Leitlinien zur Diagnostik bei Patienten mit Demenz

Zusammenfassung

Derzeit existiert kein vollständiges und valides System zur Diagnostik der Demenzen. Die Leitlinien des Berufsverbandes der Allgemeinärzte, der Canadian Medical Association und der European Federation of Medical Societies werden vorgestellt und diskutiert. Während die Feststellung des Vorliegens einer Demenz und die Abgrenzung einer Depression einfach sind, bestehen besondere Probleme in der Differenzialdiagnostik der Demenzen untereinander und in der Frühdiagnostik. Es erscheint erforderlich, die einzelnen Konsenskriterien aufeinander abzustimmen und Kriterien für die Differenzialdiagnose festzulegen. Liquoruntersuchungen und MR-Techniken erlauben in naher Zukunft möglicherweise eine positive Diagnose des M. Alzheimer.

Consensus Criteria on Diagnosis in Patients with Dementia

At present, there is no valid diagnostic system that can be used for the diagnosis of dementia and its underlying causes. The consensus criteria of the German Association of Medical Practicioners, the Canadian Medical Association and the European Federation of Medical Societies are described. While the detection of the presence of dementia and the differential diagnosis towards depression seem relatively easy, there are considerable difficulties in the differential diagnosis among the dementias and in early diagnosis. It is deemed necessary to relate the various diagnostic consensus criteria towards each other and establish consensus for differential diagnosis. CSF analysis and new MR techniques may allow a positive diagnosis of Alzheimer's disease in the near future.

