Retinal nerve fiber layer abnormalities in Alzheimer's disease

Retinal nerve fiber layer (RNFL) photographs from 26 patients with Alzheimer's disease and 23 normal, age-matched, control subjects were reviewed for quality and abnormalities by two observers. A higher proportion of Alzheimer's patients showed RNFL abnormalities when compared to control subjects. There was some disagreement between the two observers regarding quality and frequency of abnormalities, reflecting suboptimal quality of the photographs obtained in patients with advanced Alzheimer's disease. Although these findings add to the clinical and histopathological evidence that ganglion cell degeneration occurs in Alzheimer's disease, the difficulty in obtaining and evaluating retinal nerve fiber layer photographs, especially in advanced cases, may limit the clinical usefulness of retinal nerve fiber layer analysis in such patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73257/1/j.1600-0420.1996.tb00090.x.pd

An Unusual Cause of Isolated Third Nerve Palsy in an Infant

Drooping right upper eyelid; Tearing; Light sensitivity; Pupillary dilationA 9-month old male with drooping ptosis and limitation of movement OD.Impaired movement and ptosis ODN/ATissue mass ventral to right cerebral peduncle encroaching onto CN III.Surgery; Antineoplastic agentsAttache

P4‐095: The prevalence and impact of type 2 diabetes in mild cognitive impairment and Alzheimer’s disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152636/1/alzjjalz200904864.pd

FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer’s disease

Distinguishing Alzheimer’s disease (AD) and frontotemporal dementia (FTD) currently relies on a clinical history and examination, but positron emission tomography with [ 18 F] fluorodeoxyglucose (FDG-PET) shows different patterns of hypometabolism in these disorders that might aid differential diagnosis. Six dementia experts with variable FDG-PETexperience made independent, forced choice, diagnostic decisions in 45 patients with pathologically confirmed AD (n =31) or FTD (n = 14) using five separate methods: (1) review of clinical summaries, (2) a diagnostic checklist alone, (3) summary and checklist, (4) transaxial FDG-PET scans and (5) FDG-PET stereotactic surface projection (SSP) metabolic and statistical maps. In addition, we evaluated the effect of the sequential review of a clinical summary followed by SSP.Visual interpretation of SSP images was superior to clinical assessment and had the best inter-rater reliability (mean kappa = 0.78) and diagnostic accuracy (89.6%). It also had the highest specificity (97.6%) and sensitivity (86%), and positive likelihood ratio for FTD (36.5).The addition of FDG-PET to clinical summaries increased diagnostic accuracy and confidence for both AD and FTD. It was particularly helpful when raters were uncertain in their clinical diagnosis.Visual interpretatio

[P1–469]: Race And Amnestic Mci Subtype Performance In Comparison To Healthy Older Controls On The Nih Toolbox‐Cognitive

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153243/1/alzjjalz201706485.pd

Validation of consensus panel diagnosis in dementia.

BackgroundThe clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance.ObjectiveTo determine conditions that improve consensus panel diagnosis.DesignComparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images.SettingExpert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography.PatientsForty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia.Main outcome measuresStatistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations.ResultsThe consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules.ConclusionsUsing a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making