Skip to main content
AAN.com
Articles
May 1, 1997

Differential diagnosis of Alzheimer's disease

May 1997 issue
48 (5_suppl_6) 2S-9S

Abstract

Article abstract-Accurate diagnosis of dementia is essential to provide appropriate treatment as well as patient and family counseling. It may be difficult to differentiate dementia from delirium. In addition, several features distinguish dementia from depression, but the two can coexist and the distinction may be uncertain. Dementias can be grouped into two categories: dementia that presents without prominent motor signs and dementia that presents with prominent motor signs. Dementias without prominent motor signs include Alzheimer's disease, frontotemporal dementia, and Creutzfeld-Jakob and other prion diseases. Dementias characterized at onset by prominent motor signs include dementias with Lewy bodies, idiopathic Parkinson's disease, progressive supranuclear palsy, cortico-basal ganglionic degeneration, hydrocephalus, Huntington's disease, and vascular dementia. Routine diagnostic steps include a careful history, mental status screening, laboratory and imaging studies, and neuropsychologic testing. Genetic testing is available, but its use is controversial and raises complex ethical questions.
NEUROLOGY 1997;48(Suppl 6): S2-S9

Get full access to this article

View all available purchase options and get full access to this article.

REFERENCES

1.
Alzheimer A. Uber eine eigenartige Erkangkung der Hirnrinde. Allgemeine Zeitschr Psychiatr Psychisch-Gerichtliche Medizin 1907;64:146-148. (English translation: Arch Neurol 1967;21:109-110.)
2.
Mayeux R, Foster NL, Rossor M, Whitehouse PJ. The clinical evaluation of patients with dementia. In: Whitehouse PJ, ed. Dementia. Contemporary neurology series. Philadelphia: FA Davis, 1993;40:92-130.
3.
Ernst R, Hay J. The US economic and social costs of Alzheimer's disease revisited. Am J Public Health 1994;84:1261-1264.
4.
Meyer JS, Judd BW, Tawaklna T, Rogers RL, Mortel KF. Improved cognition after control of risk factors for multi-infarct dementia. JAMA 1986;256:2203-2209.
5.
Homma A, Hasegawa K. Recent developments in gerontopsychiatric research on age associated dementia in Japan [abstract]. Int Psychogeriatr 1989;1:31.
6.
Knopman DS, Schneider L, Davis K, et al. Long term tacrine (Cognex) treatment: effects on nursing home placement and mortality. Neurology 1996;47:166-177.
7.
Evans DA, Funkenstein HH, Albert MS, et al. Prevalence of Alzheimer's disease in a community population of older persons: higher than previously reported. JAMA 1989;262:2551-2556.
8.
White LR, Cartwright WS, Cornoni-Huntley J, Brock DB. Geriatric epidemiology. Annu Rev Gerontol Geriatr 1986;6:215-311.
9.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). Washington: American Psychiatric Association, 1994.
10.
Mayeux R, Foster NL, Rossor M, Whitehouse PJ. Clinical evaluation of patients with dementia. In: Whitehouse PJ, ed. Dementia. Philadelphia: FA Davis, 1993:92-130.
11.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
12.
Gearing M, Mirra SS, Hedreen JC, Sumi SM, Hansen LA, Heyman A. The Consortium to establish a registry for Alzheimer's disease (CERAD) Part X. Neuropathology confirmation of the clinical diagnosis of Alzheimer's disease. Neurology 1995;45:461-466.
13.
Becker JT, Boller F, Lopez OL, Saxton J, McGonigle KL. The natural history of Alzheimer's disease. Description of study cohort and accuracy of diagnosis. Arch Neurol 1994;51:585-594.
14.
Folstein MF, Folstein SE, McHugh PR. "Mini Mental State": a practical method of grading cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
15.
Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups. J Neurol Neurosurg Psychiatry 1994;57:416-418.
