Criteria for the diagnosis of Alzheimer's disease: Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

Frota, Norberto Anízio Ferreira; Nitrini, Ricardo; Damasceno, Benito Pereira; Forlenza, Orestes V.; Dias-Tosta, Elza; Silva, Amauri B. da; Herrera Junior, Emílio; Magaldi, Regina Miksian; ,

doi:10.1590/S1980-57642011DN05030002

Abstract

This consensus prepared by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology is aimed at recommending new criteria for the diagnosis of dementia and Alzheimer's disease (AD) in Brazil. A revision was performed of the proposals of clinical and of research criteria suggested by other institutions and international consensuses. The new proposal for the diagnosis of dementia does not necessarily require memory impairment if the cognitive or behavioral compromise affects at least two of the following domains: memory, executive function, speech, visual-spatial ability and change in personality. For the purpose of diagnosis, AD is divided into three phases: dementia, mild cognitive impairment and pre-clinical phase, where the latter only applies to clinical research. In the dementia picture, other initial forms were accepted which do not involve amnesia and require a neuroimaging examination. Cerebrospinal fluid biomarkers are recommended for study, but can be utilized as optional instruments, when deemed appropriate by the clinician.

Key words:
dementia; Alzheimer's disease; mild cognitive impairment; diagnosis; consensus guidelines; Brazil

Resumo

Este consenso realizado pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia tem como objetivo recomendar novos critérios para diagnóstico de demência e doença de Alzheimer (DA) no Brasil. Foi realizada revisão das propostas de critérios clínicos e de pesquisa sugeridas por outras instituições e consensos internacionais. A nova proposta para o diagnóstico de demência exige o comprometimento funcional e cognitivo, atingindo este último pelo dois dos seguintes cinco domínios a seguir: memória, função executiva, linguagem, habilidade visual-espacial e alteração de personalidade. No diagnóstico de DA, dividiu-se a mesma em três fases: demência, comprometimento cognitivo leve e pré-clínica, sendo esta última somente para pesquisa clínica. No quadro de demência, foram aceitas outras formas de início que não a amnéstica e incluída a necessidade de exame de neuroimagem. O diagnóstico do comprometimento cognitivo leve é clínico, podendo, em situações de pesquisas, serem utilizados marcadores biológicos buscando maior probabilidade de evolução para DA.

Palavras-chave:
demência; doença de Alzheimer; comprometimento cognitive leve; diagnóstico; consenso; diretrizes; Brasil

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References

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American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, DC: American Psychiatric Association; 1994.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. 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.
Jack CR Jr, Albert MS, Knopman DS, et al. Introduction to the recommendations from the National Institute on Aging and the Alzheimer's Association workgroup on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia In press.
Price JL, McKeel DW Jr, Buckles VD, et al. Neuropathology of nondemented aging: presumptive evidence for preclinical Alzheimer disease. Neurobiol Aging 2009;30:1026-1036.
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Shimizu MM, Raicher I, Takahashi DY, Caramelli P, Nitrini R. Disclosure of the diagnosis of Alzheimer's disease: caregivers' opinions in a Brazilian sample. Arq Neuropsiquiatr 2008;66:625-630.
Raicher I, Shimizu MM, Takahashi DY, Nitrini R, Caramelli P. Alzheimer's disease diagnosis disclosure in Brazil: a survey of specialized physicians' current practice and attitudes. Int Psychogeriatr 2008;20:471-481.
Raicher I, Shimizu MM, Caramelli P, Nitrini R. Demências - enfoque multidisciplinar: das bases fisiopatológicas ao diagnóstico e tratamento. A revelação do diagnóstico de doença de Alzheimer. In: Brucki SMD, Magaldi RM, Morillo LS, et al. (eds). São Paulo: Editora Atheneu; no prelo.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3th Ed. Washington, D.C: American Psychiatric Association; 1987.
World Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders. Diagnostic criteria for research. Genova: World Health Organization, 1993.

Publication Dates

Publication in this collection
Jul-Sep 2011

History

Received
17 Mar 2010
Accepted
17 June 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R; Academia Brasileira de Neurologia. Diagnóstico de doença de Alzheimer no Brasil: critérios diagnósticos e exames complementares. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:713-719.

[2] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, DC: American Psychiatric Association; 1994.

[3] McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. 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.

[4] Jack CR Jr, Albert MS, Knopman DS, et al. Introduction to the recommendations from the National Institute on Aging and the Alzheimer's Association workgroup on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia In press.

[5] Price JL, McKeel DW Jr, Buckles VD, et al. Neuropathology of nondemented aging: presumptive evidence for preclinical Alzheimer disease. Neurobiol Aging 2009;30:1026-1036.

[6] Forlenza OV, Diniz BS, Gattaz WF. Diagnosis and biomarkers of predementia in Alzheimer's disease. BMC Med. 2010;8:89.

[7] Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 2007;6:734-746.

[8] Dubois B, Feldman HH, Jacova C, et al. Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurol 2010;9:1118-1127.

[9] Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging and Alzheimer's Association workgroup. Alzheimer's & Dementia . In press.

[10] McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging and Alzheimer's Association workgroup. Alzheimer's & Dementia . In press.

[11] Sperling RA, Aisen PS, Beckett LA et al. Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging and Alzheimer's Association workgroup. Alzheimer's & Dementia . In press.

[12] Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups. J Neurol Neurosurg Psychiatry 1994;57:416-418.

[13] McKeith IG, Dickson DW, Lowe J, et al.; Consortium on DLB. McKeith IG, Dickson DW, Lowe J. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 2005;65:1863-1872.

[14] Cummings JL, Benson DF. Dementia: a clinical approach. 2 ed. Boston: Butterworth-Heineman; 1992.

[15] Mesulam MM. Principles of behavioral and cognitive neurology. 2nd ed. New York: Oxford University Press; 2000.

[16] Hyman BT, Trojanowski JQ. Consensus recommendations for the postmortem diagnosis of Alzheimer disease from the National Institute on Aging and the Reagan Institute Working Group on diagnostic criteria for the neuropathological assessment of Alzheimer disease. J Neuropathol Exp Neurol 1997;56:1095-1097.

[17] Raicher I, Caramelli P. Diagnostic disclosure in Alzheimer's disease. Dement Neuropsychol 2008;2:267-271.

[18] Shimizu MM, Raicher I, Takahashi DY, Caramelli P, Nitrini R. Disclosure of the diagnosis of Alzheimer's disease: caregivers' opinions in a Brazilian sample. Arq Neuropsiquiatr 2008;66:625-630.

[19] Raicher I, Shimizu MM, Takahashi DY, Nitrini R, Caramelli P. Alzheimer's disease diagnosis disclosure in Brazil: a survey of specialized physicians' current practice and attitudes. Int Psychogeriatr 2008;20:471-481.

[20] Raicher I, Shimizu MM, Caramelli P, Nitrini R. Demências - enfoque multidisciplinar: das bases fisiopatológicas ao diagnóstico e tratamento. A revelação do diagnóstico de doença de Alzheimer. In: Brucki SMD, Magaldi RM, Morillo LS, et al. (eds). São Paulo: Editora Atheneu; no prelo.

[21] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3th Ed. Washington, D.C: American Psychiatric Association; 1987.

[22] World Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders. Diagnostic criteria for research. Genova: World Health Organization, 1993.

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