Brain Mapping and Transcranial Doppler Ultrasonography in Alzheimer Disease Drug Monitoring

  • Ramón Cacabelos
  • José Caamaño
  • Dolores Vinagre
  • José I. Lao
  • Katrin Beyer
  • Antón Alvarez
Part of the Advances in Alzheimer Disease Therapy book series (AADT)

Abstract

International guidelines recommend for the early diagnosis of Alzheimer disease (AD) to proceed according to the following steps: 1) diagnostic criteria (DSM-IV/NINCDS-ADRDA); 2) clinical evaluation (general, neurologic, psychiatric); 3) biochemical study (blood, urine); 4) neuropsychological assessment (cognitive, functional, behavioral); 5) neurophysiological studies (EEG, brain mapping, evoked potentials); 6) neuroimaging (static (CT-Scan, MRI), dynamic (SPECT, PET); 7) cerebrovascular evaluation (BBF, Transcranial Doppler Ultrasonography); 8) neurochemical studies with potential biological markers; and 9) genetic studies (APOE, STM2, 182s, APP21m); relying the confirmation of the disease on 10) neuropathological studies at a postmortem level (Cacabelos et al., 1995a; 1996). The complete administration of this protocol in specialized centers yields a highly accurate diagnostic rate (>95%) in early stages. Despite the high cost of this procedure and its unlikely use in conventional clinical settings, it seems essential its implementation when trying to include AD patients in clinical protocols to investigate a particular aspect of the disease or when we recruit patients for a drug clinical trial. In terms of clinical assessment for the daily practice, the following steps would be sufficient: (a) clinical assessment, (b) basal biochemical screening, (c) psychometric assessment, and (d) static neuroimaging. However, in the selection of patients for drug clinical trials, genetic testing and functional instrumentation have proved to be very useful, since the therapeutic response of most patients varies according to their genotype, and because biological and functional parameters, together with psychometric measurements, have shown to be more reliable and precise than psychometric parameters alone.

Keywords

Attenuation Dementia Neurol Tacrine 

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Copyright information

© Birkhäuser Boston 1997

Authors and Affiliations

  • Ramón Cacabelos
    • 1
  • José Caamaño
    • 1
  • Dolores Vinagre
    • 1
  • José I. Lao
    • 1
  • Katrin Beyer
    • 1
  • Antón Alvarez
    • 1
  1. 1.EuroEspes Biomedical Research CenterInstitute for CNS DisordersBergondoSpain

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