Differentiating Alzheimer's disease from other diseases: Difference between revisions

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__NOTOC__
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{{Alzheimer's disease}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Alzheimer%27s_disease]]
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{HK}}


==Overview==
==Overview==
Alzheimer's disease must be differentiated from other causes of dementia which may share common characteristics of [[cognitive impairment]]. The differentials include, [[vascular dementia]], [[Lewy body dementia]] and [[frontotemporal dementia]].


==Differentiating Alzheimer's Disease from other Diseases==
Alzheimer's disease may be differentiated from other causes of dementia which may share common characteristics of [[cognitive impairment]]. The following table outlines the common differentials:<ref name="pmid18525132">{{cite journal |vauthors=Jellinger KA |title=The pathology of "vascular dementia": a critical update |journal=J. Alzheimers Dis. |volume=14 |issue=1 |pages=107–23 |year=2008 |pmid=18525132 |doi= |url=}}</ref><ref name="pmid19198143">{{cite journal |vauthors=Murayama S |title=[Neuropathology of frontotemporal dementia] |language=Japanese |journal=Rinsho Shinkeigaku |volume=48 |issue=11 |pages=998 |year=2008 |pmid=19198143 |doi= |url=}}</ref><ref name="pmid9375155">{{cite journal |vauthors=Hodges JR, Patterson K |title=Nonfluent progressive aphasia and semantic dementia: a comparative neuropsychological study |journal=J Int Neuropsychol Soc |volume=2 |issue=6 |pages=511–24 |year=1996 |pmid=9375155 |doi= |url=}}</ref><ref name="pmid1486461">{{cite journal |vauthors=Hodges JR, Patterson K, Oxbury S, Funnell E |title=Semantic dementia. Progressive fluent aphasia with temporal lobe atrophy |journal=Brain |volume=115 ( Pt 6) |issue= |pages=1783–806 |year=1992 |pmid=1486461 |doi= |url=}}</ref><ref name="urlDementia, Globalization and Contemporary Art">{{cite web |url=https://kohlibri.e-bookshelf.de/products/reading-epub/product-id/4033550/title/Dementia.html |title=Dementia, Globalization and Contemporary Art |format= |work= |accessdate=}}</ref><ref name="pmid3178177">{{cite journal |vauthors=Helkala EL, Laulumaa V, Soininen H, Riekkinen PJ |title=Recall and recognition memory in patients with Alzheimer's and Parkinson's diseases |journal=Ann. Neurol. |volume=24 |issue=2 |pages=214–7 |year=1988 |pmid=3178177 |doi=10.1002/ana.410240207 |url=}}</ref><ref name="pmid22474609">{{cite journal |vauthors=Weintraub S, Wicklund AH, Salmon DP |title=The neuropsychological profile of Alzheimer disease |journal=Cold Spring Harb Perspect Med |volume=2 |issue=4 |pages=a006171 |year=2012 |pmid=22474609 |pmc=3312395 |doi=10.1101/cshperspect.a006171 |url=}}</ref><ref name="pmid24757110">{{cite journal |vauthors=Goldman JG, Williams-Gray C, Barker RA, Duda JE, Galvin