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Annual Incidence of Dementia from 2003 to 2018 in Metropolitan Seoul, Korea: A Population-Based Study. J Clin Med 2022; 11:jcm11030819. [PMID: 35160270 PMCID: PMC8836574 DOI: 10.3390/jcm11030819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 12/10/2022] Open
Abstract
National dementia plans were applied in dementia support centers established in Seoul, Korea between 2007 and 2009. However, the annual incidence rates of dementia in Seoul have not been reported. We investigated this annual incidence and the characteristics of incident cases from 2003 to 2018. The customized research database of the Korean National Health Insurance Services was used. The annual crude and age-standardized incidence of dementia patients and their characteristics were analyzed. This study analyzed 108,596 incident dementia cases aged ≥60 years. The incidence rate increased from 2003 to 2011, including a rapid increment from 2007 to 2011. From 2011 to 2018, the crude (age-standardized) incidence per 105 person-years decreased from 641.51 (577.12) to 448.26 (361.23). The proportion of incident dementia cases was highest in the highest income group every year. However, the proportion of incident dementia cases in the lowest income group increased from 10.4% in 2003 to 25.8% in 2011. The annual incidence rate of dementia showed a sharp increase immediately after 2007, the year dementia support centers began to be introduced, and then stabilized after 2011. The characteristics of incident dementia cases have changed, including the proportion in the low-income group.
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Aldus CF, Arthur A, Dennington-Price A, Millac P, Richmond P, Dening T, Fox C, Matthews FE, Robinson L, Stephan BCM, Brayne C, Savva GM. Undiagnosed dementia in primary care: a record linkage study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08200] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background
The number of people living with dementia is greater than the number with a diagnosis of dementia recorded in primary care. This suggests that a significant number are living with dementia that is undiagnosed. Little is known about this group and there is little quantitative evidence regarding the consequences of diagnosis for people with dementia.
Objectives
The aims of this study were to (1) describe the population meeting the criteria for dementia but without diagnosis, (2) identify predictors of being diagnosed and (3) estimate the effect of diagnosis on mortality, move to residential care, social participation and well-being.
Design
A record linkage study of a subsample of participants (n = 598) from the Cognitive Function and Ageing Study II (CFAS II) (n = 7796), an existing cohort study of the population of England aged ≥ 65 years, with standardised validated assessment of dementia and consent to access medical records.
Data sources
Data on dementia diagnoses from each participant’s primary care record and covariate and outcome data from CFAS II.
Setting
A population-representative cohort of people aged ≥ 65 years from three regions of England between 2008 and 2011.
Participants
A total of 598 CFAS II participants, which included all those with dementia who consented to medical record linkage (n = 449) and a stratified sample without dementia (n = 149).
Main outcome measures
The main outcome was presence of a diagnosis of dementia in each participant’s primary care record at the time of their CFAS II assessment(s). Other outcomes were date of death, cognitive performance scores, move to residential care, hospital stays and social participation.
Results
Among people with dementia, the proportion with a diagnosis in primary care was 34% in 2008–11 and 44% in 2011–13. In both periods, a further 21% had a record of a concern or a referral but no diagnosis. The likelihood of having a recorded diagnosis increased with severity of impairment in memory and orientation, but not with other cognitive impairment. In multivariable analysis, those aged ≥ 90 years and those aged < 70 years were less likely to be diagnosed than other age groups; those living with a spouse (odds ratio 2.38, 95% confidence interval 1.04 to 5.41) were more likely to be diagnosed than people living alone. The median time to diagnosis from first meeting the criteria for dementia was 3 years. Diagnosis did not affect survival or the probability of a move to residential care.
Limitations
People with moderate to severe dementia at baseline could not consent to record linkage. The small numbers in some groups limited power to detect effects.
Conclusions
The lack of relationship between severity of non-memory impairment and diagnosis may reflect low awareness of other symptoms of dementia. There remains little objective evidence for benefits of diagnosis for people with dementia.
Future work
Potential benefits of diagnosis can be realised only if effective interventions are accessible to patients and carers. Future work should focus on improving support for people living with cognitive impairment.
Study registration
National Institute for Health Research Clinical Research Network Central Portfolio Management System (CPMS 30655).
