Articles: dementia.
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To validate a sensitive and specific screening test for AD and other dementias, assess its reliability and discriminative validity, and present normative data for its use in various applied settings. ⋯ The MIS provides efficient, reliable, and valid screening for AD and other dementias.
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The use of neuroimaging is reviewed in the diagnosis of dementia, especially Alzheimer's disease (AD). Computed tomography (CT) may be used to exclude other causes of dementia than AD. The finding of cortical or subcortical atrophy on CT or magnetic resonance imaging (MRI) itself does not indicate AD. ⋯ CT- and MRI-based measurements of hippocampal atrophy show promise in providing useful diagnostic information for discriminating patients with probable AD from normal elderly individuals. Using a standardized imaging protocol, including some assessment of hippocampal atrophy, can save costs since patients with suspected AD must undergo a cross-sectional imaging study to exclude other (treatable) causes of dementia. Combining an assessment of hippocampal atrophy with cerebral blood flow measurements by single photon emission computed tomography is not warranted either from a clinical or from an economic point of view.
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Neuropsychology contributes greatly to the diagnosis of dementia. Cognitive deficits can be detected several years before the clinical diagnosis of dementia. The neuropsychological profile may indicate the underlying neuropathology. ⋯ These patterns must be interpreted in the light of the history, rate of progression, imaging results, and nature of existing behavioral disturbances. Moreover, there may be overlap between two or more pathologies, which complicates the diagnostic process. Follow-up of patients is necessary to improve diagnostic accuracy.
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Am J Hosp Palliat Care · Jan 1999
Criteria for enrolling dementia patients in hospice: a replication.
Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a key criterion for the Medicare Hospice Benefit, a six-month survival time. In a previous study, the authors examined guidelines for admitting dementia patients to hospice; the National Hospice Organization (NHO) guidelines were found to work well in identifying appropriate candidates for hospice among dementia patients. This was especially true for those patients whose deficits had progressed in an ordinal fashion consistent with Functional Assessment Staging (FAST) and who had reached stage 7C. ⋯ Foley catheters decreased survival time; and the use of antibiotics did not make a difference. This study echoed our previous findings regarding the usefulness of NHO guidelines in identifying dementia patients with a survival time of six months or less, specifically those at stage 7C or greater. The findings also suggest that the nature of the palliative care plan influences survival time.