There is a growing population of individuals diagnosed with various forms of Frontotemporal Dementia (FTD) and Primary Progressive Aphasia (PPA), and this number is likely to increase as medical ...practitioners and speech-language pathologists (SLPs) become more expert at identifying these conditions. More clinicians will be seeing, and treating, patients with a diagnosis of FTD or PPA. Toward that end, the goal of this book is to expand this clinical knowledge base and support the development of skills in diagnosis, but also in clinical management.
Alzheimer's disease, a haunting and harrowing ailment, is one of
the world's most common causes of death. Alzheimer's lingers for
years, with patients' outward appearance unaffected while their
...cognitive functions fade away. Patients lose the ability to work
and live independently, to remember and recognize. There is still
no proven way to treat Alzheimer's because its causes remain
unknown. Mind Thief is a comprehensive and engaging
history of Alzheimer's that demystifies efforts to understand the
disease. Beginning with the discovery of "presenile dementia" in
the early twentieth century, Han Yu examines over a century of
research and controversy. She presents the leading hypotheses for
what causes Alzheimer's; discusses each hypothesis's tangled
origins, merits, and gaps; and details their successes and
failures. Yu synthesizes a vast amount of medical literature,
historical studies, and media interviews, telling the gripping
stories of researchers' struggles while situating science in its
historical, social, and cultural contexts. Her chronicling of the
trajectory of Alzheimer's research deftly balances rich scientific
detail with attention to the wider implications. In narrating the
attempts to find a treatment, Yu also offers a critical account of
research and drug development and a consideration of the philosophy
of aging. Wide-ranging and accessible, Mind Thief is an
important book for all readers interested in the challenge of
Alzheimer's.
Background
Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive ...impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini‐Mental State Examination (MMSE) is the best‐known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings.
Objectives
To determine the accuracy of the Mini Mental State Examination for the early detection of dementia in people with mild cognitive impairment
Search methods
We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of s of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data.
Selection criteria
We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow‐up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer’s dementia, Lewy body dementia, vascular dementia and frontotemporal dementia.
Data collection and analysis
We screened all titles generated by the electronic database searches. Two review authors independently assessed the s of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS‐2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve.
Main results
In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all‐cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer’s disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis.
Authors' conclusions
Our review did not find evidence supporting a substantial role of MMSE as a stand‐alone single‐administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.
One of the largest patient populations seen by neuropsychologists are older adults suffering from problems associated with aging. Further, the proportion of the population aged 65 and above is rising ...rapidly. This book provides a guide to neuropsychological clinicians increasingly called upon to assess this population. The book details in a step-by-step fashion the phases and considerations in performing a neuropsychological assessment of an older patient. It covers procedural details including review of patient's medical records, clinical interview, formal testing, interpretation of test scores, addressing referral questions, and preparing an evaluation report.
Key Features* Outlines a clear, logical approach to neuropsychological evaluation* Provides specific clinical practice guidelines for each phase of the evaluation* Integrates clinical practice with up-to-date research findings* Recommends specific tests for evaluating older adults* Details how to interpret test findings and identify the patient's neuropsychological profile* Illustrates important points with examples and case materials, many neuropathologically-confirmed* Includes forms useful in clinical practice
Advances in neuroimaging have enabled greater understanding of the progression of cerebral degenerative processes associated with ageing‐related dementias. Leukoaraiosis or rarefied white matter (WM) ...originally described on computed tomography is one of the most prominent changes which occurs in older age. White matter hyperintensities (WMH) evident on magnetic resonance imaging have become commonplace to describe WM changes in relation to cognitive dysfunction, types of stroke injury, cerebral small vessel disease and neurodegenerative disorders including Alzheimer's disease. Substrates of WM degeneration collectively include myelin loss, axonal abnormalities, arteriolosclerosis and parenchymal changes resulting from lacunar infarcts, microinfarcts, microbleeds and perivascular spacing. WM cells incorporating astrocytes, oligodendrocytes, pericytes and microglia are recognized as key cellular components of the gliovascular unit. They respond to ongoing pathological processes in different ways leading to disruption of the gliovascular unit. The most robust alterations involve oligodendrocyte loss and astrocytic clasmatodendrosis with displacement of the water channel protein, aquaporin 4. These modifications likely precede arteriolosclerosis and capillary degeneration and involve tissue oedema, breach of the blood–brain barrier and induction of a chronic hypoxic state in the deep WM. Several pathophysiological mechanisms are proposed to explain how WM changes commencing with haemodynamic changes within the vascular system impact on cognitive dysfunction. Animal models simulating cerebral hypoperfusion in man have paved the way for several translational opportunities. Various compounds with variable efficacies have been tested to reduce oxidative stress, inflammation and blood–brain barrier damage in the WM. Our review demonstrates that WM degeneration encompasses multiple substrates and therefore more than one pharmacological approach is necessary to preserve axonal function and prevent cognitive impairment.
This article is part of the Special Issue “Vascular Dementia”.
In this review, we discuss disintegration of the cellular components of the gliovascular unit in the white matter. This has consequences on blood–brain barrier integrity and is a strong correlate of white matter damage associated with cognitive impairment. Animal models of cerebral hypoperfusion replicate several features of white matter changes in man. They have been valuable in identifying various agents which target oxidative stress, inflammation and BBB damage.
This article is part of the Special Issue “Vascular Dementia”.
ObjectiveTo analyse data from two previously published individual studies and two meta-analyses of the Ascertain Dementia 8 (AD8) cognitive screening instrument to calculate the recently described ...‘likelihood to be diagnosed or misdiagnosed’ (LDM) metric, the ratio of ‘number needed to misdiagnose’ (NNM = 1/Inaccuracy) to either ‘number needed to diagnose’ (NND = 1/Youden index) or ‘number needed to predict’ (NNP = 1/predictive summary index).ResultsRaw data (true positives and negatives, false positives and negatives) were extracted and LDM values for the diagnosis of dementia were calculated. For the individual studies (n=212, 67 respectively) LDM values were all <1, favouring misdiagnosis, whereas for the meta-analyses (n=3278, 3694 respectively) all LDM values were >1, favouring diagnosis. This discrepancy may be explained by the poor specificity of AD8 in the individual studies, lower than in any other study included in the meta-analyses, giving very high values for NND and NNP and lower values of NNM than in the meta-analytic data. This may relate to differences in casemix between the various studies.ConclusionLDM is an easily calculated and potentially useful test metric. LDM values derived from meta-analytic data may differ from those of individual test accuracy studies.
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