Dementia is an umbrella term used to describe a state where an individual has lost the ability to carry out daily life activities independently because of cognitive impairment that is not due to an underlying psychiatric condition. Alzheimer’s disease (AD) refers to the abnormal presence of Aβ and tau proteins, which define AD among many other neurodegenerative diseases. Dementia -including dementia due to AD- is likely to be underestimated because of underdiagnosis and misdiagnosis.

This slide deck has been developed by Joseph Therriault, PhD, McGill University, Montréal, Québec, Canada; and Professor Serge Gauthier, McGill University, Montréal, Québec, Canada, in collaboration with Cambridge (a division of Prime, Cambridge, UK).

Index for
slide deck

Introduction

AD history definitions and diagnosis slide1
History, definitions and diagnosis
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History and definitions

AD history definitions and diagnosis slide2
History and definitions
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AD history definitions and diagnosis slide3
Alzheimer’s disease is not synonymous with dementia

References:
1.Alzheimer's Disease International website. Dementia facts and figures. Available at: https://www.alzint.org/about/dementia-facts-figures/. Accessed 11 December 2023.

2.Alzheimer's Association website. What is dementia? Available at: https://www.alz.org/al…

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AD history definitions and diagnosis slide4
The global prevalence of dementia is increasing

References:
1.Alzheimer’s Disease International. Dementia facts and figures. Available at: https://www.alzint.org/about/dementia-facts-figures/. Accessed 2 November 2023.

2.Alzheimer’s Association. What is dementia? Available at: https://www.alz.org/alzheimers-dementia…

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AD history definitions and diagnosis slide5
Alzheimer’s disease research timeline

Diagnosis of AD has developed from a pathological approach to a more clinical and exclusionary approach.1,3 NIA-AA Criteria published in 2011, combined with a clinical and biological approach developed by the International Working Group (IWG), allowed for the emergence o…

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AD history definitions and diagnosis slide7
Historical development of Alzheimer’s disease diagnosis criteria – II

References:
1.NIA-AA Revised Clinical Criteria for Alzheimer’s disease draft. 9 October 2023. Available at: https://alz.org/media/Documents/scientific-conferences/Clinical-Criteria-for-Staging-and-Diagnosis-for-Public-Comment-Draft-2.pdf. Accessed 30 November 2023.

2.N…

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Diagnosis, signs and symptoms

AD history definitions and diagnosis slide8
Diagnosis, signs and symptoms
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AD history definitions and diagnosis slide11
Clinical diagnosis of neurocognitive disorders

Both primary care and secondary care physicians contribute to dementia diagnosis. Primary care is involved in:1

  • exploring the patient’s ideas and concerns about their symptoms; excluding any potentially treatable or reversible illnesses
  • referring for specialist as…
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AD history definitions and diagnosis slide12
Medical history relevant to neurocognitive disorders

Although the diagnostic journey for an individual with cognitive disturbances may differ around the world, in most countries, the first step involves a visit to the primary care physician.1 In many cases, the primary care physician is supported by a nurse who may record …

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AD history definitions and diagnosis slide13
Cognitive, functional, behavioural and mental state examination

Cognitive assessments most commonly used by clinicians are the MMSE and the MoCA.1 The MMSE assesses global cognitive efficiency and is usually used to evaluate the dementia stage and overall progression of cognitive decline.2 However, the ability of the MMSE to detect c…

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AD history definitions and diagnosis slide14
Physical examination and basic laboratory tests

In the initial stages of a dementia diagnosis, a physical examination is conducted.1 This examination is similar to the physical examination conducted when visiting a new doctor.1 Assessments will focus on vital signs such as heart rate, blood pressure, and listening to …

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AD history definitions and diagnosis slide15
Basic biomarker work up

The biomarker classification system for AD provides three main classes of biomarkers: amyloid-β (Aβ; A), tau (T), and neurodegeneration (N), denoted as A/T/(N).4 While abnormal Aβ and p-tau are considered to be key features of AD in this framework, neurodegeneration may …

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AD history definitions and diagnosis slide16
Differential diagnosis of progressive cognitive decline

Subjective cognitive decline is a broad condition that can develop over time due to a variety of potential underlying causes.1 Brain diseases and illnesses that may negatively affect cognition include Alzheimer’s disease, Parkinson’s disease, CVD, inflammatory brain dise…

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AD history definitions and diagnosis slide17
Vascular abnormalities and proteinopathies involved in cognitive decline

Abnormalities in blood flow to the brain, as well as CVD cause dementia.1 It has been well established that dementia symptoms represent neuronal loss resulting from the progressive accumulation of dysfunctional brain proteins – a process called proteinopathy. 1 Particula…

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AD history definitions and diagnosis slide18
Atypical presentations of Alzheimer’s disease and dementia

The most common clinical presentation of typical AD involves a slow, progressive amnestic disorder which reflects the predominant early distribution of neurofibrillary tangles (NFTs) in medial temporal-lobe structures.3 These changes can be observed as medial temporal at…

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AD history definitions and diagnosis slide19
Cognitive–behavioural profiles of neuropsychologically distinct dementia syndromes

In elderly individuals, AD is the leading cause of dementia, however dementia may arise from a range of aetiologically and neuropathologically distinct disorders that contribute to different patterns of cognitive impairment.1 Understanding these different patterns, and t…

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