4 results
Detailed assessment of activities of daily living in moderate to severe Alzheimer's disease
- D. GALASKO, F. SCHMITT, R. THOMAS, S. JIN, D. BENNETT, S. FERRIS
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- Journal:
- Journal of the International Neuropsychological Society / Volume 11 / Issue 4 / July 2005
- Published online by Cambridge University Press:
- 01 July 2005, pp. 446-453
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- Article
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Patients with Alzheimer's Disease (AD) who have reached a stage of moderate to severe dementia are capable of completing a restricted range of cognitive tests and performing a limited range of activities of daily living (ADL). As part of an initiative to develop instruments to evaluate AD, we analyzed data describing the performance of a large number of ADL and scores on cognitive and global assessment measures in a cohort of patients with AD with moderate to severe cognitive impairment, defined as a Mini-Mental State Examination score ranging from 0–15 (out of 30). From the large pool of ADL, 19 met criteria of applicability, reliability, good scaling, concordant validity, and sensitivity to detect change in performance over 6–12 months. A total score derived from these 19 ADL ratings, comprising a scale termed the Alzheimer Disease Cooperative Study ADL-sev, correlated strongly with measures of cognition and of global dementia severity. Patients with moderate to severe AD showed a decline on the ADL-sev and cognitive measures over 6 and 12 months, consistent with the progression of AD. Detailed evaluation of ADL may provide a useful index to evaluate patients with moderate to severe AD and may complement cognitive assessment, especially for characterizing change in interventional or therapeutic studies. (JINS, 2005, 11, 446–453.)
8 - Neuropsychological aspects of Lewy body dementia
- from Part one - Clinical issues
- Edited by Robert Perry, Department of Neuropathology, Newcastle General Hospital, Ian McKeith, University of Newcastle upon Tyne, Elaine Perry, MRC Neurochemical Pathology Unit, Newcastle General Hospital
- Foreword by Jeffrey L. Cummings
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- Book:
- Dementia with Lewy Bodies
- Published online:
- 06 July 2010
- Print publication:
- 28 November 1996, pp 99-113
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Summary
Summary
Recent clinico-neuropathological studies have shown that approximately 25% of patients who manifest a syndrome similar to dementia of the Alzheimer type during life have diffuse Lewy body disease (DLBD), a condition characterized by neocortical and subcortical Lewy body pathology that occurs, in many cases, along with the typical cortical distribution of senile plaques and neurofibrillary tangles associated with Alzheimer's disease (AD). Studies of the neuropsychology of this disorder demonstrate that DLBD, without concomitant AD, can produce a global dementia characterized by particularly pronounced deficits in memory (i.e. retrieval), attention, visuospatial abilities and psychomotor speed. When both DLBD and AD pathology is present, patients exhibit severe deficits in memory, language, and executive functions, most likely due to the severe hippocampal and neocortical damage that occurs in AD, as well as particularly severe deficits in visuospatial abilities, attention, and psychomotor processes, which may reflect the additive effects of Lewy body pathology. This pattern of neuropsychological deficits has also been observed in recent prospective studies of patients with clinically diagnosed DLBD, and may prove to be an important addition to the diagnostic criteria for DLBD.
Introduction
Recent clinico-neuropathological studies have shown that approximately 25% of patients who manifest a syndrome similar to dementia of the Alzheimer type during life have Lewy bodies diffusely distributed throughout the neocortex (for review, see Hansen & Galasko, 1992). This cortical Lewy body pathology occurs along with the typical subcortical changes of Parkinson's disease (i.e. Lewy bodies and cell loss) in the substantia nigra and other pigmented brainstem nuclei, and in many cases with the typical cortical distribution of senile plaques and neurofibrillary tangles associated with Alzheimer's disease (AD) (Hansen et al., 1990).
2 - The nosological status of Lewy body dementia
- from Part one - Clinical issues
- Edited by Robert Perry, Department of Neuropathology, Newcastle General Hospital, Ian McKeith, University of Newcastle upon Tyne, Elaine Perry, MRC Neurochemical Pathology Unit, Newcastle General Hospital
- Foreword by Jeffrey L. Cummings
-
- Book:
- Dementia with Lewy Bodies
- Published online:
- 06 July 2010
- Print publication:
- 28 November 1996, pp 21-32
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Summary
Summary
Lewy bodies (LB), the pathological hallmark of Parkinson's disease, occur in cortical as well as subcortical areas in the brains of about 10?–30% of patients with dementia clinically consistent with Alzheimer's disease (AD). Lewy body dementia (LBD) overlaps with AD both at autopsy, where most demented patients with cortical LB also have senile and neuritic plaques and to a lesser extent the neurofibrillary tangles typical of AD, and clinically, where patients with LBD generally meet clinical criteria for probable or possible AD. The nosology of LBD and proposed diagnostic criteria therefore need to take cognizance of AD.
A major pathological problem is how many plaques, tangles, or both are required to diagnose AD in the presence of LB. Similarly, since nondemented PD patients also show cortical LB, should LBD be defined pathologically by a threshold cortical LB count? A descriptive and quantitative approach to pathology in well-characterized patients with dementia (AD and LBD), and PD (with and without dementia) is needed.
Clinical criteria for LBD have been proposed and validated in studies that retrospectively reviewed entire case records. Key features are parkinsonian signs, cognitive fluctuations, hallucinations, and a ‘frontalsubcortical’ dementia profile. There are problems in reliably assessing and documenting each of these elements. We suggest a flexible approach that is compatible with published criteria and studies, and includes categories of probable and possible LBD, to help determine which combination of features optimally discriminates LBD from ‘pure’ AD and other dementias.
Résumé of treatment workshop sessions
- from Part one - Clinical issues
- Edited by Robert Perry, Department of Neuropathology, Newcastle General Hospital, Ian McKeith, University of Newcastle upon Tyne, Elaine Perry, MRC Neurochemical Pathology Unit, Newcastle General Hospital
- Foreword by Jeffrey L. Cummings
-
- Book:
- Dementia with Lewy Bodies
- Published online:
- 06 July 2010
- Print publication:
- 28 November 1996, pp 187-192
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- Chapter
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Summary
The clinical workshop adopted a two-stage approach to the challenging task of agreeing clinical diagnostic criteria for dementia with Lewy bodies (DLB).
Session one – Where does DLB fit within the diagnostic framework?
The first step was to define the scope of the new criteria, in particular whether they ought to be part of a unifying diagnostic category covering the whole spectrum of clinical presentations of LB disorders, or whether they should restrict themselves to only one part of this. The subsequent task would then be to select and operationally define the specific items of diagnostic importance. Two existing sets of clinical diagnostic criteria (the Newcastle criteria for senile dementia of Lewy body type (SDLT) (McKeith et al., 1992) and the Nottingham criteria for dementia associated with cortical Lewy bodies (Byrne et al., 1991)) were tabled for consideration, as were supplementary data from other participants (all to be found in the preceding clinical chapters).
Preliminary discussion centred on the principle that diagnostic criteria should be framed in the way most relevant to established clinical procedures. It was agreed that a single set of clinical criteria encompassing the whole spectrum of LB disorders, ranging from motor Parkinson's disease (PD) to primary cognitive failure, would produce a diagnostic category containing enormous clinical heterogeneity. Such a system would be difficult to apply in clinical practice and would have low face validity.