16.
Holman RC, Khan AS, Kent J, Strine TW, Schonberger LB. Epidemiology of Creutzfeldt-Jakob disease in the United States. 1979-1990: analysis of national mortality data. Neuroepidemiology 1995;14:174-181.
17.
Prusiner SB. Human prion diseases. Ann Neurol 1994;35:385-395.
18.
Kalra S, Bergeron C, Lang AE. Lewy body disease and dementia. A review. Arch Intern Med 1996;156:487-493.
19.
Louis ED, Goldman JE, Powers JM, Fahn S. Parkinsonian features of eight pathologically diagnosed cases of diffuse Lewy body disease. Mov Disord 1995;10:188-194.
20.
Gibb WR, Luthert PJ, Janota I, Lantos PL. Cortical Lewy body dementia: clinical features and classification. J Neurol Neurosurg Psychiatry 1989;52:185-192.
21.
Hanson L, Salmon D, Galasko D, et al. The Lewy body variant of Alzheimer's disease: a clinical and pathological entity. Neurology 1990;40:1-8.
22.
McKeith IG, Fairbairn AF, Bothwell RA, et al. An evaluation of the predictive validity and inter-rater reliability of clinical diagnostic criteria for senile dementia of the Lewy body type. Neurology 1994;44:872-877.
23.
Byrne EJ, Lennox G, Lowe J, Godwin-Austen RB. Diffuse Lewy body disease: clinical features in 15 cases. J Neurol Neurosurg Psychiatry 1989;52:709-717.
24.
Mayeux R, Chen J, Mirabello E, et al. An estimate of the incidence of dementia in idiopathic Parkinson's disease. Neurology 1990;40:1513-1516.
25.
Steele JC, Richardson JC, Olszewski J. Progressive supranuclear palsy. Arch Neurol 1964;10:333-359.
26.
Jankovic J. Parkinsonism-plus syndromes. Mov Disord 1989;4(suppl 1):S95-S119.
27.
Maher ER, Smith EM, Lees AJ. Cognitive deficits in the Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). J Neurol Neurosurg Psychiatry 1985;48:1234-1239.
28.
Podoll K, Schwarz M, Noth J. Language functions in progressive supranuclear palsy. Brain 1991;114:1457-1472.
29.
Maher ER, Lees AJ. The clinical features of Steele-Richardson-Olszwewski syndrome (progressive supranuclear palsy). Neurology 1986;36:1005-1008.
30.
Foster NL, Gilman S, Berent S, et al. Progressive subcortical gliosis and progressive supranuclear palsy can have similar clinical and PET abnormalities. J Neurol Neurosurg Psychiatry 1992;55:707-713.
31.
Riley DE, Lang AE, Lewis A, et al. Cortical-basal ganglionic degeneration. Neurology 1990;40:1203-1212.
32.
Lang AE, Riley DE, Bergeron C. Cortical-basal ganglionic degeneration. In: Calne DB, ed. Neurodegenerative diseases. Philadelphia: WB Saunders, 1994:877-894.
33.
Wikkelso C, Andersson H, Blomstrand C, Lindqvist G, Svendsen P. Normal pressure hydrocephalus: predictive value of the cerebrospinal fluid tap-test. Acta Neurol Scand 1986;73:566-573.
34.
Vanneste J, Augustijn P, Davies GA, Dirven C, Tan WF. Normal-pressure hydrocephalus. Is cisternography still useful in selecting patients for a shunt? Arch Neurol 1992;49:366-370.
35.
Chui HC. Dementia: a review emphasizing clinicopathologic correlation and brain-behavior relationships. Arch Neurol 1989;46:806-814.
36.
Hachinski VC, Lassen NA, Marshall J. Multi-infarct dementia: a cause of mental deterioration in the elderly. Lancet 1974;2:207-210.
37.
Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R. Criteria for ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology 1992;42:473-480.
38.
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology 1993;43:250-260.
39.
Katzman R, Lasker B, Bernstein N. Advances in the diagnosis of dementia: accuracy of diagnosis and consequence of misdiagnosis of disorders causing dementia. In: Terry RD, ed. Aging and the brain. New York: Raven Press, 1988:17-62.
40.
Erkinjuntti T, Haltia M, Palo J, Sulkava R, Paetau A. Accuracy of the clinical diagnosis of vascular dementia: a prospective clinical and post-mortem pathological study. J Neurol Neurosurg Psychiatry 1988;51:1037-1044.
