A review of the issues surrounding the diagnosis of Alzheimer's disease (AD) is presented in this paper. Discussed are complications in diagnosis resulting from inconsistent agreement about what's considered “normal” impairment in the elderly. Also discussed are diagnostic complications resulting from factors other than dementia that produce AD-like symptoms and deficits (depression, psychosocial issues). A definition of AD is presented, along with an explanation of the course of data and is a rived at through the exclusion of other possibilities. Clinical indicators of whether a patient possibly has AD, probably has it, or definitely has it, are also discussed.
Get full access to this article
View all access options for this article.
References
1.
1. CharcotJM: Lecons sur les maladies des viellards et les maladies chroniques. Paris, 1867
2.
2. Besdine R: Geriatric medicine: an overview. In Eisdorfer C (ed.): Annual Review of Gerontology and Geriatrics, vol 1. New York, Springer, 1980
3.
3. Heckler M: The fight against Alzheimer's Disease. Am Psychologist1985;40: 1240-1244
4.
4. Akhtar AJ, Broe GA, Crombie A, McLean WMR, Andrews GR, Caird FI: Disability and dependence in the elderly at home. Age and Aging1973;2: 102-110
5.
5. Khachaturian ZS: Progress of research on Alzheimer's Disease. Am Psychologist1985;40:1251-1261
6.
6. Alexander MP, Geschwind N: Dementia in the elderly. In Albert ML (ed): Clinical Neurology of Aging. New York, Oxford University Press, 1984
7.
7. Albert PC, Albert ML. History and scope of geriatric neurology. In Albert ML (ed): Clinical Neurology of Aging. New York, Oxford University Press, 1984
8.
8. Brody EM, Lawton MP, Liebowitz B: Senile dementia: public policy and adequate institutional care. Am J Public Health, 1984;74:1381-1383
9.
9. Obler LK, Albert ML: Language in aging. In Albert ML (ed): Clinical Neurology of Aging. New York, Oxford University Press, 1984
10.
10. Kay DWK: The epidemiology of brain deficit in the aged. In Eisdorfer C, Friedel RO (eds): The Cognitively and Emotionally Impaired Elderly. Chicago, Year Book Medical Publishers, 1977
11.
11. Katzman RD: The prevalence and malignancy of Alzheimer's Disease. Arch Neurology1976;33:217-218
12.
12. Campbell A, McCosh L, Reinkenj, Allen B. Dementia in old age and the need for services. Age and aging1983;12:11-16
13.
13. Jarvik L: Diagnosis of dementia in the elderly: a 1980 perspective. In Eisdorfer C (ed.) Annual Review of Gerontology and Geriatrics, vol 1. New York, Springer, 1980
14.
14. Cohen D., Eisdorfer C, Holm CL. Mental status examinations in the elderly. In Albert ML (ed) Clinical Neurology of Aging. New York, Oxford University Press, 1984
15.
15. Kurtzke JF, Kurland LT. The epidemiology of neurologic disease. In Baker AB, Baker LJ (eds): Clinical Neurology, vol. 3. Hagerstown, Md, Harper & Row, 1981
16.
16. United States Vital and Health Statistics Data, series 13, no 43 (National Nursing Home Survey: 1977 Summary for the United States), Hyattsville, Md, 1979
17.
17. Sabin TD, Vitug AJ, Mark VH: Are nursing home diagnosis and treatment adequate?JAMA1982;248:321-322
19. Marsden CD, Harrison MJG: Outcome of investigations of patients with presenile dementia. Br Med J1972;2:249-252
20.
20. Ron MA, Toone BK, Garralda ME, Lishman WA. Diagnostic accuracy in presenile dementia. Br J Psychiat1979;134:161-168
21.
21. Wells CD (ed): Dementia. Philadelphia, FA Davis, 1977
22.
22. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's Disease. Neurology1984; 34:939-944
23.
