Dementias pp 223-231 | Cite as

Non-Cognitive Symptoms and Alterations in Demented Patients

  • W. C. McCormick


Promising new medical therapies for Alzheimer’s disease are being tested [1] that may be useful in preventing or delaying the cognitive impairment characteristic of Alzheimer’s disease. So far these agents have been used in persons already at a fairly advanced stage of illness. To effectively prevent symptoms from progressing to advanced stages, therapies will probably need to be applied as early as possible, when symptoms are barely detectable [2]. Yet, Alzheimer’s disease can be difficult to diagnose with certainty ante mortem, especially early in the course of the illness [3], and it is sometimes not recognized in elderly individuals even when advanced [4]. The disease usually manifests initially with very subtle symptoms that increase insidiously over several years [5]. Diagnostic tests (chemical markers [6] or brain imaging [7]) may some day allow definitive diagnosis, perhaps even prior to the onset of symptoms. Currently, however, codified clinical diagnostic criteria such as those developed by the NINCDS-ADRDA [8] or those in the DSM-IIIR [9] are the research standards for diagnosing Alzheimer’s disease ante mortem. These criteria are based on typical symptoms of the illness and have good reliability [10] and validity [11] when judged against post mortem pathological diagnoses.


Demented Patient Memory Complaint Elderly Outpatient Dementing Illness Demented Group 
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  1. 1.
    Davis KL, Thal LJ, Gamzu ER, et al (1992) A double-blind, placebo-controlled multicenter study of tacrine for Alzheimer’s disease. Tacrine Collaborative Study Group. N Engl J Med 327: 1253–1259PubMedCrossRefGoogle Scholar
  2. 2.
    Rubin EH, Morris JC, Grant EA, Vendegna T (1989) Very mild senile dementia of the Alzheimers type. Arch Neurol 46: 379–382PubMedCrossRefGoogle Scholar
  3. 3.
    Morris JC, Fulling K (1988) Early Alzheimer’s disease: diagnostic considerations. Arch Neurol 45: 345–349PubMedCrossRefGoogle Scholar
  4. 4.
    Roca RP, Klein LE, Kirby SM, et al (1984) Recognition of dementia among medical inpatients. Arch Int Med 144: 73–75CrossRefGoogle Scholar
  5. 5.
    Teri L, Hughes JP, Larson EB (1990) Cognitive deterioration in Alzheimer’s disease: behavioral and health factors. J Gerontol 45: P58–P63PubMedCrossRefGoogle Scholar
  6. 6.
    Farlow M, Ghetti B, Benson MD, Farrow JS, van Nostrand WE, Wagner SL (1992) Low cerebrospinal fluid concentrations of soluble amyloid beta-protein precursor in hereditary Alzheimer’s disease. Lancet 340: 453–454PubMedCrossRefGoogle Scholar
  7. 7.
    DeCarli C, Kaye J, Horwitz B, Rapoport S (1990) Critical analysis of the use of computer-assisted transverse, axial tomography to study human brain in aging and dementia of the Alzheimer’s type. Neurology 409: 872–883CrossRefGoogle Scholar
  8. 8.
    McKhann G, Drachman D, Folstein M, et al (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group. Neurology 34: 939–944PubMedCrossRefGoogle Scholar
  9. 9.
    American Psychiatric Association (APA) (1980) Diagnostic and statistical manual of mental disorders, 3rd edn, revised. APA, Washington DCGoogle Scholar
  10. 10.
    Kukull WA, Larson EB, Reifler BV, Lampe TH, Yerby M, Hughes JP (1990) Inter-rater reliability of Alzheimer’s disease diagnosis. Neurology 40: 257–260PubMedCrossRefGoogle Scholar
  11. 11.
    Kukull WA, Larson EB, Reifler BV, Lampe TH, Yerby M, Hughes JP (1990) The validity of 3 clinical diagnostic criteria for Alzheimer’s disease. Neurology 40: 1364–1369PubMedCrossRefGoogle Scholar
  12. 12.
    Hughes JP, van Belle G, Kukull WA, Larson EB, Teri L (1989) On the uses of registries for Alzheimer’s disease. Alzheimer Dis Assoc Disord 3: 205–217PubMedGoogle Scholar
  13. 13.
    Larson EB, Kukull WA, Teri L, McCormick WC, Pfanschmidt M, van Belle G, Sumi M (1990) University of Washington Alzheimer’s Disease Patient Registry (ADPR): 1987-1988. Aging 2: 404–408PubMedGoogle Scholar
  14. 14.
    McCormick WC, Kukull WA, van Belle G, Bowen JD, Teri L, Larson EB (1994) Symptom patterns and comorbidity in the early stages of Alzhiemer’s disease. J Am Geriatr Society 42: 517–521Google Scholar
  15. 15.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40: 373–383PubMedCrossRefGoogle Scholar
  16. 16.
    O’Brien PC, Shampo MA (1988) Statistical considerations for performing multiple tests in a single experiment. Mayo Clin Proc 63: 813–820PubMedGoogle Scholar
  17. 17.
    Folstein MF, Folstein SE, McHugh PR (1975) Mini-Mental State — a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198PubMedCrossRefGoogle Scholar
  18. 18.
    Larson EB, Reifler BV, Featherstone HJ, English DR (1984) Dementia in elderly outpatients: a prospective study. Ann Int Med 100: 417–423PubMedGoogle Scholar
  19. 19.
    Larson EB, Reifler BV, Sumi M, Canfield CG, Chinn NM (1986) Diagnostic tests in the evaluation of dementia: a prospective study of 200 elderly outpatients. Arch Int Med 146: 1917–1922CrossRefGoogle Scholar
  20. 20.
    Teri L, Wagner AW (1991) Assessment of depression in patients with Alzheimer’s disease: concordance among informants. Psychol Aging 6: 280–285PubMedCrossRefGoogle Scholar
  21. 21.
    Wolf-Klein GP, Silverstone FA, Brod MS, Levy A, Foley CJ, Termotto V, Breuer J (1988) Are Alzheimer patients healthier? J Am Geriatr Soc 36: 219–224PubMedGoogle Scholar
  22. 22.
    Rosenfeld SA (1989) Are Alzheimer patients healthier than others. J Am Geriatr Soc 37: 486 (letter)Google Scholar
  23. 23.
    Pawlson LG (1989) Are Alzheimer patients healthier than others. J Am Geriatr Soc 37: 486 (letter)Google Scholar
  24. 24.
    Piccinin AM (1991) Uncertain diagnosis or uncertain entity? J Am Geriatr Soc 39: 1141–1142 (letter)PubMedGoogle Scholar
  25. 25.
    Detsky AS, Sackett DL (1985) When was a negative clinical trial big enough? Arch Intern Med 145: 709–712PubMedCrossRefGoogle Scholar
  26. 26.
    Welch HG, Walsh JR, Larson EB (1992) The cost of institutional care in Alzheimer’s disease: nursing home and hospital use in a prospective cohort. J Am Geriatr Soc 40: 221–224PubMedGoogle Scholar

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© Springer-Verlag Italia 1999

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  • W. C. McCormick

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