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 20. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clare F Aldus
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Paul Millac
- Alzheimer’s Society Research Network, London, UK
| | - Peter Richmond
- Inspire, Research and Development, The Knowledge Centre, Hellesdon Hospital, Norwich, UK
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Chris Fox
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona E Matthews
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom CM Stephan
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
- Quadram Institute Bioscience, Norwich, UK
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O'Keeffe M, Barratt A, Maher C, Zadro J, Fabbri A, Jones M, Moynihan R. Media Coverage of the Benefits and Harms of Testing the Healthy: a protocol for a descriptive study. BMJ Open 2019; 9:e029532. [PMID: 31446410 PMCID: PMC6721653 DOI: 10.1136/bmjopen-2019-029532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Much testing in medicine is aimed at healthy people to facilitate the early detection of health conditions. However, there is growing evidence that early detection is a double-edged sword that may cause harm in the form of overdiagnosis. The media can be seen as a major generator of consumer demand for health services. Previous research shows that media coverage tends to overstate the benefits and downplay the harms of medical interventions for the sick, and often fails to cover relevant conflicts of interest of those promoting those interventions. However, little is known about how the benefits and harms of testing the healthy are covered by media. This study will examine the media coverage of the benefits and harms of testing the healthy, and coverage of potential conflicts of interest of those promoting the testing. METHODS AND ANALYSIS We will examine five tests: 3D mammography for the early detection of breast cancer; blood liquid biopsy for the early detection of cancer; blood biomarker tests for the early detection of dementia; artificial intelligence technology for the early detection of dementia; and the Apple Watch Series 4 electrocardiogram sensor for the early detection of atrial fibrillation. We will identify media coverage using Google News and the LexisNexis and ProQuest electronic databases. Sets of two independent reviewers will conduct story screening and coding. We will include English language media stories referring to any of the five tests from January 2016 to May 2019. We will include media stories if they refer to any benefits or harms of the test for our conditions of interest. Data will be analysed using categorical data analysis and multinomial logistic regression. ETHICS AND DISSEMINATION No ethical approval is required for this study. Results will be presented at relevant scientific conferences and in peer-reviewed literature.
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Maher
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Zadro
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alice Fabbri
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Ray Moynihan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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Page A, Etherton-Beer C. Undiagnosing to prevent overprescribing. Maturitas 2019; 123:67-72. [PMID: 31027680 DOI: 10.1016/j.maturitas.2019.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 12/23/2022]
Abstract
Health care focuses on controlling symptoms and managing risk factors to improve survival by avoiding future complications. Diagnoses describe a group of signs and symptoms, often implying specific aetiologies and underlying pathophysiological disease processes. The diagnosis provides a tool for the health professional to conceptualise and classify a presentation, and thus manage the condition, and can provide the patient with an explanation or validation of their experience. Not every diagnosis holds significant clinical implications. There are diagnosed conditions that do not require treatment and, moreover, where treatment has the potential for harm without the potential for benefit. Promoting investigations and diagnoses can lead to overdiagnosis related to vested interests in increased services, use of devices or therapeutics. Multiple factors drive this issue, including broadening disease definitions and cultural factors that encourage tests and treatments, as well as medicolegal factors. While the traditional medicine review process typically involved cross-referencing medicines used with current diagnoses, a more sophisticated version of this process critically reviews the medicines and associated diagnosis, giving less emphasis to diagnoses that are no longer relevant. Known as undiagnosis, this process facilitates the withdrawal of corresponding medicines used to manage those conditions. Systematically reviewing diagnoses regularly and the associated medicine management strategies could reduce prescribing. The novel ERASE process can help clinicians Evaluate diagnoses to consider Resolved conditions, Ageing normally and Selecting appropriate targets to Eliminate unnecessary diagnoses and their corresponding medicines.
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Affiliation(s)
- Amy Page
- Alfred Health, 55 Commercial Rd, Australia; Monash University, Centre for Medicine Use and Safety, Melbourne, Australia; University of Western Australia, School of Allied Health, Centre for Medicines Optimisation, Perth, Australia.