23. Miles WR: Measures of certain human abilities throughout the life span. Proc Na Acad Sci1931;17:627-633
24.
24. Corsellis JAN: Aging and the dementias. In Blackwood W, Corsellis JAN (eds) Greenfield's Neuropathology, 3rd ed.Chicago, Year Book Medical Publishers, 1976
25.
25. Selkoe D, Kosik K: Neurochemical changes with aging. In Albert ML (ed) Clinical Neurology of Aging. New York, Oxford University Press, 1984
26.
26. Critchley M: Neurologic changes in the aged. J Chronic Dis, 1956;3:459-477
27.
27. Brody H: Organization of the cerebral cortex. III. A study of aging in the human cerebral cortex. J Compar Neurol, 1955; 102:511-556
28.
28. Brody H: The effects of age upon the main nucleus of the inferior olive in the human. J Compar Neurol, 1975;206:854-856
29.
29. Kemper T: Neuroanatomical and neuropathological changes in normal aging and in dementia. In Albert ML (ed): Clinical Neurology of Aging. New York, Oxford University Press, 1984
30.
30. Yakovlev PI: Morphological criteria of growth and maturation of the nervous system in man. In Kolb LC, Maseland RL, Cooke RE (eds) Mental Retardation, vol 39. Baltimore, Williams & Wilkens Co, 1962
31.
31. Buell SJ, Coleman PD: Dendritic growth in the aged human brain and failure of growth in senile dementia. Science1979;206:854-856
32.
32. Eisdorfer C, Busse E, Cohen L. The WAIS performance of an aged sample: the relationship between verbal and performance IQ's. J Gerontol, 1959; 14: 197-201
33.
33. Horn JL: Psychometric studies of aging and intelligence. In Raskin GS (ed) Aging: Genesis and Treatment of Psychological Disorders in the Elderly
34.
34. Olber L: Narrative discourse styles in the elderly. In Obler LK, Albert ML (eds): Language and Communication in the Elderly. Lexington, Mass, DC Health, 1980
35.
35. Wechsler D: The Measurement and Appraisal of Adult Intelligence, 4th ed.Baltimore, Williams & Wilkins, 1958
36.
36. Bondareff W, Mountjoy CQ, Roth M: Loss of neurons of the andrenergic projection of cerebral cortex in senile dementia. Neurology1982;32: 164-168
37.
37. Drachman DA, DiGirolami U, Ellis JM: Familial thalamic dementia and amyotrophy. Neurology1982;32;168-168
38.
38. Whitehouse PJ, Price DL, Struble RG, Clark AW, Coyle JT, Delong MR: Alzheimer's Disease and senile dementia: loss of neurons in the basal forebrain. Science1982;215:1237-1239
39.
39. Meier-Ruge W, Reichlmeier K, Iwangoff P. Enzymatic and enzyme histochemical changes of the aging animal brain and consequences for experimental pharmacology on aging. In Terry RD, Gershon S (ed): Aging, vol 3. New York, Raven Press, 1976
40.
40. Geinisman Y, Vondareff W, Telser A. Transport of (3H) fucose labeled glycoproteins in the septo-hippocampal pathway of young adult and senescent rats. Brain Res, 1977;125:182-186
41.
41. Thompson LW: Cerebral blood flow, EEG, and behavior in aging. In Terry RD, Gershon S (eds): Aging, vol 3. New York, Raven Press, 1976
42.
42. Botwinick J: Behavioral processes. In Gershaw S, Raskin A (eds): Aging vol 2. New York, Raven Press, 1975
43.
43. Botwinick J. Behavioral processes in aging. In Gershaw S, Sherwin I (eds): Genesis and Treatment of Psychologic Disorders in the Elderly. New York, Raven Press, 1975
44.
44. Celesia GG, Daly RF. Effects of aging on visual evoked responses. Arch Neurol, 1977;34:403-407
45.