JE |title=The spectrum of cognitive impairment in Lewy body diseases |journal=Mov. Disord. |volume=29 |issue=5 |pages=608–21 |year=2014 |pmid=24757110 |pmc=4126402 |doi=10.1002/mds.25866 |url=}}</ref><ref name="pmid17715794">{{cite journal |vauthors=Metzler-Baddeley C |title=A review of cognitive impairments in dementia with Lewy bodies relative to Alzheimer's disease and Parkinson's disease with dementia |journal=Cortex |volume=43 |issue=5 |pages=583–600 |year=2007 |pmid=17715794 |doi= |url=}}</ref><ref name="pmid18855701">{{cite journal |vauthors=Uversky VN |title=Alpha-synuclein misfolding and neurodegenerative diseases |journal=Curr. Protein Pept. Sci. |volume=9 |issue=5 |pages=507–40 |year=2008 |pmid=18855701 |doi= |url=}}</ref><ref name="pmid15023815">{{cite journal |vauthors=Bennett DA, Schneider JA, Wilson RS, Bienias JL, Arnold SE |title=Neurofibrillary tangles mediate the association of amyloid load with clinical Alzheimer disease and level of cognitive function |journal=Arch. Neurol. |volume=61 |issue=3 |pages=378–84 |year=2004 |pmid=15023815 |doi=10.1001/archneur.61.3.378 |url=}}</ref><ref name="pmid9748670">{{cite journal |vauthors=Brion JP |title=Neurofibrillary tangles and Alzheimer's disease |journal=Eur. Neurol. |volume=40 |issue=3 |pages=130–40 |year=1998 |pmid=9748670 |doi= |url=}}</ref><ref name="pmid28748674">{{cite journal |vauthors=Lee JS, Jung NY, Jang YK, Kim HJ, Seo SW, Lee J, Kim YJ, Lee JH, Kim BC, Park KW, Yoon SJ, Jeong JH, Kim SY, Kim SH, Kim EJ, Park KC, Knopman DS, Na DL |title=Prognosis of Patients with Behavioral Variant Frontotemporal Dementia Who have Focal Versus Diffuse Frontal Atrophy |journal=J Clin Neurol |volume=13 |issue=3 |pages=234–242 |year=2017 |pmid=28748674 |pmc=5532319 |doi=10.3988/jcn.2017.13.3.234 |url=}}</ref><ref name="pmid21346515">{{cite journal |vauthors=Pao WC, Dickson DW, Crook JE, Finch NA, Rademakers R, Graff-Radford NR |title=Hippocampal sclerosis in the elderly: genetic and pathologic findings, some mimicking Alzheimer disease clinically |journal=Alzheimer Dis Assoc Disord |volume=25 |issue=4 |pages=364–8 |year=2011 |pmid=21346515 |pmc=3107353 |doi=10.1097/WAD.0b013e31820f8f50 |url=}}</ref><ref name="pmid11603162">{{cite journal |vauthors=Tsolaki M, Kokarida K, Iakovidou V, Stilopoulos E, Meimaris J, Kazis A |title=Extrapyramidal symptoms and signs in Alzheimer's disease: prevalence and correlation with the first symptom |journal=Am J Alzheimers Dis Other Demen |volume=16 |issue=5 |pages=268–78 |year=2001 |pmid=11603162 |doi=10.1177/153331750101600512 |url=}}</ref><ref name="pmid19810010">{{cite journal |vauthors=McGuinness B, Barrett SL, Craig D, Lawson J, Passmore AP |title=Executive functioning in Alzheimer's disease and vascular dementia |journal=Int J Geriatr Psychiatry |volume=25 |issue=6 |pages=562–8 |year=2010 |pmid=19810010 |doi=10.1002/gps.2375 |url=}}</ref>