| | - Christopher Etherton-Beer
- University of Western Australia, Western Australian Centre for Health and Ageing, Australia; Department of Geriatric Medicine, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
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Abstract
SummaryThe UK's Choosing Wisely campaign aims to tackle the pressing issue of overuse in healthcare (i.e. overdiagnosis and overtreatment) through improving awareness and promoting shared decisionmaking. This campaign involves medical societies developing lists of interventions that are of questionable value and so require a genuine discussion between doctors and patients about their use. This article is about the problem of overuse and the launch of the Royal College of Psychiatrists' Choosing Wisely campaign. It provides a critical review of why this might occur and whether Choosing Wisely is likely to be successful.Learning Objectives• Understand the aims of the Choosing Wisely programme• Define overdiagnosis and overtreatment• Develop a critical perspective on potential areas of overuse in your clinical practice
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Phelps A, Kingston B, Wharton RM, Pendlebury ST. Routine screening in the general hospital: what happens after discharge to those identified as at risk of dementia? Clin Med (Lond) 2017; 17:395-400. [PMID: 28974585 PMCID: PMC6301921 DOI: 10.7861/clinmedicine.17-5-395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cognitive screening is recommended for older patients with unplanned hospital admission. We determined rates of reassessment/specialist memory referral after routine inclusion of at risk of dementia status in discharge documentation to primary care. Questionnaires were sent to relevant GP practices on consecutive patients aged ≥75 years identified as at risk and discharged 6 months earlier. Among 53 patients (mean age ±SD = 87.3±6.0 years, mean±SD Abbreviated Mental Test Score = 4.4±2.7), 49 (92%) patients had been reviewed since discharge, and 12/43 (28%) without previously known cognitive problem had had a cognitive reassessment. The most common reasons for non-assessment/referral included clinical factors (eg terminal illness/comorbidities) (n=15) and patient/family wishes (n=5) and that confusion was expected in unwell older patients (n=5). Routine cognitive reassessment/specialist referral appears unjustified in patients identified as at risk of dementia during unplanned hospital admission. However, the prognostic value of delirium/confusion in acute illness is under-recognised and could be used to highlight those at risk.
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Affiliation(s)
| | | | - Rose M Wharton
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - Sarah T Pendlebury
- Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK
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van Dijk W, Faber MJ, Tanke MAC, Jeurissen PPT, Westert GP. Medicalisation and Overdiagnosis: What Society Does to Medicine. Int J Health Policy Manag 2016; 5:619-622. [PMID: 27801356 PMCID: PMC5088721 DOI: 10.15171/ijhpm.2016.121] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/23/2016] [Indexed: 11/09/2022] Open
Abstract
The concept of overdiagnosis is a dominant topic in medical literature and discussions. In research that targets overdiagnosis, medicalisation is often presented as the societal and individual burden of unnecessary medical expansion. In this way, the focus lies on the influence of medicine on society, neglecting the possible influence of society on medicine. In this perspective, we aim to provide a novel insight into the influence of society and the societal context on medicine, in particularly with regard to medicalisation and overdiagnosis.
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Affiliation(s)
- Wieteke van Dijk
- Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J Faber
- Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marit A C Tanke
- Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert P Westert
- Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Jacobi F, Barnikol UB. [Estimation of prevalence and treatment needs of mental disorders. The problem of diagnostic thresholds]. DER NERVENARZT 2015; 86:42-50. [PMID: 25503066 DOI: 10.1007/s00115-014-4110-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Uncertainties in the context of threshold-based diagnostics represent a theoretically unsolved methodological problem that may require multidimensional solutions. Pragmatically, current research focuses on establishing reliable and valid operationalized criteria within the framework of diagnostic systems, such as the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). AIM AND METHODS By means of model calculations based on epidemiological data we show how exemplified changes in the disorder spectrum and diagnostic criteria influence case numbers. Furthermore, we investigate how threshold-based constructs, such as DSM-IV diagnoses, relate to the general criteria of illness and sickness. RESULTS Variations in the disorder spectrum and thresholds lead to slight to moderate changes in case numbers. Regarding distress and impairment, mental disorders are associated with significantly reduced health-related quality of life and an increased number of days out of role (due to mental and/or physical problems). With increasing distress and impairment, the percentage of mental disorders increases significantly; in the 5 % of the general population with the highest distress and impairment, the proportion is nearly 80 %. DISCUSSION Despite fuzzy boundaries, threshold-based diagnoses (DSM-IV) represent a satisfactory and reproducible disease classification (in terms of illness and sickness) for estimation of prevalence. There is a lack of definitions and instruments to assess treatment needs. It is still debated whether diagnostic symptom criteria always represent pathological disorders (i. e. disease).
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Affiliation(s)
- F Jacobi
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Deutschland,
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Wojtowicz A, Larner AJ. General Practitioner Assessment of Cognition: use in primary care prior to memory clinic referral. Neurodegener Dis Manag 2015; 5:505-10. [DOI: 10.2217/nmt.15.43] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aims: To measure current and comparative frequencies of use of the General Practitioner Assessment of Cognition (GPCOG) scale in consecutive primary care referrals to a dedicated secondary care memory clinic. Methods: Over 6 months (January–June 2015), referral letters from primary care (n = 121) were examined for mention of GPCOG use. Results: The proportion of patients administered any cognitive screening instrument before referral was 41.3%, with 11.6% administered the GPCOG, a significant increase compared with prior cohorts. However, GPCOG was incorrectly used or documented in 29% of cases. Conclusion: GPCOG use is increasing in primary care settings, but training in its correct use and scoring may be required to ensure that its administration makes meaningful information available.
