Clinical Heterogeneity in Patients with Dementia of the Alzheimer Type

  • Richard Mayeux
  • Yaakov Stern
Part of the Advances in Behavioral Biology book series (ABBI, volume 29)


Clinical criteria for the diagnosis of dementia of the Alzheimer type (DAT) vary considerably in the current literature (1–4). Most investigators develop uniform criteria in order to be certain of homogeneity within a given cohort of patients for research purposes. Restricted criteria can lead to refinement in diagnosis, particularly when supported by careful postmortem verification (4–6). In view of this, several investigations are currently in progress to develop both qualitative and quantitative clinical and diagnostic measures for use in DAT.


Alzheimer Type Extrapyramidal Sign Restricted Criterion Motor Manifestation Hachinski Ischemic Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Eisendorfer C, Cohen D: Diagnostic criteria for primary neuronal degeneration of the Alzheimer type. J Fam Pract 1980; 2: 553–7.Google Scholar
  2. 2.
    Hughes CP, Berg L, Danziger WL, Coben LA, Martin RD: A new clinical scale for the staging of dementia. Brit J Psychiat 1982; 140: 566–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Berg L, Hughes CP, Coben LA, Danziger WL, Martin RL, Knesevich J: Mild senile dementia of the Alzheimer type: Research diagnostic criteria,recruitment and description of a study population. J Neurol Neurosurg Psychiat 1982; 45: 962–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Todorov AB, Go RCP, Constantinidis J, Elston RC: Specificity of the clinical diagnosis of dementia. J Neurol Sci 1975; 26: 81–98.PubMedCrossRefGoogle Scholar
  5. 5.
    Ron MA, Toone BK, Graralda ME, Lishroan WA: Diagnostic Accuracy in presenile dementia. Brit J Psychiat 1979: 161–8.Google Scholar
  6. 6.
    Sulka R, Matti H, Paetan A, Wikstom J, Palo J: Accuracy of clinical diagnosis in primary degenerative donentia: Correlation with neuropathological findings. J Neurol Neurosurg Psychiat 1983; 46: 9–13.CrossRefGoogle Scholar
  7. 7.
    Crystal HA, Horoupian DS, Katzman R, Jotkowitz S: Biopsy-proven Alzheimer disease presenting as a right parietal lobe syndrome. Ann Neurol 1982; 12: 186–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Bird TD, stranahan S, Sumi M, Raskind M: Alzheimer’s disease and choline acetyltransferase activity in brain tissue from clinical and pathological subgroups. Ann Neurol 1983; 14: 284–93.PubMedCrossRefGoogle Scholar
  9. 9.
    Jacob H: Muscular twitching in Alzheimer’s disease. In: Wolstenholme GEW, O’Conner M, eds. Alzheimer’s disease and related ccnditions. London: Churchill. 1970: 75–93.Google Scholar
  10. 10.
    Faden AL, Townsoid JJ: myoclonus in Alzheimer’s disease. Arch Neurol 1976; 33: 278–80.PubMedGoogle Scholar
  11. 11.
    Mayeux R, Hunter S, Fahn S: More on myoclonus in Alzheimer’s disease. Ann Neurol 1980; 8: 200.PubMedCrossRefGoogle Scholar
  12. 12.
    Pearce J: The extrapyramidal disorder of Alzheimer’s disease. Europ Neurol 1974; 12: 94–103.PubMedCrossRefGoogle Scholar
  13. 13.
    Molsa PK, Martilla R, Rinne UK: Extrapyramidal signs in Alzheimer’s disease. Neurology 1984; 34: 1114–6.PubMedGoogle Scholar
  14. 14.
    Leverenz J, Sumi SM: Prevalence of Parkinson’s disease in patients with Alzheimer’s disease. Neurology 1984; 34: 101.Google Scholar
  15. 15.
    American Psychiatric Associationr Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Washington, D.C. 1980, pp. 205–24.Google Scholar
  16. 16.
    Hachinski VC, Iliff ID, Zhilka E, duBoulay GHD, McAllister VC, Marshall J, Russell RWR, Syinon L: Cerebral blood flow in dementia. Arch Neurol 1975; 32: 632–7.PubMedGoogle Scholar
  17. 17.
