Journal of Alzheimer's disease : JAD
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Many cognitive screening instruments have been developed during the last decades to detect mild cognitive dysfunction and dementia, and there is an ongoing discussion as to which tool should be used in which setting and which challenges have to be considered. Among other aspects, dependence on age is a recognized problem in screening tools which still has not found its way into common scoring procedures. Another aspect which has been handled very heterogeneously is which domain is represented in which proportion in the total score. ⋯ In this review, four cognitive screening tools that all follow a common, stringent concept and pay regard to some critical aspects are described: the DemTect, a "generic" tool; the PANDA for Parkinson's disease patients; the EASY, a non-verbal, culture-fair screening test for patients with migration background; and the MUSIC for patients with multiple sclerosis. All of these screening instruments have an age-correction, provide a total score in which the different subtests are weighted according to their individual sensitivity and specificity, and include tasks that are specifically aligned to the cognitive profile of the target group, including the EASY with non-verbal, culture-fair tasks to overcome language and cultural barriers. The development, main characteristics, data, and limitations of these tools are presented and discussed against the background of the current landscape of cognitive screening tools.
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To date, the exact pathogenesis of dementia is still unknown. The most frequently hypothesized initiating factor is an accumulation of the protein amyloid-β in the brain, which has been associated with dementia of the Alzheimer type. Another potentially important initiating factor is a disrupted blood-brain barrier. ⋯ Although amyloid-β and blood-brain barrier dysfunction have both been associated with one particular type of dementia (Alzheimer's disease and vascular dementia, respectively), they co-exist in most demented patients. In fact, increasing evidence indicates that amyloid-β and blood-brain barrier disruption may interact and facilitate each other in their effect on neurodegeneration. The present systematic analysis describes the available evidence for a significant interplay between amyloid-β and blood-brain barrier function in dementia.
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To date, the exact pathogenesis of dementia is still unknown. The most frequently hypothesized initiating factor is an accumulation of the protein amyloid-β in the brain, which has been associated with dementia of the Alzheimer type. Another potentially important initiating factor is a disrupted blood-brain barrier. ⋯ Although amyloid-β and blood-brain barrier dysfunction have both been associated with one particular type of dementia (Alzheimer's disease and vascular dementia, respectively), they co-exist in most demented patients. In fact, increasing evidence indicates that amyloid-β and blood-brain barrier disruption may interact and facilitate each other in their effect on neurodegeneration. The present systematic analysis describes the available evidence for a significant interplay between amyloid-β and blood-brain barrier function in dementia.