Introduction     Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D.     Defining Alzheimer's Disease       Evaluating Patients       Pre-Dementia Impairment       Mild Cognitive Impairment       Treatment Strategies for Dementia and Mild Cognitive Impairment Mary Sano, Ph.D.     Treatment of Depression, Agitation, and Psychosis in Dementia Davangere P. Devanand, M.D.     Recognition of Vascular Dementia, Dementia with Lewy Bodies, and Frontotemporal Dementia Lawrence S. Honig, M.D., Ph.D.     Neuropsychology of Mild Cognitive Impairment, Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia Penne Sims, Ph.D.     Neuroimaging in Dementia Scott A. Small, M.D.     Genetics of Neurodegenerative Disease: Alzheimer's Disease, Frontotemporal Dementia Jennifer Williamson-Catania, M.S.     Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq.     Posttest         Accreditation     Reference List     Acknowledgements		Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D. Defining Alzheimer's Disease   In order to talk about dementia, we must start by defining our terms. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), dementia is characterized for diagnosis by short-term and long-term memory impairment, as well as impairment of higher cortical function, such as abstract reasoning or judgment. We also look for some type of decline or dysfunction in social or occupational abilities. The diagnosis of dementia cannot be made in the setting of delirium. The prevalence, or the proportion of existing cases in a defined population at a given point of time, of dementia doubles with every five-year increase in age. Different series report a range of frequencies, from 4 to 15 percent of the population over age 75 to 16 to 40 percent of the population over age 85. Incidence rates, or the number of new cases arising in a defined population over time, also increase with age. Age is by far the greatest risk factor for developing Alzheimer's disease.         Prevalence of Alzheimer's Disease   As shown in a number of studies, the prevalence of Alzheimer's disease doubles with every five-year increase in age. Courtesy of Dr. Karen Bell     Family history is also an important epidemiological factor; a history of Alzheimer's disease in a first-degree relative—a mother, father, brother, or sister—has consistently been shown to be associated with Alzheimer's disease. We estimate that the lifetime risk in relatives of affected people is 25 to 40 percent, compared to 10 percent or less in relatives of unaffected people. There are certain genes associated with Alzheimer's disease, particularly early-onset Alzheimer's disease, including amyloid precursor protein, presenilin-1, and presenilin-2.   We can use research criteria to give clinicians some degree of certainty in making a diagnosis. Probable Alzheimer's disease is reserved for those who have a usual course: progressive, insidious onset, two or more deficits in cognitive function, and the absence of any other illnesses that could account for the dementia. Possible Alzheimer's disease is reserved for anyone with an atypical course or someone who might have some other comorbid illness that can cause dementia but that is not the cause of the dementia. Definite Alzheimer's disease is reserved for those for whom there is pathological confirmation, either by autopsy or brain biopsy, showing neurofibrillary tangles and senile plaques.         Criteria for Alzheimer's Disease (NINCDS/ADRDA)   Definite Alzheimer's disease must be pathologically confirmed by autopsy or brain biopsy showing neurofibrillary tangles and senile plaques. Courtesy of Dr. Karen Bell       PREVIOUS | NEXT