45. Carlsson A: Aging and brain neurotransmitters. In Crook T, Gershon S (eds): Strategies for the Development of an Effective Treatment for Senile Dementia. New Canaan, CT, M. Powley Association, 1981
46.
46. Drachman DA: Central cholinergic system and memory. In Lipton MA, Dismascio A, Killam KF (eds): Psychopharmacology: A Generation of Progress. New York, Raven Press, 1978
47.
47. Drachman DA, Glosser G: Pharmacologic strategies in aging and dementia: the cholinergic hypothesis. In Crook T, Gershon S (eds): Strategies for the Development of an Effective Treatment for Senile Dementia. New Canaan, CT, M Powley Association, 1981
48.
48. Hochanadel G, Kaplan E. Neuropsychology of normal aging. In Albert ML (ed): Clinical Neurology of Aging. New York, Oxford University Press, 1984
49.
49. Cattell RB: Theory of fluid and crystallized intelligence: a critical experiment.J Ed Psychol, 1963;54:1-22
50.
50. Gilbert JC, Levee DF. Age differences on the Bender Visual-Motor Gestalt Test and Archimedes Spiral Test. Gerontology1965;2:196-198
51.
51. Abrams M: Beyond Three Score and Ten: A First Report on a Survey of the Elderly. Surrey, Age Concern Publications, 1978
52.
52. Botwinick J, Storandt M: Vocabulary ability in later life. J Gen Psychol, 1974;125:303-308
53.
53. Howard D, McAndrews M, Lasaga M. Semantic priming of lexical decisions in young and old adults. J Gerontol, 1981;36:707-714
54.
54. Pezdek K: Life span differences in semantic integration of pictures and sentences in memory. Child Devel, 1980;51:720-729
55.
55. Ceci STabor L: Flexibility and memory: are the elderly really less flexible. Exp Aging Res, 1981;7:147-158
56.
56. Goodglass H: Naming disorders and aphasia and aging. In Obler LK and Albert ML (eds): Language and Communications in the Elderly. Lexington, Mass, DC Health, 1980
57.
57. Dovenmushe RH, Reekless JB, Newman G. Depression reactions in the elderly. In Normal Aging. Durham, NC, Duke University Press, 1970
58.
58. Sabin TD, Vitug AJ, Mark VH: Are nursing home diagnosis and treatment adequate?JAMA1982;248:321-322
59.
59. Weingarten H, Cohen PM, Murphy DL, Martello J, Gerdt C. Cognitive processes in dementia. Arch Gen Psychiat, 1981;38:42-47
60.
60. Williamson J, Chopin JM: Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age and Aging1980;9:73-80
61.
61. Lipowski ZJ: Acute confusional states (delirium) in the elderly. In Albert ML (ed): Clinical Neurology of Aging. New York, Oxford University Press, 1984
62.
62. Salzman C: Update on geriatric psychopharmacology. Geriatrics1979;34:87-90
63.
63. Stroka H, Elizan TS, Yahr MD: Organic mental syndrome and confusional states in Parkinson's Disease. Arch Neurol, 1981;38:339-342
64.
64. Bliss MR: Prescribing for the elderly. Br Med J, 1981;283:203-206
68. Albert MS, Kaplan E: Organic implications of neuropsychological deficits in the elderly. In Poon L, Fozard J, Germak L, Arenberg D, Thompson LJ (eds): New Directions in Memory and Aging. Hillsdale, NJ, Erlbaum, 1980
69.
69. Adams RD, Victor M: Principles of Neurology. New York, McGraw-Hill, 1977
70.
70. Freedman M, Knoefel J, Naeser M, Levine H. Computerized axial tomography in aging. In Albert ML (ed): Clinical Neurology of Aging. New York, Oxford University Press, 1984
71.
71. Katz RI, Harner RN. Electroencephalography in aging. In Albert ML (ed): Clinical Neurology of Aging. New York, Oxford University Press, 1984
