Update on diagnostic methods, natural history and outcome variablesin Alzheimer's disease
S. Gauthier
Bok Engelsk 1998
| Utgitt | 1998
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|---|---|
| Omfang | Side 2- 7
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| Opplysninger | The diagnosis of Alzheimer's disease (AD) currently relies on historyobtained from family or friends and on mental status assessmentmatched to National Institute of Neurological and CommunicativeDisorders and Stroke criteria. Progression over time may or may notbe typical, suggesting alternate diagnoses such as Lewy body orfrontotemporal dementias. Apolipoprotein E genotype does not appearto be useful as a diagnostic marker. The usefulness of brain imagingin AD must be reexamined. Critical events in the natural history ofAD, such as institutionalization and loss of ability for self-care,could be used as end points. Loss of ability for instrumental tasks,such as driving: traveling alone, or managing finances, would bepreferable for early-stage stabilization studies. Differentsymptomatic domains of AD (mood, cognition: functional autonomy,behavior, motoricity) can be quantified using specific outcomemeasures. Although cognitive loss has been considered a core symptomof AD from a regulatory perspective, loss of functional autonomy andbehavioral disinhibition are considered more important by cliniciansand families. Recently, the availability of new scales has led to allinterest in all of these domains. Results from symptomatic drugstudies suggest a differential effect of cholinesterase inhibitors oncognition versus muscarinic agonists on functional autonomy andbehavior. Hence there is a need to measure these domains separatelyand, eventually, to attempt combination therapy. Quality of life is adifficult but important dimension of AD therapeutic research, and itrequires further methodological research.
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| Emner |