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Affiliation(s)
- Alex Wojtowicz
- Cognitive Function Clinic, Walton Centre for Neurology & Neurosurgery, Liverpool, UK
| | - AJ Larner
- Cognitive Function Clinic, Walton Centre for Neurology & Neurosurgery, Liverpool, UK
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Creavin S, Fish M, Gallacher J, Bayer A, Ben-Shlomo Y. Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study. Br J Gen Pract 2015; 65:e489-99. [PMID: 26212844 PMCID: PMC4513736 DOI: 10.3399/bjgp15x686053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/16/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Diagnosis of dementia often requires specialist referral and detailed, time-consuming assessments. AIM To investigate the utility of simple clinical items that non-specialist clinicians could use, in addition to routine practice, to diagnose all-cause dementia syndrome. DESIGN AND SETTING Cross-sectional diagnostic test accuracy study. Participants were identified from the electoral roll and general practice lists in Caerphilly and adjoining villages in South Wales, UK. METHOD Participants (1225 men aged 45-59 years) were screened for cognitive impairment using the Cambridge Cognitive Examination, CAMCOG, at phase 5 of the Caerphilly Prospective Study (CaPS). Index tests were a standardised clinical evaluation, neurological examination, and individual items on the Informant Questionnaire for Cognitive Disorders in the Elderly (IQCODE). RESULTS Two-hundred and five men who screened positive (68%) and 45 (4.8%) who screened negative were seen, with 59 diagnosed with dementia. The model comprising problems with personal finance and planning had an area under the curve (AUC) of 0.92 (95% confidence interval [CI] = 0.86 to 0.97), positive likelihood ratio (LR+) of 23.7 (95% CI = 5.88 to 95.6), negative likelihood ratio (LR-) of 0.41 (95% CI = 0.27 to 0.62). The best single item for ruling out was no problems learning to use new gadgets (LR- of 0.22, 95% CI = 0.11 to 0.43). CONCLUSION This study found that three simple questions have high utility for diagnosing dementia in men who are cognitively screened. If confirmed, this could lead to less burdensome assessment where clinical assessment suggests possible dementia.
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Affiliation(s)
- Sam Creavin
- NIHR academic clinical fellow in general practice
| | - Mark Fish
- Department of Neurology, Musgrove Park Hospital, Taunton
| | - John Gallacher
- Department of Primary Care and Public Health, Cardiff University, Cardiff
| | - Antony Bayer
- Department of Primary Care and Public Health, Cardiff University, Academic Centre, University Hospital Llandough, Cardiff
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol
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Dubroff JG, Nasrallah IM. Will PET amyloid imaging lead to overdiagnosis of Alzheimer dementia? Acad Radiol 2015; 22:988-94. [PMID: 26100192 DOI: 10.1016/j.acra.2015.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/02/2015] [Accepted: 02/05/2015] [Indexed: 11/16/2022]
Abstract
Alzheimer disease (AD), a progressive neurodegenerative disease that causes dementia, affects millions of elderly Americans and represents a growing problem with the aging of the population. There has been an increasing effort for improved and earlier diagnosis for AD. Several newly developed radiolabeled compounds targeting β-amyloid plaques, one of the major pathologic biomarkers of AD, have recently become available for clinical use. These radiopharmaceuticals allow for in vivo noninvasive visualization of abnormal β-amyloid deposits in the brain using positron emission tomography (PET). Amyloid PET imaging has demonstrated high sensitivity for pathologic cerebral amyloid deposition in multiple studies. Principal drawbacks to this new diagnostic test are declining specificity in older age groups and uncertain clinical role given lack of disease-modifying therapy for AD. Although there is strong evidence for the utility of amyloid PET in certain situations, detailed in a set of guidelines for appropriate use from the Alzheimer's Association and the Society of Nuclear Medicine and Molecular Imaging, the question of overdiagnosis, the diagnosis of a disease that would result in neither symptoms nor deaths, using this new medical tool needs to be carefully considered in light of efforts to secure reimbursement for the new technology that is already widely available for use as a clinical tool.
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Affiliation(s)
- Jacob G Dubroff
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 110 Donner Building, Philadelphia, PA 19104.
| | - Ilya M Nasrallah
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 110 Donner Building, Philadelphia, PA 19104
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Affiliation(s)
- Baba M Aji
- Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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Ghadiri-Sani M, Larner AJ. Cognitive screening instrument use in primary care: is it changing? ACTA ACUST UNITED AC 2014. [DOI: 10.2217/cpr.14.37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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