore the causes of dementia
* Describe the etiology, neuropathology and clinical symptoms of AD
* Briefly review the clinical symptoms of other common dementing disorders
Multiple cognitive deficits, including memory loss and at least one of the following:
* Problems with language (aphasia)
* Inability to performpurposeful actions (apraxia)
* Poor recognition (agnosia)
* Impaired executive functioning
* Interfering with occupational and/or social functioning
* Representing a decline from a higher level
Table 1. Adapted from DSM IV criteria for dementia, 1994. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition. Copyright 1994; American Psychiatric Association
Developed from scientific presentations at a special IPA meeting.
Sponsored by an educational grant from Pfizer Inc and Eisai Ltd.
International Psychogeriatric Association