Differential Diagnosis of Dementias - Alzheimer's Association

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Saint Louis University Mental Status Examination • Designed to improve screening for mild neurocognitive disorder (MNCD) • 11-item, clinician-scored scale High School Education Less Than High School Education Normal 27–30 25–30 MNCD 21–26 20–24 Dementia 1–20 1–19 • Study of SLUMS vs MMSE (N = 705) – DSM-IV-TR ® criteria used to diagnose MNCD or dementia – Patients assessed by MMSE and SLUMS – Sensitivity and specificity • Dementia: similar for MMSE and SLUMS • MNCD: SLUMS appears superior to MMSE Tariq SH et al. Am J Geriatr Psychiatry. 2006;14:900-910. 16
Rapid Brief Cognitive Screens: Pros and Cons Screening Test Pros Cons MMSE 1,2 Widely used, validated, reliable Adjustments for age, education, and race may be necessary Copyright issues AD8 informant interview 3 Mini-Cog assessment 4 MoCA 5,6 SLUMS examination 7 Reliable, sensitive, specific, rapidly administered Superior to MMSE in prediction of dementia status, rapidly administered, produces a visible performance indicator Useful in patients with scores >25 on MMSE, strong executive function component Potentially superior to MMSE for early detection of cognitive impairment Knowledgeable informants may not be readily available Clock-drawing test scoring is vulnerable to varying interpretations Conclusions regarding validity in PDD restricted to specialty clinic setting Research needed to confirm applicability beyond initial study group Note: insufficient information is available to determine whether any one screening tool is superior to another. Positive screening results should be followed by complete neurologic and medical examinations. 1. Folstein MF et al. J Psychiatr Res. 1975;12:189-198. 2. Weiner MF, Garrett MD, Bret ME. Neuropsychiatric Assessment and Diagnosis. In: Weiner MF, Lipton AM, eds. Textbook of Alzheimer disease and other dementias. Washington, DC: American Psychiatric Pub.; 2009. 3. Galvin JE et al. Neurology. 2005;65:559-564. 4. Borson S et al. Int J Geriatr Psychiatry. 2000;15:1021-1027. 5. Nasreddine ZS et al. J Am Geriatr Soc. 2005;53:695- 699. 6. Zadikoff C et al. Mov Disord. 2008;23:297-299. 7. Tariq SH et al. Am J Geriatr Psychiatry. 2006;14:900-910. 17
Page 1 and 2: Differential Diagnosis of Dementias
Page 3 and 4: Differential Diagnosis of Dementias
Page 5 and 6: The Typical Dementia Scenario • P
Page 7 and 8: Clinical Evaluation for Dementia 1
Page 9 and 10: Delirium is a Reversible Cause of C
Page 11 and 12: Examples of Cognitive Assessment To
Page 13 and 14: The Informant Interview: The AD8
Page 15: Montreal Cognitive Assessment (MoCA
Page 19 and 20: Core Clinical Alzheimer’s Dementi
Page 21 and 22: Core Clinical Dementia with Lewy Bo
Page 23 and 24: Frontotemporal Dementia • FTD may
Page 25 and 26: Imaging in the Diagnosis • Left -
Page 27 and 28: Neuropsychiatric Symptoms in Dement
Page 29 and 30: Current FDA-Approved Therapies AD P
Page 31 and 32: Caregiver Challenges in Different T

Differential Diagnosis of Dementias - Alzheimer's Association

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