==Differentiating Alzheimer's disease from other Diseases==
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"


{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Cause of dementia}}
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Cause of dementia}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Characteristics and clinical and cognitive features}}
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF; width: 400px;" + | Clinical features
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated features
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Nature of progression
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathological findings
|-
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" + |Cognitive impairment
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Recall
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Recollection
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cue requirement for recall
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Infirngement of thoughts
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Semantic memory
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Procedural memory
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Working memory
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Awareness
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Attention
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Executive functioning issues
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Visuo-spatial skills
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Alzheimer's disease]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Alzheimer's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |Brain disease that encompasses predementia and dementia phases. Memory changes and AD biomarker evidence required for diagnosis of probable AD. Slow cognitive and functional decline with early loss of awareness. Amnestic and nonamnestic phenotypes
| style="padding: 5px 5px; background: #F5F5F5;" | +++
 
(Slow [[cognitive]] and functional decline with early loss of awareness)
|<nowiki>+++</nowiki>
|Not helpful
|<nowiki>+++</nowiki>
|<nowiki>++</nowiki>
|<nowiki>-</nowiki>
|<nowiki>++</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>++</nowiki>
|<nowiki>++</nowiki>
|<nowiki>++</nowiki>
|
* [[Focal neurologic signs|Focal neurological signs]] absent during early stage (may develop later)
* Mild [[extrapyramidal]] signs
|Has the following clinical stages:
* Pre-clinical
* [[Mild cognitive impairment]]
* Advanced [[dementia]] (full blown dementia)
|
* [[Neurofibrillary tangle|Neurofibrillary tangles]]
* [[Senile plaques|Senile (neuritic) plaques]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lewy body dementia]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lewy body dementia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Spectrum of disorders with movement, cognitive, autonomic changes. Includes dementia with Lewy bodies and Parkinson's disease dementia. Early visual hallucinations, muscle rigidity, sleep disturbance. α-synuclein deposits present in neurons
| style="padding: 5px 5px; background: #F5F5F5;" | ++ 
|<nowiki>-</nowiki>
|Helpful
|<nowiki>+++</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>+++</nowiki>
|
* Focal neurological signs present in majority
* Strongly associated with [[extrapyramidal]] signs
* [[Autonomic]] changes
|
* Early [[visual hallucinations]]
* [[Muscle rigidity]]
* [[Sleep disturbance]]
|
* [[Alpha-synuclein|α-synuclein]] deposits present in [[Neuron|neurons]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Frontotemporal lobar degeneration]]
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Frontotemporal lobar degeneration]]
| style="padding: 5px 5px; background: #F5F5F5;" |Focal atrophy of frontal and temporal lobes; knife-edge atrophy noted on MRI. Younger onset, changes in personality and behavior, language impairment, strong familial component.
| style="padding: 5px 5px; background: #F5F5F5;" | +/-
|-
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Vascular dementia]]
|Helpful
| style="padding: 5px 5px; background: #F5F5F5;" |Stepwise progression and focal neurologic signs (also known as multi-infarct dementia or poststroke dementia). Dysexecutive syndrome, slowed processing speed, retrieval difficulties, depression, mild motor signs in subcortical vascular dementia. Symptoms overlap with alzheimer's disease.
|<nowiki>+++</nowiki>
|}
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>++</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>-</nowiki>
|
* [[Focal neurologic signs|Focal neurological signs]] present ([[motor neuron disease]])
* [[Extrapyramidal|Extrapyramidal signs]]  present (familial [[Frontotemporal lobar degenerations|frontotemporal lobar degeneration]])


* Onset in young age


*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
* Strong [[familial]] association
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
* Focal [[atrophy]] of [[Frontal lobe|frontal]] and [[temporal lobes]]
* Knife-edge [[atrophy]] noted on [[Magnetic resonance imaging|MRI]]
* [[Personality changes|Personality]] and behavioral changes
* Language impairment
|
* Two major variants:
** Progressive nonfluent [[aphasia]]
** [[Semantic Dementia|Semantic]] variant
* [[Progressive supranuclear palsy]]
|
* [[Pick bodies]]
* [[Corticobasal degeneration]]
* [[Ubiquitination|Ubiquitinated]] inclusions
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Vascular dementia]]
| style="padding: 5px 5px; background: #F5F5F5;" | + (Dysexecutive syndrome)
|<nowiki>-</nowiki>
|Helpful
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>++</nowiki>
|<nowiki>-</nowiki>
|<nowiki>++</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>+</nowiki>
|
* [[Focal neurologic signs|Focal neurological signs]] present typically
* Mild [[extrapyramidal]] signs


* [[Depression]]
* Mild [[Motor disorders|motor signs]] in subcortical [[vascular dementia]]
* Slowed processing speed
* Presentation might be similar to Alzheimer's disease
|
* Stepwise progression and focal neurologic signs (also known as [[multi-infarct dementia]] or poststroke [[dementia]])
|
* Multifocal and/or diffuse lesions (lacunes and microinfarcts)
* The following [[brain]] areas may be involved:
** [[Subcortical|Subcortical area]]
** [[Thalamus]]
** Frontobasal[[limbic system]]
** [[White matter]] lesions
** [[Hippocampal sclerosis]]
** Diffuse post-ischemic lesions
|}


==References==
==References==

Latest revision as of 18:51, 15 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Alzheimer's disease must be differentiated from other causes of dementia which may share common characteristics of cognitive impairment. The differentials include, vascular dementia, Lewy body dementia and frontotemporal dementia.

Differentiating Alzheimer's Disease from other Diseases

Alzheimer's disease may be differentiated from other causes of dementia which may share common characteristics of cognitive impairment. The following table outlines the common differentials:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]

Cause of dementia Clinical features Associated features Nature of progression Histopathological findings
Cognitive impairment
Recall Recollection Cue requirement for recall Infirngement of thoughts Semantic memory Procedural memory Working memory Awareness Attention Executive functioning issues Visuo-spatial skills
Alzheimer's disease +++

(Slow cognitive and functional decline with early loss of awareness)

+++ Not helpful +++ ++ - ++ +++ ++ ++ ++ Has the following clinical stages:
Lewy body dementia ++ - Helpful +++ + + +++ + +++ +++ +++
Frontotemporal lobar degeneration +/- - Helpful +++ + - +++ +++ ++ +++ -
  • Onset in young age
Vascular dementia + (Dysexecutive syndrome) - Helpful + + + ++ - ++ +++ +

