Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment-Part 2.
This article focuses on the effects of operational differences in case ascertainment on estimates of prevalence and incidence of cognitive impairment and/or dementia of the Alzheimer type. Experience and insights are discussed by investigators from the Framingham Heart Study, the East Boston Senior Health Project, the Chicago Health and Aging Project, the Mayo Clinic Study of Aging, the Baltimore Longitudinal Study of Aging, and the Aging, Demographics, and Memory Study. There is a general consensus that the single most important factor determining prevalence estimates of Alzheimer's disease (AD) is the severity of cognitive impairment used as a threshold to define cases. Studies that require a level of cognitive impairment in which persons are unable to provide self-care will have much lower estimates than the studies aimed at identifying persons in the earliest stages of AD. There are limited autopsy data from the aforementioned epidemiological studies to address accuracy in the diagnosis of etiological subtype, namely the specification of AD alone or in combination with other types of pathology. However, other community-based cohort studies show that many persons with mild cognitive impairment and also some persons without dementia or mild cognitive impairment meet pathological criteria for AD, thereby suggesting that the number of persons who would benefit from an effective secondary prevention intervention is probably higher than the published prevalence estimates. Improved accuracy in the clinical diagnosis of AD is anticipated with the addition of molecular and structural biomarkers in the next generation of epidemiological studies.
Department of Neurology, Boston University School of Medicine, MA, USA. suseshad@bu.edu
Sudha
S
Seshadri
Alexa
A
Beiser
Rhoda
R
Au
Philip A
PA
Wolf
Denis A
DA
Evans
Robert S
RS
Wilson
Ronald C
RC
Petersen
David S
DS
Knopman
Walter A
WA
Rocca
Claudia H
CH
Kawas
Maria M
MM
Corrada
Brenda L
BL
Plassman
Kenneth M
KM
Langa
Helena C
HC
Chui
D000367:Age Factors; D000375:Aging; D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D018672:Community Health Planning / Q000379:methods / Q000592:standards*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies / Q000379:methods / Q000592:standards; D009483:Neuropsychological Tests; D015995:Prevalence; D014481:United States / Q000453:epidemiology
Lancet Neurol. 2009 Jul;8(7):619-27
19523877
Arch Neurol. 2000 May;57(5):713-9
10815138
Neurology. 2000 Jun 13;54(11):2072-7
10851365
Neurology. 2008 Jul 29;71(5):337-43
18596243
Neurology. 1993 Feb;43(2):250-60
8094895
Arch Neurol. 2006 May;63(5):674-81
16682537
Stroke. 2006 Feb;37(2):345-50
16397184
Lancet Neurol. 2007 Dec;6(12):1106-14
18031707
J Intern Med. 2004 Sep;256(3):240-6
15324367
Am J Public Health. 1998 Sep;88(9):1337-42
9736873
J Clin Epidemiol. 2001 Jul;54(7):661-74
11438406
Twin Res Hum Genet. 2006 Dec;9(6):950-7
17254435
J Psychiatr Res. 1975 Nov;12(3):189-98
1202204
N Engl J Med. 1998 Feb 19;338(8):506-11
9468467
Stat Med. 2000 Jun 15-30;19(11-12):1495-522
10844714
Neurology. 1991 Apr;41(4):479-86
2011243
J Am Geriatr Soc. 1999 May;47(5):564-9
10323650
J Am Geriatr Soc. 2008 Aug;56(8):1424-33
18662209
Neurology. 1999 Sep 22;53(5):902-5
10496243
Brain. 2008 Jun;131(Pt 6):1630-45
18339640
Neurology. 1995 Mar;45(3 Pt 1):461-6
7898697
Neurology. 1997 Apr;48(4):937-42
9109881
Neurology. 2009 Mar 3;72(9):829-34
19255410
Psychopharmacol Bull. 1988;24(4):637-9
3249765
Neurology. 1989 Jun;39(6):773-6
2725870
Arch Neurol. 1999 Mar;56(3):303-8
10190820
Neurobiol Aging. 2008 Oct;29(10):1448-55
17499884
Prev Med. 1975 Dec;4(4):518-25
1208363
Neurology. 2010 Sep 7;75(10):889-97
20820000
Ann Neurol. 2009 Apr;65(4):403-13
19296504
Arch Neurol. 1995 Aug;52(8):763-71
7639628
Neurology. 2010 Jan 19;74(3):201-9
20042704
Ann Neurol. 1989 Apr;25(4):317-24
2712531
Arch Neurol. 1999 Oct;56(10):1274-9
10520945
Neuroepidemiology. 2008;30(1):58-69
18259084
Neurology. 1992 Mar;42(3 Pt 1):473-80
1549205
Arch Neurol. 2009 Dec;66(12):1447-55
20008648
Neurobiol Aging. 2010 Aug;31(8):1443-51, 1451.e1
20541287
J Gerontol A Biol Sci Med Sci. 2000 Feb;55(2):M84-9
10737690
Neurology. 1997 Dec;49(6):1498-504
9409336
JAMA. 1989 Nov 10;262(18):2551-6
2810583
Ann Neurol. 2010 Jan;67(1):114-21
20186856
Int J Neurosci. 1991 Apr;57(3-4):167-78
1938160
Circulation. 1966 Oct;34(4):553-5
5921755
JAMA. 1995 May 3;273(17):1354-9
7715060
Neurology. 2009 Oct 13;73(15):1193-9
19822868
J Alzheimers Dis. 2006;9(3 Suppl):409-15
16914879
Ann Neurol. 2009 Aug;66(2):200-8
19743450
J Alzheimers Dis. 2009;18(3):691-701
19749406
Neurology. 1984 Jul;34(7):939-44
6610841
Lancet Neurol. 2010 Jan;9(1):4-5
20083022
Lancet Neurol. 2010 Jan;9(1):119-28
20083042
Neurology. 1999 Jul 22;53(2):321-31
10430421
J Neuropathol Exp Neurol. 2003 Nov;62(11):1087-95
14656067
Neurology. 2010 Mar 23;74(12):951-5
20308679
Neurology. 1993 Mar;43(3 Pt 1):515-9
8450993
J Neuropathol Exp Neurol. 1999 Apr;58(4):376-88
10218633
Alzheimers Dement. 2011 Jan;7(1):61-73
21255744
Neurology. 1992 Jan;42(1):115-9
1734291
Br J Psychiatry. 1968 Jul;114(512):797-811
5662937
N Engl J Med. 2009 May 28;360(22):2302-9
19474427
Psychol Rep. 1987 Jun;60(3 Pt 2):1023-40
3628637
Arch Neurol. 1999 Nov;56(11):1368-73
10555657
Alzheimers Dement. 2006 Jan;2(1):2-11
19595851
Neurology. 2000 Oct 24;55(8):1158-66
11071494
J Fam Pract. 1980 Oct;11(4):553-7
7420031
Neuroepidemiology. 2005;25(4):181-91
16103729
Neurology. 2009 Sep 8;73(10):754-60
19587325
Arch Neurol. 2003 Feb;60(2):185-9
12580702
Alzheimers Dement. 2011 Jan;7(1):15-34
21255741
Arch Neurol. 2000 Jun;57(6):808-13
10867777
Ann Neurol. 2004 Mar;55(3):306-19
14991808
Alzheimers Dement. 2011 Jan;7(1):74-9
21255745