    Lesser RP, Fahn S, Shider SR, Cote LJ, Isgreoi WP, Barrett RE: Analysis for the clinical problenns in parkinsonism and the complications of long-term levodopa therapy. Neurology 1979; 29: 1253–60.PubMedGoogle Scholar
  18. 18.
    Blessed G, Tomlinson BE, Roth M: ihe association between quantitative measures of dementia and of senile changes in the cerdDral grey matter of elderly subjects. Brit J Psychiat 1968; 225: 797–811.CrossRefGoogle Scholar
  19. 19.
    Folstein MF, Folstein SE, McHugh PR: “Mini-Mental State” a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.PubMedCrossRefGoogle Scholar
  20. 20.
    Mayeux R, Stem Y, Rosen J, Leventhal J: Depression, intellectual iirpairment and Parkinson’s disease. Neurolocrv 1981; 31: 645–50.Google Scholar
  21. 21.
    Overall JE, Groham DR: The Brief Psychiatric Rating Scale. Psychol Rep 1962; 10: 799 - 812.Google Scholar
  22. 22.
    Rosenblum WI, Ghatak NR: Lewy bodies in the presence of Alzheimer’s disease. Arch Neurol 1979: 36: 170–1.PubMedGoogle Scholar
  23. 23.
    Perl DP, Pendlebury WW, Bird ED: Detailed neuropathological evaluation of banked brain specimens submitted with a clinical diagnosis of Alzheimer’s disease. In: Wurtman RJ, Corkin SH, Growdon JH, eds. Alzheioner’s Disease: Advances in Basic Research and Therapies. Center for Brain Scioices and Metabolism Charitable Trust: Zurich, 1984: 463.Google Scholar
  24. 24.
    Alvord EC: The pathology of parkinsonism: etiologic, pathogenetic and pronostic implications. Trans Am Neurol Assoc 1965; 90: 167–8.PubMedGoogle Scholar
  25. 25.
    Alvord EC, Forno LS, Kusske JA, Kauffman RJ, Rhodes JS, Goetowski CR: The pathology of parkinsaiism: A coirparison of degeneration in the cerebral; cortex and brain stem. Adv Neurol 1975; 5: 175–93.Google Scholar
  26. 26.
    Hakim AM, Mathieson G: Dementia in Parkinson disease: A neuropathologic study. Neurology 1979; 29: 1209–14.PubMedGoogle Scholar
  27. 27.
    Boiler F, Mizutani T, Roessmann V, Gambetti P: Parkinson disease, dementia, and Alzheimer disease: Clinicopathological correlations. Ann Neurol 1980; 1: 329–35.CrossRefGoogle Scholar
  28. 28.
    Whitdiouse P, Hedreai JC White C, DeLong M, Price DL: Basal forebrain neurons in the dementia of Parkinson’s disease. Ann Neurol 1983; 13: 243–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Ruberg M, Ploska A, Javoy-Agid F, Agid Y: Muscarinic binding and choline acetyltransferase activity in parkinsonian subjects with reference to denaitia. Brain Res 1982; 232: 129–33.PubMedCrossRefGoogle Scholar
  30. 30.
    Perry RH, Tomlinsai BE, Candy JM, Blessed G, Foster JF, Blaxham CA, Perry E: Cortical cholinergic deficit in mentally impaired parkinsonian patients. Lancet 1983; 309: 789–90.CrossRefGoogle Scholar
  31. 31.
    Mayeux R, Stern Y, Rosen J, Benson DF: Is subcortical dementia a recognizable clinical entity? Ann Neurol 1983; 14: 278–83.PubMedCrossRefGoogle Scholar
  32. 32.
    Krai VA: Benign Senescent forgetfulness. In: Katzman R, Terry RD, Bick KL, eds. Alzheimer’s disease: Senile dementia and related disorders. New York: Raven Press, 1978: 47–51.Google Scholar
  33. 33.
    Tagliavini F, Pilleri G: Neuronal counts in basal nucleus of Meynert in Alzheimer disease and in simple senile dementia. Lancet 1983; 1: 469–70.PubMedCrossRefGoogle Scholar
  34. 34.
    Berg L, Danziger WL, Storandt M, Coben LA, Gado M, Hughes CP, Knesevich JW, Botwinick J: Predictive features in mild soiile dementia of the Alzheimer type. Neurology 1984; 34: 563–9.PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • Richard Mayeux
    • 1
  • Yaakov Stern
    • 1
  1. 1.College of Physicians and Surgeons Neurological InstituteColumbia UniversityNew YorkUSA

Personalised recommendations