The continuing enigma in differential diagnosis of degenerative dementias
Prof. Alessandro Padovani
56 slide(s) – 00:21:02– English –2010-09-28
Many causes of dementia, as well as other syndromes of cognitive impairment, can mimic the clinical state of dementia. Differentiating among these causes is important because of potential differences in symptom management and prognosis. Identifying causes of dementia more precisely is likely to become a prerequisite to initiating disease-specific, long-term, disease-modifying therapy. Differentiating the clinical state of dementia from the causative dementing illness is likely to become more important in the future as more treatment options become available. Our understanding of the molecular basis of the most common neurodegenerative dementias has greatly advanced in recent years. The growth of scientific knowledge with the description of distinctive and reliable biomarkers of AD, which are now available through structural MRI, molecular neuroimaging with PET, and cerebrospinal fluid analysis makes possible to identify with a high accuracy AD at a symptomatic predementia stage. Interestingly, the high specificity of the new criteria was recently confirmed by two studies showing:
1) that it is possible to identify AD patients 2 years before dementia with a specificity of 92% as long as a specific verbal memory test is chosen, using cues for the control of encoding and the facilitation of retrieval; and
2) that a specificity of 100%can be reached ifMRI and CSF studies are added to memory investigation. This ongoing evidence suggests that it is possible to diagnoseAD before the occurrence of a full blown dementia and to differentiate among different degenerative diseases leading to dementia since the early stages.