title: Detection of Alzheimer's disease and dementia in the preclinical phase: population based cohort study.
abstract: OBJECTIVE
  To evaluate a simple three step procedure to identify people in the general population who are in the preclinical phase of Alzheimer's disease and dementia.
  
  
  METHODS
  Three year population based cohort study.
  
  
  METHODS
  Kungsholmen cohort, Stockholm, Sweden.
  
  
  METHODS
  1435 people aged 75-95 years without dementia.
  
  
  METHODS
  Single question asking about memory complaints, assessment by mini-mental state examination, and neuropsychological testing.
  
  
  METHODS
  Alzheimer's disease and dementia at three year follow up.
  
  
  RESULTS
  None of the three instruments was sufficiently predictive of Alzheimer's disease and dementia when administered separately. After participants had been screened for memory complaints and global cognitive impairment, specific tests of word recall and verbal fluency had positive predictive values for dementia of 85-100% (95% confidence intervals range from 62% to 100%). However, only 18% of future dementia cases were identified in the preclinical phase by this three step procedure. Memory complaints were the most sensitive indicator of Alzheimer's disease and dementia in the whole population, but only half the future dementia cases reported memory problems three years before diagnosis.
  
  
  CONCLUSIONS
  This three step procedure, which simulates what might occur in clinical practice, has a high positive predictive value for dementia, although only a small number of future cases can be identified.
authors.affiliation: Aging Research Center, Division of Geriatric Epidemiology and Medicine, Neurotec, Karolinska Institute, and Stockholm Gerontology Research Center, Box 6401, 11382, Stockholm, Sweden. katie.palmer@neurotec.ki.se
authors.forename: Katie
authors.initials: K
authors.lastname: Palmer
authors.forename: Lars
authors.initials: L
authors.lastname: Bäckman
authors.forename: Bengt
authors.initials: B
authors.lastname: Winblad
authors.forename: Laura
authors.initials: L
authors.lastname: Fratiglioni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis; D003072:Cognition Disorders / Q000523:psychology; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000523:psychology; D008609:Mental Status Schedule / Q000592:standards; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity