Seminars in Neurology, Table of Contents Semin Neurol 2002; 22(1): 063-070DOI: 10.1055/s-2002-33049 Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662 Cost-Effective Recognition and Diagnosis of DementiaDavid S. Geldmacher Associate Professor of Neurology, Case Western Reserve University, and Clinical Director, University Memory and Aging Center, University Hospitals of Cleveland, Cleveland, Ohio Recommend Article Abstract Buy Article ABSTRACT Alzheimer's disease (AD) has the potential to become the most overwhelming public health concern of this century due to increasing life expectancy and growth in the aging population. As a result, primary care physicians and neurologists will be seeing a greater number of elderly patients in their practice and will subsequently be expected to both identify and initiate treatment in those individuals who may display signs of dementia and related neurologic conditions. There is good evidence that AD is underrecognized or undercoded in primary care settings. Underrecognition is an important problem in this population because early treatment and counseling have been shown to provide benefits to both patients and caregivers. As their patient population ages, physicians need to learn to recognize the early symptoms of AD and make a diagnosis in order to provide cost-effective therapies. KEYWORDS Alzheimer's disease - dementia - pharmacoeconomics - economics - diagnosis Full Text References REFERENCES 1 Hendrie H C. Epidemiology of dementia and Alzheimer's disease. Am J Geriatr Psychiatry . 1998; S3-S18 2 Evans D A, Funkenstein H H, Albert M S. Prevalance of Alzheimer's disease in a community population of older persons: higher than previously reported. JAMA . 1989; 262 2551-2556 3 Meek P D, McKeithan E K, Schumock G T. Economic considerations in Alzheimer's disease. Pharmacotherapy . 1998; 18 68-73 4 Gutterman E M, Markowitz J S, Lewis B, Fillit H. Cost of Alzheimer's disease and related dementia in managed-Medicare. JAGS . 1999; 47 1065-1071 5 Weiner M, Powe N R, Weller W E. Alzheimer's disease under managed care: implications from Medicare utilization and expenditure patterns. J Am Geriatr Soc . 1998; 46 762-770 6 Lyketsos C G, Sheppard J M, Rabins P V. Dementia in elderly persons in a general hospital. Am J Psychiatry . 2000; 157 704-707 7 Torian L, Davidson E, Fulop G. The effect of dementia on acute care in a geriatric medical unit. Int Psychogeriatr . 1992; 4 231-239 8 Small G W, Rabins P V, Barry P B. Diagnosis and treatment of Alzheimer disease and related disorders: consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society. JAMA . 1997; 278 1363-1371 9 Knopman D S, DeKosky S T, Cummings J L. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology . 2001; 56 1143-1153 10 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th ed. Washington, DC: American Psychiatric Association; 1994 11 Larrabee G J, Crook T H. Estimated prevalence of age-associated memory impairment derived from standardized tests of memory function. Int Psychogeriatr . 1994; 6 95-104 12 Costa Jr P T, Williams T F, Somerfeld M. Early identification of Alzheimer's disease and related dementias. Clinical Practice Guideline, Quick Reference Guide for Clinicians, No. 19. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy Research; 1996. AHCPR Publication No. 97-0703 . 13 Petersen R C, Smith G E, Waring S C. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol . 1999; 56 303-308 14 Petersen R C, Stevens J C, Ganguli M. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology . 2001; 56 1133-1142 15 Callahan C M, Hendrie H C, Tierney W M. Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med . 1995; 122 422-429 16 Kukull W A, Brenner D E, Speck C E. Causes of death associated with Alzheimer disease: variation by level of cognitive impairment before death. J Am Geriatr Soc . 1994; 42 723-726 17 Newcomer R, Clay T, Luxenberg J S, Miller R H. Misclassification and selection bias when identifying Alzheimer's disease solely from Medicare claims records. J Am Geriatr Soc . 1999; 47 215-219 18 Boise L, Camicioli R, Morgan D L. Diagnosing dementia: perspectives of primary care physicians. Gerontologist . 1999; 39 457-464 19 Knopman D S, Schneider L, Davis K. Long term tacrine (Cognex) treatment: effects on nursing home placement and mortality, Tacrine Study Group. Neurology . 1996; 47 166-177 20 Sano M, Ernesto C, Thomas R G. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study. N Eng J Med . 1997; 336 1216-1222 21 Mittelman M S, Ferris S H, Shulman E. A family intervention to delay nursing home placement of patients with Alzheimer disease. A randomized controlled trial. JAMA . 1996; 276 1725-1731 22 American Psychiatric Association. Practice guideline for the treatment of patients with Alzheimer's disease and other dementia of late life. Am J Psychiatry . 1997; 154(suppl) 1-33 23 Esteban-Santillan C, Praditsuwan R, Ueda H. Clock drawing test in very mild Alzheimer's disease. J Am Geriatr Soc . 1998; 46 1266-1269 24 Geldmacher D S. Contemporary diagnosis and management of Alzheimer's disease. 1st ed. Newtown, PA: Handbooks in Health Care, Co.; 2001 25 Folstein M F, Folstein S E, McHugh P. ``Mini-Mental State'': a practical method of grading cognitive state of patients for the clinician. J Psychiatr Res . 1975; 12 189-198 26 Crum R M, Anthony J C, Bassett S S. Population-based norms for the Mini-Mental State Examination by age and education level. JAMA . 1993; 269 2386-2391 27 Doody R S, Stevens J C, Beck C. Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology . 2001; 56 1154-1166 28 Tariot P N, Solomon P R, Morris J C. A 5-month, randomized, placebo controlled trial of galantamine in AD. Neurology . 2000; 54 2269-2276
