Progression of illness in the differential diagnosis of primary dementia

Article Abstract:

Traditional diagnostic criteria used in making a differential diagnosis of dementia refer to the progression of illness and the age at symptom onset. However, these factors have seldom been the focus of empirical studies. This study examined the value of these determinations in 124 dementia patients, all of whom were over 55 years old, in a clinical setting. The illness was characterized as either insidious or stepwise in form of progression and patients were diagnosed with either primary degenerative dementia, multi-infarct dementia, or Alzheimer's disease. Typically, these patients had been referred for treatment for mental disorders resulting in behavioral problems that occurred late in life. Most of the patients experienced insidious mental deterioration, regardless of their specific type of dementia. Eighty-six patients (66 percent) had insidious progression, compared with 15 subjects (12 percent) who had a stepwise progression of illness; in another 27 patients this characteristic could not be determined. Of the 15 patients with step-wise progression, at least two had cerebral infarctions. However, the type of progression did not appear to be associated with the form of dementia the patient had. Alzheimer's patients were not distinguished from those with multi-infarct dementia by this characteristic. In those with primary degenerative dementia, episodic behavioral complications significantly contributed to whether or not they were classified as having a stepwise pattern. The authors also concluded that assessment of the course of illness seems to be less significant than the evidence derived from neurologic signs and symptoms and X-rays in distinguishing the causes of dementia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Multi-infarct dementia

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Neuropathological findings in patients with clinical diagnoses of probable Alzheimer's disease

Article Abstract:

Although Alzheimer's disease is the primary cause of dementia, or impaired cognitive function, in older adults, reliable diagnosis is difficult to achieve. Methods of diagnosis performed during autopsy are more definitive; microscopic examination of the brain tissue is needed for positive confirmation of this condition, and removal of brain tissue from a living person for diagnosis of Alzheimer's is not done. Alzheimer's disease is a progressive, deteriorating dementia involving loss of intellectual abilities, memory, judgment, abstract thought, and is accompanied by personality changes. This disorder usually develops after age 65, but its onset may be earlier. A total of 25 patients were examined who met criteria for probable Alzheimer's disease from the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) and the National Institute of Neurological and Communicative Disorders and Stroke. The accuracy of the diagnostic methods used to assess these patients was evaluated. The patients were followed until death, at which point neuropathological examinations were performed; the diagnosis of Alzheimer's disease was corroborated in 68 percent of the cases. This represents a lower rate of positive diagnosis than previously reported in similar studies. Six of the subjects were confirmed for diseases other than Alzheimer's and five of those had experienced early onset of dementia, defined as the development of dementia before the age of 65 years. The importance of long-term follow-up and post mortem evaluation is stressed, if accurate diagnoses are to be obtained. (Consumer Summary produced by Reliance Medical Information, Inc.)

Autopsy, Neurologic examination

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Implications of self-reported cognitive and motor dysfunction in HIV-positive patients

Article Abstract:

AIDS dementia complex, which may develop in the later stages of human immunodeficiency virus (HIV) infection, is characterized by slowed mental processing, forgetfulness, apathy, instability of movement, and general motor slowness. The relationship between patient complaints, psychiatric status, and cognitive and motor performance was investigated in 77 patients with the HIV infection. Forty of the patients did not have symptoms, 29 had early symptoms (AIDS-related complex), and eight subjects had AIDS. Neurological examination identified subjects with cognitive and motor dysfunction, scales measured depression and anxiety, and psychiatric diagnoses were assigned using standard diagnostic criteria. Actual cognitive and motor performance was measured as well. About 49 percent of the patients complained of cognitive problems. While these complaints were associated with psychiatric symptoms such as depression and anxiety, no relation was found between complaints of cognitive dysfunction and impaired performance on standardized tests. For the 16 percent of the subjects who complained of motor function problem, a correlation with poorer test results was found. Complaints were related to motor function performance, but no relationship was found between such complaints and psychiatric symptoms. However, potentially treatable psychiatric symptoms were common in the overall group as well. This was especially true for subjects with cognitive complaints. Subjects with motor complaints were more likely to have neurological conditions than psychiatric problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Evaluation, Complications and side effects, HIV infection, HIV infections, HIV patients, Motor ability, Motor skills, Cognition disorders, Cognitive disorders

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