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The Dementias: Early Diagnosis and Evaluation

2006 Edition, June 12, 2006

Complete Document

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Active, Most Current

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ISBN: 978-0-8247-2897-7
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Product Details:

  • Revision: 2006 Edition, June 12, 2006
  • Published Date: June 12, 2006
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 484
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Our motivation to compile this book stems from our exposure to a number of issues that are difficult to reconcile. Most people probably welcome the increase in longevity that is observed in many countries today, but this also brings with it a substantial increase in dementia with prevalence and incidence rising steeply beyond 70 years of age. It is widely acknowledged that this imposes severe stress on families and caregivers and risks the failure of social welfare systems. Dementia may therefore become one of the most difficult challenges for societies in this century. Yet, we are far away from a medical solution. Even if a drug that could slow or halt the progression of dementing diseases was made available tomorrow, it probably would have only limited effect since too much brain function has been lost to degenerative brain disease once the clinical symptoms of dementia become clearly evident. Restoration of normal cognition will therefore remain an elusive goal. Thus, there is the danger that any available drug would either be given too late to prevent dementia and its consequences, or it would be given indiscriminately to people with nonspecific complaints or even without any symptoms. Since only a small proportion of these individuals are likely to develop dementia within the next few years, precious medical resources would be wasted. Early and accurate diagnosis of dementing diseases before the onset of dementia therefore becomes of paramount importance if we are to avoid such a situation and use preventative treatment strategies efficiently once they become available.

Over the past few years, many new methods and techniques have been developed to improve early diagnosis. Most of these require special training and expert knowledge for application and an understanding of their potential and limitations. In this book, active researchers who are experts in their respective fields present and evaluate these methods to provide a guide to their use in early  dementia diagnosis and assessment. It is, however, quite clear that no single method can cover all aspects that are relevant for early diagnosis. With this overview we hope to provide comprehensive information to clinicians, researchers, and the pharmaceutical industry about which methods are the most effective ones for screening, early diagnosis of symptomatic subjects, and distinguishing between different dementing diseases. While we cannot yet provide definitive answers to all these questions, we hope that the evaluation will provide guidance for further research.

Clinical evaluation and care are the basis of dementia diagnosis and treatment, and we therefore put the chapter on clinical issues at the beginning. Neuropsychology provides methods for the objective and quantitative assessment of symptoms and behavioral and cognitive deficits, and therefore this naturally takes its place close to clinical evaluation. Next comes cerebrospinal fluid and blood biomarkers that hold promise in complementing symptom-based diagnosis by adding biochemical information on the underlying disease process. Chapters on genetics and novel molecular targets provide the latest information on risk factors and molecular mechanisms with their perspectives for early diagnosis. After that we enter the wide arena of in vivo imaging methods, which have undergone rapid development and bewildering diversification in recent years, ranging from structural imaging with computed tomography and magnetic resonance imaging to functional and molecular imaging with functional magnetic resonance imaging, magnetic resonance spectroscopy, single-photon emission computed tomography, and positron emission tomography. Most of these are ready to be applied in the clinical arena, but quite often their actual value and efficacy is still under dispute. Authors therefore explain the techniques and provide information on diagnostic sensitivity and specificity when available. The methods chapters are then concluded with a view from neuropathology, which still provides the most detailed methods for tissue examination and therefore sets the diagnostic gold standard, although the significance of post-mortem studies in early dementia is limited because of the lack of clinical follow-up data, for obvious reasons. We did not want to leave our readers with just a compilation of methods and data but felt that an overview and final evaluation, although necessarily somewhat subjective, should conclude the book. We also address some of the wider implications of improved early diagnosis that need consideration when we enter this extremely important clinical field, which may hold dangers, but hopefully many surprises as well.