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Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.
Literature Information
| DOI | 10.1212/wnl.34.7.939 |
|---|---|
| PMID | 6610841 |
| Journal | Neurology |
| Impact Factor | 8.5 |
| JCR Quartile | Q1 |
| Publication Year | 1984 |
| Times Cited | 8257 |
| Keywords | Alzheimer's Disease, Clinical Diagnosis, Neuropsychological Tests |
| Literature Type | Guideline, Journal Article, Practice Guideline |
| ISSN | 0028-3878 |
| Pages | 939-44 |
| Issue | 34(7) |
| Authors | G McKhann, D Drachman, M Folstein, R Katzman, D Price, E M Stadlan |
TL;DR
The research outlines the clinical criteria for diagnosing Alzheimer's disease, emphasizing the importance of recognizing insidious onset and cognitive decline without early motor or sensory deficits, as laboratory tests cannot confirm the diagnosis but help rule out other causes of dementia. The proposed diagnostic criteria aim to guide clinicians in identifying different stages of Alzheimer's disease, with the intention of refining these guidelines as new information emerges.
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Alzheimer's Disease · Clinical Diagnosis · Neuropsychological Tests
Abstract
Clinical criteria for the diagnosis of Alzheimer's disease include insidious onset and progressive impairment of memory and other cognitive functions. There are no motor, sensory, or coordination deficits early in the disease. The diagnosis cannot be determined by laboratory tests. These tests are important primarily in identifying other possible causes of dementia that must be excluded before the diagnosis of Alzheimer's disease may be made with confidence. Neuropsychological tests provide confirmatory evidence of the diagnosis of dementia and help to assess the course and response to therapy. The criteria proposed are intended to serve as a guide for the diagnosis of probable, possible, and definite Alzheimer's disease; these criteria will be revised as more definitive information become available.
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Primary Questions Addressed
- What are the latest advancements in neuropsychological testing for Alzheimer's disease diagnosis?
- How do the proposed diagnostic criteria for Alzheimer's disease differ from those for other types of dementia?
- What role do biomarkers play in the early detection of Alzheimer's disease compared to traditional clinical criteria?
- How can caregivers and healthcare professionals differentiate between normal aging and the early signs of Alzheimer's disease?
- What are the implications of the NINCDS-ADRDA criteria for clinical practice and future research in Alzheimer's disease?
Key Findings
1. Research Background and Objectives: The growing prevalence of Alzheimer's disease (AD) has necessitated the development of clear clinical criteria for its diagnosis. Alzheimer's is characterized by cognitive decline, particularly memory impairment, that progresses slowly over time. The primary aim of the NINCDS-ADRDA Work Group, under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease, was to establish standardized diagnostic criteria that clinicians can use to effectively identify and categorize Alzheimer's disease into probable, possible, and definite cases. This work is critical for improving diagnostic accuracy and facilitating appropriate patient management.
2. Main Methods and Findings: The work group reviewed existing literature and expert opinions to formulate clinical criteria focusing on the insidious onset of cognitive impairments. They emphasized that early stages of Alzheimer's do not present with motor, sensory, or coordination deficits, which sets it apart from other types of dementia. Importantly, the diagnosis of Alzheimer's cannot be established through laboratory tests; instead, these tests are utilized to exclude other dementia-causing conditions. Neuropsychological assessments were highlighted as vital tools that provide corroborative evidence for a dementia diagnosis and can help track the disease's progression and response to treatment. The proposed criteria serve as a structured guideline for clinicians to accurately diagnose varying levels of Alzheimer's disease.
3. Core Conclusions: The work group concluded that the establishment of clear clinical criteria enhances the reliability of Alzheimer's disease diagnoses, allowing for differentiation between probable, possible, and definite cases. These criteria are essential for ensuring that individuals receive appropriate interventions and support at various disease stages. The acknowledgment that laboratory tests cannot confirm Alzheimer's but are useful for exclusionary purposes is a significant advancement in understanding the diagnostic process. The work group also indicated that these criteria would be subject to revision as new research findings emerge, ensuring that diagnostic practices remain current and evidence-based.
4. Research Significance and Impact: This research represents a pivotal moment in Alzheimer's disease diagnostics, as it provides a systematic approach for clinicians that could lead to earlier and more accurate diagnoses. By clarifying the clinical manifestations of Alzheimer's and the role of neuropsychological testing, this work supports improved patient care and management strategies. The ongoing revision of these criteria in light of new findings underscores the dynamic nature of medical research and the importance of adapting clinical practices to enhance patient outcomes. Ultimately, this work will aid in better understanding and addressing the challenges associated with Alzheimer's disease, potentially impacting policy, funding, and research directions aimed at combating this devastating condition.
Literatures Citing This Work
- Increased CSF HVA response to arecoline challenge in Alzheimer's disease. - N Pomara;M Stanley;P A LeWitt;M Galloway;R Singh;D Deptula - Journal of neural transmission. General section (1992)
- Brain stem serotonin-synthesizing neurons in Alzheimer's disease: a clinicopathological correlation. - G M Halliday;H L McCann;R Pamphlett;W S Brooks;H Creasey;E McCusker;R G Cotton;G A Broe;C G Harper - Acta neuropathologica (1992)
- Mapping of neurofibrillary degeneration in Alzheimer's disease: evaluation of heterogeneity using the quantification of abnormal tau proteins. - P Vermersch;B Frigard;A Delacourte - Acta neuropathologica (1992)
- Memory deficits in Alzheimer's patients: a comprehensive review. - G A Carlesimo;M Oscar-Berman - Neuropsychology review (1992)
- Lack of ubiquitin immunoreactivities at both ends of neuropil threads. Possible bidirectional growth of neuropil threads. - T Iwatsubo;M Hasegawa;Y Esaki;Y Ihara - The American journal of pathology (1992)
- Evidence for a membrane defect in Alzheimer disease brain. - R M Nitsch;J K Blusztajn;A G Pittas;B E Slack;J H Growdon;R J Wurtman - Proceedings of the National Academy of Sciences of the United States of America (1992)
- Serotonergic pathology is not widespread in Alzheimer patients without prominent aggressive symptoms. - A W Procter;P T Francis;G C Stratmann;D M Bowen - Neurochemical research (1992)
- Detection of glutamine synthetase in the cerebrospinal fluid of Alzheimer diseased patients: a potential diagnostic biochemical marker. - D Gunnersen;B Haley - Proceedings of the National Academy of Sciences of the United States of America (1992)
- An improved thioflavine S method for staining neurofibrillary tangles and senile plaques in Alzheimer's disease. - R Guntern;C Bouras;P R Hof;P G Vallet - Experientia (1992)
- A comparative study of histological and immunohistochemical methods for neurofibrillary tangles and senile plaques in Alzheimer's disease. - P G Vallet;R Guntern;P R Hof;J Golaz;A Delacourte;N K Robakis;C Bouras - Acta neuropathologica (1992)
... (8247 more literatures)
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