41.
Kotsoris H, Barclay LL, Kheyfets S, Hulyalkar A, Dougherty J. Urinary and gait disturbances as markers for early multi-infarct dementia. Stroke 1987;18:138-141.
42.
Kertesz A, Clydesdale S. Neuropsychological deficits in vascular dementia vs. Alzheimer's disease. Frontal lobe deficits prominent in vascular dementia. Arch Neurol 1994;51:1226-1231.
43.
Hachinski VC, Iliff LD, Zilhka E, et al. Cerebral blood flow in dementia. Arch Neurol 1975;32:632-637.
44.
Hachinski VC, Potter P, Merskey H. Leuko-araiosis. Arch Neurol 1987;44:21-23.
45.
Corey-Bloom J, Thal LJ, Galasko D, et al. Diagnosis and evaluation of dementia. Neurology 1995;45:211-218.
46.
US Department of Health and Human Services. Clinical Practice Guideline, Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias. Silver Spring, MD: Agency for Health Care Policy and Research Publications, 1996.
47.
Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and education level. JAMA 1993;269:2386-2391.
48.
Geldmacher DS, Whitehouse MD. Current concepts: evaluation of dementia. N Engl J Med 1996;335:330-336.
49.
Weytingh MD, Bossuyt PMM, van Crevel H. Reversible dementia: more than 10% or less than 1%? A quantitative review. J Neurol 1995;242:446-471.
50.
Alexander EM, Wagner EH, Buchner DM, Cain KC, Larson EB. Do surgical brain lesions present as isolated dementia? A population based study. J Am Geriatr Soc 1995;43:138-143.
51.
Jacobs DM, Sano M, Dooneief G, Marder K, Bell KL, Stern Y. Neuropsychological detection and characterization of preclinical Alzheimer's disease. Neurology 1995;45:957-962.
52.
Waldemar G, Bruhn P, Kristensen M, Johnsen A, Paulson OB, Lassen NA. Heterogeneity of neocortical cerebral blood flow deficits in dementia of the Alzheimer type: a [99mTc]-d,1-HMPAO SPECT study. J Neurol Neurosurg Psychiatry 1994;57:285-295.
53.
Read SL, Miller BL, Mena I, Kim R, Itabashi H, Darby A. SPECT in dementia: clinical and pathological correlation. J Am Geriatr Soc 1995;43:1243-1247.
54.
Post SG. Genetics, ethics, and Alzheimer's disease. J Am Geriatr Soc 1994;42:782-786.
55.
Post SG, Whitehouse PJ. Fairhill guidelines on ethics of the care of people with Alzheimer's disease: a clinical summary. J Am Geriatr Soc 1995;43:1423-1429.
56.
Roses AD. Apolipoprotein E genotyping in the differential diagnosis, not prediction, of Alzheimer's disease. Ann Neurol 1995;38:6-13.
57.
Saunders AM, Roses A. Re: Evaluation of dementia [letter]. N Engl J Med 1996;335:1996.
58.
Whitehouse PJ, Geldmacher DS. Reply [letter]. N Engl J Med 1996;335:1997-1998.
59.
National Institute on Aging/Alzheimer's Association Working Group. Apolipoprotein E genotyping in Alzheimer's disease. Lancet 1996;347:1091-1095.
60.
Huang HM, Martins R, Gandy S, et al. Use of cultured fibroblasts in elucidating the pathophysiology and diagnosis of Alzheimer's disease. Ann NY Acad Sci 1994;747:225-244.
61.
Sorbi S, Piacentini S, Latorraca S, Piersanti P, Amaducci L. Alterations in metabolic properties in fibroblasts in Alzheimer disease. Alzheimer Dis Assoc Disord 1995;9:73-77.
62.
Matsushima H, Shimohama S, Tanaka S, et al. Platelet protein kinase C levels in Alzheimer's disease. Neurobiol Aging 1994;15:671-674.
63.
van Rensburg SJ, Daniels WM, van Zyl J, Potocnik FC, van der Walt BJ, Taljaard JJ. Lipid peroxidation and platelet membrane fluidity-implications for Alzheimer's disease? Neuroreport 1994;5:2221-2224.
64.
Scinto LF, Daffner KR, Dressler D, et al. A potential noninvasive neurobiological test for Alzheimer's disease. Science 1994;266:1051-1054.
65.
Loupe DN, Newman NJ, Green RC, et al. Pupillary response to tropicamide in patients with Alzheimer's disease. Ophthalmology 1996;103:495-503.

