Establishing diagnostic criteria: the role of clinical pragmatics

The study of pragmatic disorders is of interest to speech-language pathologists who have a professional responsibility to assess and treat communication impairments. However, these disorders, it will be argued in this paper, have a significance beyond the clinical management of clients with communication impairments. Specifically, pragmatic disorders can now make a contribution to the diagnosis of a range of clinical conditions in which communication is adversely affected. These conditions include attention deficit hyperactivity disorder (ADHD), the autistic spectrum disorders, schizophrenia and the dementias. Pragmatic disorders are already among the criteria used to diagnose some of these conditions (e.g. ADHD), although they are not described in these terms. In other conditions (e.g. the dementias), pragmatic disorders have potential diagnostic value in the absence of reliable biomarkers markers of these conditions and similar initial presenting symptoms. Using clinical data, and the findings of empirical studies, the case is made for the inclusion and/or greater integration of pragmatic disorders in the formal classificatory systems that are used to diagnose a range of disorders. A previously unrecognised role for pragmatic impairments in the nosology and diagnosis of clinical disorders is thereby established

CSF lactate dehydrogenase activity in patients with Creutzfeldt-Jakob disease exceeds that in other dementias

The diagnosis of Creutzfeldt- Jakob disease (CJD) is still made by exclusion of other dementias. We now evaluated lactate dehydrogenase (LDH) in the cerebrospinal fluid (CSF) as a possible additional diagnostic tool. CSF LDH levels of patients with CJD ( n = 26) were compared with those in other dementias ( n = 28). LDH isoenzymes were determined in a subset ( n = 9). Total LDH and isoenzyme LDH-1 were significantly higher, whereas the fractions of LDH-2 and LDH-3 were significantly lower in CJD patients. We conclude that in addition to established CSF parameters, LDH and its isoenzymes might serve as a further help to discriminate between CJD and other dementias. Copyright (C) 2004 S. Karger AG, Basel

What Can Quantitative Gait Analysis Tell Us about Dementia and Its Subtypes? A Structured Review

Distinguishing dementia subtypes can be difficult due to similarities in clinical presentation. There is increasing interest in discrete gait characteristics as markers to aid diagnostic algorithms in dementia. This structured review explores the differences in quantitative gait characteristics between dementia and healthy controls, and between four dementia subtypes under single-task conditions: Alzheimer’s disease (AD), dementia with Lewy bodies and Parkinson’s disease dementia, and vascular dementia. Twenty-six papers out of an initial 5,211 were reviewed and interpreted using a validated model of gait. Dementia was associated with gait characteristics grouped by slower pace, impaired rhythm, and increased variability compared to normal aging. Only four studies compared two or more dementia subtypes. People with AD are less impaired in pace, rhythm, and variability domains of gait compared to non-AD dementias. Results demonstrate the potential of gait as a clinical marker to discriminate between dementia subtypes. Larger studies using a more comprehensive battery of gait characteristics and better characterized dementia sub-types are required

Alzheimer's disease and HIV associated dementia related genes: I. location and function.

Alzheimer's disease (AD), the most common cause of dementia, has few clinical similarities to HIV-1-associated dementia (HAD). However, genes were identified related among these dementias. Discovering correlations between gene function, expression, and structure in the human genome continues to aid in understanding the similarities between pathogenesis of these two dementing disorders. The current work attempts to identify relationships between these dementias in spite of their clinical differences, based on genomic structure, function, and expression. In this comparative study, the NCBI Entrez Genome Database is used to detect these relationships. This approach serves as a model for future diagnosis and treatment in the clinical arena as well as suggesting parallel pathways of disease mechanisms. Identifying a correlation among expression, structure, and function of genes involved in pathogenesis of these dementing disorders, may assist to understand better their interaction with each other and the human genome

Resilience in Caregivers of Partners With Young Onset Dementia: A Concept Analysis

Introduction: Over 200,000 Americans diagnosed with young onset dementia (YOD), dementia diagnosed prior to age 65, are cared for by family members. This can be costly to caregivers’physical and psychological health. Some adapt well to the caregiver role and are said to be resilient. Aim/Question: This paper builds on current understanding of the concept of resilience and applies this to caregivers of partners diagnosed with YOD. Method: Concept analysis. Results: Resilient caregivers exhibit attributes including determination, flexibility, positive thinking, self-efficacy, resourcefulness, social support and spirituality. Discussion: YOD affects caregiver’s health. Much research has been done on interventions for dementia caregivers. These interventions do not necessarily meet the needs of YOD caregivers as they do not account for dynamics in the family. By recognizing what is resiliency in YOD caregivers, interventions can be developed that focus on characteristics that build these attributes. Implications for Practice: Understanding the concept of resilience related to caregiving for a partner diagnosed with YOD allows for future development, measurement, and evaluation of nursing interventions. Nursing staff are in a strategic position to provide effective interventions to enhance resilience among caregivers of YOD

Diagnosis in vascular dementia, applying ‘Cochrane diagnosis rules’ to ‘dementia diagnostic tools’

In this issue of Clinical Science, Biesbroek and colleagues describe recent work on magnetic resonance imaging (MRI)-based cerebral lesion location and its association with cognitive decline. The authors conclude that diagnostic neuroimaging in dementia should shift from whole-brain evaluation to focused quantitative analysis of strategic brain areas. This commentary uses the review of lesion location mapping to discuss broader issues around studies of dementia test strategies. We draw upon work completed by the Cochrane Dementia and Cognitive Improvement Group designed to improve design, conduct and reporting of dementia biomarker studies

Preventing the Unnecessary Losses of Alzheimer\u27s Disease

Educational Objectives 1. To state the importance of early detection and diagnosis of Alzheimer\u27s disease. 2. To describe common concerns of people in the early stages of Alzheimer\u27s disease. 3. To describe interventions to help people who have recently been diagnosed with Alzheimer\u27s disease or other dementias

Predeath Grief, Resourcefulness, and Perceived Stress Among Caregivers of Partners With Young-Onset Dementia

More than 200,000 Americans are currently diagnosed with young-onset dementia (YOD). YOD is dementia diagnosed prior to the age of 65. Most persons of YOD are cared for by their partners. Using the theoretical framework of Resilience Theory, this cross-sectional, correlational study examined the moderating effects of personal and social resourcefulness on the relationship between predeath grief and perceived stress among 104 YOD caregiving partners (life partners/spouses) using an online survey platform. Results indicated a large positive correlation between predeath grief and caregiver perceived stress (r = .65; p \u3c .001). Together predeath grief, personal resourcefulness and social resourcefulness explained 51.5% of the variance in perceived stress. Personal resourcefulness did not moderate the relationship. Social resourcefulness did positively moderate this relationship between predeath grief and perceived stress. These findings allow for a better understanding of the caregiving experience for a partner with YOD and creates opportunities for future research studies