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Alzheimer's disease and brain infarcts in the elderly. Agreement with neuropathology

Duyckaerts, Charles
Belmin, Joël
Geoffre, Caroline
Moulias, Robert
Hauw, Jean-Jacques
Published in Journal of Neurology. 2002, vol. 249, no. 11, p. 1529-34
Abstract Clarifying the etiology of dementia is one of the most difficult diagnostic challenges, especially in the elderly. We examined the accuracy of clinical criteria to distinguish Alzheimer's disease (AD) and dementia associated with infarcts of the brain, either isolated (vascular dementia) or associated with degenerative lesions (mixed dementia). We carried out a prospective clinico-neuropathological study in a selected series of hospitalized patients. We evaluated the clinical aspects of 33 patients aged over 75 years by use of the criteria and scores of DSMIII, NINCDS-ADRDA, Loeb and Gandolfo, ADDTC and NINDS-AIREN and the Hachinski Ischemic Score. The neuropathological diagnosis was considered to be the gold standard. When comparing clinical criteria and neuropathology, the agreement was moderate for Hachinski's score (0.50) and Loeb's score (0.43) and substantial for the ADDTC (0.63) and the NINDS-AIREN (0.67). When mixed dementias were excluded, the agreement between all clinical criteria and scores and the pathological diagnosis rose to 0.88. Hachinski's score was the most sensitive (0.89) and the NINDS-AIREN the most specific (0.86) for the diagnosis of vascular dementia. In conclusion, all sets of clinical criteria distinguished pure AD from vascular dementia with a high accuracy whereas mixed dementia was clinically under-recognized. The NINDS-AIREN criteria were the most discriminating for the accurate identification of patients with mixed dementia.
Keywords AgedAged, 80 and overAging/pathologyAlzheimer Disease/diagnosis/pathology/physiopathologyBrain/blood supply/pathologyBrain Infarction/diagnosis/pathology/physiopathologyDementia, Vascular/diagnosis/pathology/physiopathologyDiagnosis, DifferentialFemaleHumansMalePredictive Value of TestsProspective StudiesReproducibility of Results
PMID: 12420093
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Article (Published version) (182 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Research group Démence du sujet âgé, troubles cognitifs, la symptomatologie cognitive (577)
Project PHRC et France Alzheimer
(ISO format)
ZEKRY BERGER, Dina Selma et al. Alzheimer's disease and brain infarcts in the elderly. Agreement with neuropathology. In: Journal of Neurology, 2002, vol. 249, n° 11, p. 1529-34. doi: 10.1007/s00415-002-0883-1

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Deposited on : 2014-02-03

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