Literatur

• 1 Habs M, Künzel D, Wahle K. Demenz-Manual, 2., erw. Aufl. Emsdetten; Kybermed 1999
• 2 Kanowski S. Diagnostik der Hirnleistungsstörungen. In: Habs M, Künzel D, Wahle K (Hrsg) Demenz Manual. Emsdetten; Kybermed 1999: 33-43
• 3 Reisberg B, Ferris S H. Brief Cognitive Rating Scale (BCRS).  Psychopharmacol Bull. 1998;  24 629-636
• 4 Folstein M F, Folstein S E, McHugh P R. Mini mental state. A practical method for grading the cognitive state of patients for the clinician.  J Psychiatr Res. 1975;  12 189-198
• 5 Erzigkeit H. SKT - ein Kurztest zur Erfassung von Gedächtnis- und Aufmerksamkeitsstörungen. Göttingen; Hogrefe 1992
• 6 Ihl R, Grass-Kapanke B, Lahrem P. et al . Entwicklung und Validierung eines Tests zur Früherkennung der Demenz mit Depressionsabgrenzung.  Fortschr Neurol Psychiatrie. 2000;  68 413-422
• 7 van Crevel H, van Gool W A, Walstra G J. Early diagnosis of dementia: which tests are indicated? What are their costs?.  J Neurol. 1999;  246 43-48
• 8 Foster G R, Scott D A, Payne S. The use of CT scanning in dementia. A systematic review.  Int J Technol Assess Health Care. 1999;  15 406-423
• 9 Patterson C JS, Gautheir S, Bergman H. et al . The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia.  CMAJ. 1999;  160, (Suppl 12) S1-S15
• 10 Waldemar G, Dubois B, Emre M. et al . Diagnosis and management of Alzheimer's disease and other disorders associated with dementia. The role of neurologists in Europe.  Eur J Neurol. 2000;  7 133-144
• 11 Reisberg B, Borenstein J, Salob S P. et al . Behavioral symptoms in Alzheimer's disease. Phenomenology and treatment.  J Clin Psychiatry. 1987;  48 9-15
• 12 Cummings J L, Mega M, Gray K. et al . The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.  Neurology. 1994;  44 2308-2314
• 13 Neary D, Snowden J S, Gustafson L. et al . Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria.  Neurology. 1998;  51 1546-1554
• 14 Solomon P R, Hirschoff A, Kelly B. et al . A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease.  Arch Neurol. 1998;  55 349-355
• 15 Yousef G, Ryan W J, Lambert T. et al . A preliminary report: a new scale to identify the pseudodementia syndrome.  Int J Geriatr Psychiatry. 1998;  13 389-399
• 16 Burkart M, Heun R, Maier W, Benkert O. Demenz-Screening im Alltag. Eine vergleichende Analyse von MMSE, SIDAM und ADAS.  Nervenarzt. 1998;  69 983-990
• 17 Kropp S, Schlimme J, Bleich S. et al . Diagnostische Schritte bei Alzheimer-Demenz vor Therapiebeginn mit neuen Antidementiva.  Fortschr Neurol Psychiatrie. 2000;  68 257-261
• 18 Hulstaert F, Blennow K, Ivanoiu A. et al . Improved discrimination of AD patients using beta-amyloid (1-42) and tau levels in CSF.  Neurology. 1999;  52 1555-1562
• 19 Galasko D. Cerebrospinal fluid levels of A beta 42 and tau: potential markers of Alzheimer's disease.  J Neural Transm. 1998;  53, Suppl 209-221
• 20 Arai H, Satoh-Nakagawa T, Higushi M. et al . No increase in cerebrospinal fluid tau protein levels in patients with vascular dementia.  Neurosci Lett. 1998;  256 174-178
• 21 McConnell L M, Sanders G D, Owens G K. Evaluation of genetic tests: APOE genotyping for the diagnosis of Alzheimer's disease.  Genetic Testing. 1999;  3 47-53
• 22 Zakzanis K K. Quantitative evidence for neuroanatomic and neuropsychological markers in dementia of the Alzheimer's type.  J Clin Exp Neuropsychol. 1998;  20 259-269
• 23 Juottonen K, Laakso M P, Partanen K, Sominen H. Comparative MR analysis of the entorhinal cortex and hippocampus in diagnosing Alzheimer disease.  AJNR. 1999;  20 139-144
• 24 Killiany R J, Gomez-Isla T, Moss M. et al . Use of structural magnetic resonance imaging to predict who will get Alzheimer's disease.  Ann Neurol. 2000;  47 430-439
• 25 Jack C R, Petersen R C, Xu Y C. et al . Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment.  Neurology. 1999;  52 1397-1403
• 26 Jessen F, Block W, Träber F. et al . Proton MR spectroscopy detects a relative decrease of N-acetylaspartate in the medial temporal lobe of patients with AD.  Neurology. 2000;  55 684-688
• 27 Meyer J S, Muramatsu K, Mortel K F. et al . Prospective CT differences between vascular and Alzheimer's dementia.  Stroke. 1995;  26 735-742
• 28 Kalaria R N, Ballard C. Overlap between pathology of Alzheimer disease and vascular dementia.  Alzheimer Dis Assoc Disord. 1999;  13 S115-123
• 29 Barber R, Scheltens P, Gholkar A. et al . White matter lesions on magnetic resonance imaging in dementia with Lewy bodies, Alzheimer's disease, vascular dementia, and normal aging.  J Neurol Neurosurg Psychiatry. 1999;  67 66-72
• 30 Smith C D, Snowdon D A, Wang H, Markesberry W R. White matter volume and periventricular white matter hyperintensities in aging and dementia.  Neurology. 2000;  54 838-842
• 31 Talbot P R, Lloyd J J, Snowden J S. et al . A clinical role for 99mTc-HMPAO SPECT in the investigation of dementia.  J Neurol Neurosurg Psychiatry. 1998;  64 306-313
• 32 Gainotti G, Marra C, Villa G. et al . Sensitivity and specificity of some neuropsychological markers of Alzheimer dementia.  Alzheimer Dis Assoc Disord. 1998;  12 152-162
• 33 Pasquier F. Early diagnosis of dementia: neuropsychology.  J Neurol. 1999;  246 6-15
• 34 Pasquier F, Lebert F, Grymonprez L, Petit H. Verbal fluency in dementia of frontal lobe type and dementia of Alzheimer type.  J Neurol Neurosurg Psychiatry. 1995;  58 81-84
• 35 Perry R J, Hodges J R. Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer's disease.  Neurology. 2000;  54 2277-2284
• 36 Lebert F, Pasquier F, Souliez L, Petit H. Frontotemporal behavioural scale.  Alz Dis Assoc Disord. 1998;  12 335-339
• 37 Jobst K A, Barnetson L P, Shepstone B J. Accurate prediction of histologically confirmed Alzheimer's disease and the differential diagnosis of dementia: the use of NINCDS-ADRDA and DSM-III-R criteria, SPECT, X-ray CT, and Apo E4 in medial temporal lobe dementias.  Int Psychogeriatr. 1998;  10 271-302
• 38 Varma A R, Snowden J S, Lloyd J J. et al . Evaluation of the NINCDS-ADRDA criteria in the differentiation of Alzheimer's disease and frontotemporal dementia.  J Neurol Neurosurg Psychiatry. 1999;  66 184-188
• 39 McKhann G, Drachman D, Folstein M. et al . Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.  Neurology. 1984;  34 939-944
• 40 Lopez O L, Litvan I, Catt K E. et al . Accuracy of four clinical diagnostic criteria for the diagnosis of neurodegenerative dementias.  Neurology. 1999;  53 1292-1299
• 41 Hohl U, Tiraboschi P, Hansen L A. et al . Diagnostic accuracy of dementia with Lewy bodies.  Arch Neurol. 2000;  57 347-351
• 42 Walker M P, Ayre G A, Cummings J L. et al . Quantifying fluctuations in dementia with Lewy bodies, Alzheimer's disease and vascular dementia.  Neurology. 2000;  54 1616-1625
• 43 McKeith I G, Galasko D, Kosaka K. et al . Consensus guidelines for the clinical and pathological diagnosis of dementia with Lewy bodies (DLB).  Neurology. 1996;  47 1113-1124
• 44 Lopez O L, Hamilton R L, Becker J T. et al . Severity of cognitive impairment and the clinical diagnosis of AD with Lewy bodies.  Neurology. 2000;  54 1780-1787
• 45 Chui H C, Mack W, Jackson J E. et al . Clinical criteria for the diagnosis of vascular dementia: a multicenter study of comparability and interrater reliability.  Arch Neurol. 2000;  57 191-196
• 46 Gold G, Giannakopoulos P, Montes-Paixao C. et al . Sensitivity and specificity of newly proposed clinical criteria for possible vascular dementia.  Neurology. 1997;  49 690-694
• 47 Inzitan D, Erkinjuntti T, Wallin A. et al . Subcortical vascular dementia: a specific target for clinical trials.  Ann NY Acad Sci. 2000;  903 510-521
• 48 Crystal H A, Dickson D, Davies P. et al . The relative frequency of „dementia of unknown etiology” increases with age and is nearly 50 % in nonagenarians.  Arch Neurol. 2000;  57 713-719