References

  1. ↑ Jellinger KA (2008). "The pathology of "vascular dementia": a critical update". J. Alzheimers Dis. 14 (1): 107–23. PMID 18525132.
  2. ↑ Murayama S (2008). "[Neuropathology of frontotemporal dementia]". Rinsho Shinkeigaku (in Japanese). 48 (11): 998. PMID 19198143.
  3. ↑ Hodges JR, Patterson K (1996). "Nonfluent progressive aphasia and semantic dementia: a comparative neuropsychological study". J Int Neuropsychol Soc. 2 (6): 511–24. PMID 9375155.
  4. ↑ Hodges JR, Patterson K, Oxbury S, Funnell E (1992). "Semantic dementia. Progressive fluent aphasia with temporal lobe atrophy". Brain. 115 ( Pt 6): 1783–806. PMID 1486461.
  5. ↑ "Dementia, Globalization and Contemporary Art".
  6. ↑ Helkala EL, Laulumaa V, Soininen H, Riekkinen PJ (1988). "Recall and recognition memory in patients with Alzheimer's and Parkinson's diseases". Ann. Neurol. 24 (2): 214–7. doi:10.1002/ana.410240207. PMID 3178177.
  7. ↑ Weintraub S, Wicklund AH, Salmon DP (2012). "The neuropsychological profile of Alzheimer disease". Cold Spring Harb Perspect Med. 2 (4): a006171. doi:10.1101/cshperspect.a006171. PMC 3312395. PMID 22474609.
  8. ↑ Goldman JG, Williams-Gray C, Barker RA, Duda JE, Galvin JE (2014). "The spectrum of cognitive impairment in Lewy body diseases". Mov. Disord. 29 (5): 608–21. doi:10.1002/mds.25866. PMC 4126402. PMID 24757110.
  9. ↑ Metzler-Baddeley C (2007). "A review of cognitive impairments in dementia with Lewy bodies relative to Alzheimer's disease and Parkinson's disease with dementia". Cortex. 43 (5): 583–600. PMID 17715794.
  10. ↑ Uversky VN (2008). "Alpha-synuclein misfolding and neurodegenerative diseases". Curr. Protein Pept. Sci. 9 (5): 507–40. PMID 18855701.
  11. ↑ Bennett DA, Schneider JA, Wilson RS, Bienias JL, Arnold SE (2004). "Neurofibrillary tangles mediate the association of amyloid load with clinical Alzheimer disease and level of cognitive function". Arch. Neurol. 61 (3): 378–84. doi:10.1001/archneur.61.3.378. PMID 15023815.
  12. ↑ Brion JP (1998). "Neurofibrillary tangles and Alzheimer's disease". Eur. Neurol. 40 (3): 130–40. PMID 9748670.
  13. ↑ Lee JS, Jung NY, Jang YK, Kim HJ, Seo SW, Lee J, Kim YJ, Lee JH, Kim BC, Park KW, Yoon SJ, Jeong JH, Kim SY, Kim SH, Kim EJ, Park KC, Knopman DS, Na DL (2017). "Prognosis of Patients with Behavioral Variant Frontotemporal Dementia Who have Focal Versus Diffuse Frontal Atrophy". J Clin Neurol. 13 (3): 234–242. doi:10.3988/jcn.2017.13.3.234. PMC 5532319. PMID 28748674.
  14. ↑ Pao WC, Dickson DW, Crook JE, Finch NA, Rademakers R, Graff-Radford NR (2011). "Hippocampal sclerosis in the elderly: genetic and pathologic findings, some mimicking Alzheimer disease clinically". Alzheimer Dis Assoc Disord. 25 (4): 364–8. doi:10.1097/WAD.0b013e31820f8f50. PMC 3107353. PMID 21346515.
  15. ↑ Tsolaki M, Kokarida K, Iakovidou V, Stilopoulos E, Meimaris J, Kazis A (2001). "Extrapyramidal symptoms and signs in Alzheimer's disease: prevalence and correlation with the first symptom". Am J Alzheimers Dis Other Demen. 16 (5): 268–78. doi:10.1177/153331750101600512. PMID 11603162.
  16. ↑ McGuinness B, Barrett SL, Craig D, Lawson J, Passmore AP (2010). "Executive functioning in Alzheimer's disease and vascular dementia". Int J Geriatr Psychiatry. 25 (6): 562–8. doi:10.1002/gps.2375. PMID 19810010.

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