Information & Authors

Information

Published In

Neurology®
Volume 48Number 5_suppl_6May 1997
Pages: 2S-9S

Publication History

Published online: May 1, 1997
Published in print: May 1997

Permissions

Request permissions for this article.

Authors

Affiliations & Disclosures

David S. Geldmacher, MD
Peter J. Whitehouse, Jr., MD, PhD
From the University Alzheimer Center, University Hospitals of Cleveland, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH.
Address correspondence and reprint requests to Dr. David S. Geldmacher, University Alzheimer Center, 12200 Fairhill Road, Cleveland, OH 44120.

Metrics & Citations

Metrics

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Alzheimer\'s disease and traditional medicinal plants: A review, IP Indian Journal of Neurosciences, 8, 4, (226-233), (2023).https://doi.org/10.18231/j.ijn.2022.047
    Crossref
  2. Personalized Management and Treatment of Alzheimer’s Disease, Life, 12, 3, (460), (2022).https://doi.org/10.3390/life12030460
    Crossref
  3. Anti-Inflammatory Agents: An Approach to Prevent Cognitive Decline in Alzheimer’s Disease, Journal of Alzheimer's Disease, 85, 2, (457-472), (2022).https://doi.org/10.3233/JAD-215125
    Crossref
  4. Toxoplasma gondii: A possible etiologic agent for Alzheimer's disease, Heliyon, 7, 6, (e07151), (2021).https://doi.org/10.1016/j.heliyon.2021.e07151
    Crossref
  5. Can Alzheimer’s Disease Be Prevented? First Evidence from Spinal Stimulation Efficacy on Executive Functions, Journal of Alzheimer's Disease, 77, 4, (1755-1764), (2020).https://doi.org/10.3233/JAD-200695
    Crossref
  6. Acetyl-cholinesterase Inhibition by Extracts and Isolated Flavones from Linaria reflexa Desf. (Scrophulariaceae) , Natural Product Communications, 2, 7, (1934578X0700200), (2019).https://doi.org/10.1177/1934578X0700200711
    Crossref
  7. New cyclooctathienopyridine derivatives in the aim of discovering better Anti-Alzheimer's agents, Journal of Molecular Structure, 1196, (162-168), (2019).https://doi.org/10.1016/j.molstruc.2019.06.071
    Crossref
  8. Galantamine, Reference Module in Biomedical Sciences, (2019).https://doi.org/10.1016/B978-0-12-801238-3.98174-1
    Crossref
  9. Alzheimer’s Disease, Clinical Trials in Neurology, (297-338), (2018).https://doi.org/10.1007/978-1-4939-7880-9_9
    Crossref
  10. Seroprevalence of Toxoplasma gondii Infection in Patients with Alzheimer’s Disease, Archives of Clinical Infectious Diseases, 11, 3, (2016).https://doi.org/10.5812/archcid.37205
    Crossref
  11. See more
Loading...

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share