New developments in the diagnosis of dementia.
BACKGROUND
The terms "dementia" and "Alzheimer's disease" are often wrongly used as if they were synonyms. Dementia is a clinical syndrome whose main element is memory impairment; it is due to Alzheimer's disease in more than 75% of cases. Alzheimer's disease, on the other hand, is a neuropathological entity that is characterized by a protracted preclinical phase followed by the onset of slowly progressive dementia.


METHODS
We here review relevant literature that we retrieved by a selective Medline search (2005-2009), paying special attention to the early diagnosis of Alzheimer's disease, its clinical manifestations, and its relevance in primary care.


RESULTS
The early clinical manifestations of a dementing illness can be detected in primary care through the use of simple screening tests such as the mini mental state examination, clock drawing tests, and DemTect. A diminished concentration of Abeta-peptide and an increase of (phospho-)tau in the cerebrospinal fluid can suggest the presence of Alzheimer's disease even before the onset of dementia: these substances are components of amyloid plaques and neurofibrillary tangles, which are the characteristic neuropathological lesions of Alzheimer's disease. New types of morphological magnetic resonsance imaging (MRI), and automated analysis of the images obtained, can improve the consistency of radiological assessment over the traditional visual method and thus enable more secure diagnosis.


CONCLUSIONS
The early, preclinical phase of Alzheimer's disease involves what has been termed mild cognitive impairment and may last as long as five years until the onset of dementia. With the aid of the new biomarkers described here, the likelihood of diagnosing Alzheimer's disease correctly in this phase can be raised above 80%. Early detection of Alzheimer's disease before the onset of dementia provides an opportunity to study potential approaches for secondary prevention, which are now an object of intense clinical research.
Universitätsklinik für Psychiatrie und Psychotherapie Tübingen, Geriatrisches Zentrum am Universitätsklinikum Tübingen, Germany. gerhard.eschweiler@med.uni-tuebingen.de
Gerhard W
GW
Eschweiler
Thomas
T
Leyhe
Stefan
S
Klöppel
Michael
M
Hüll
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology; D000647:Amnesia / Q000175:diagnosis / Q000453:epidemiology; D016229:Amyloid beta-Peptides / Q000134:cerebrospinal fluid; D001921:Brain / Q000473:pathology; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D018450:Disease Progression; D042241:Early Diagnosis; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging; D008403:Mass Screening; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D017410:Practice Guidelines as Topic; D016875:tau Proteins / Q000134:cerebrospinal fluid
D016229:Amyloid beta-Peptides; C054369:MAPT protein, human; D016875:tau Proteins