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Diagnostic Criteria of Dementia

Published online by Cambridge University Press:  02 December 2014

Rémi W. Bouchard
Rémi W. Bouchard*
Affiliation:
The Clinique de mémoire et unité de recherche Alzheimer, CHA Hôpital de l'Enfant-Jésus, Québec, QC, Canada
*
Clinique de mémoire et unité de recherche Alzheimer, CHA Hôpital de l'Enfant-Jésus, 1401, 18e rue, Québec, Québec, G1J 1Z4, Canada.
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Abstract

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In the past two decades there has been a tremendous effort among clinicians and searchers to improve the diagnostic criteria of the dementias on the basis of the differential neurological and neuropsychological profiles. This was an obligatory requirement for clinical trials and the development of treatments. Over the years it became rapidly evident that the cohorts of patients in studies had some degree of heterogeneity, making it difficult to interpret the results of some studies, particularly in the vascular dementias and the mild cognitive impairment (MCI) group. For example, many sub-types of the vascular group were included in clinical trials, such as the cortical strokes, the lacunar states and the diffuse white matter disease cases, and some of the patients might have had also mixed pathology. In addition, the standard DSM IV criteria for dementia no longer represent our present knowledge of the clinical profile of some of the dementias such as vascular dementia (VaD) and fronto-temporal dementia where the memory impairment is not necessarily the first requirement. To improve the validity of clinical trials and eventually help developing more appropriate treatments, we revised the present diagnostic criteria and made recommendations for some changes in the context of the 2nd Canadian Conference on the Development of Antidementia Therapies, held in 2004 and reviewed in the light of the recent literature as of early 2006. It is expected that in the near future, these dementia criteria for clinical trials will have to be revised again in order to include specific subtypes of the dementias as well as biomarkers, structural and functional imaging.

Résumé:

RÉSUMÉ:

Au cours des deux dernières décades, les cliniciens et chercheurs ont fait beaucoup de travail pour améliorer les critères diagnostiques des démences sur la base d'une meilleure connaissance des profils neurologiques et neuropsychologiques. Cela était nécessaire pour les essais cliniques et le développement de nouveaux traitements. Au cours des années il est devenu évident que les patients dans les protocoles de recherche avaient un certain degré d'hétérogénéité qui rendait difficile parfois l'interprétation de certains résultats notamment dans les démences vasculaires et les déficits cognitifs légers. Par exemple dans les études vasculaires, différents sous-groupes étaient inclus dans les études, comme les accidents vasculaires corticaux, les états lacunaires et les atteintes diffuses de la substance blanche et en plus certains des patients pouvaient aussi avoir des pathologies mixtes. De plus les critères classiques de démence selon le DSM IV ne correspondent plus au profil qu'on connaît maintenant des démences vasculaires et des démences fronto-temporales où la mémoire n'est pas nécessairement le premier critère obligatoire. Dans le but d'améliorer la validité des résultats des essais cliniques et éventuellement de développer des traitements appropriés, nous avons révisé les critères actuels des différentes démences et avons recommandé des modifications dans certains critères diagnostiques dans le cadre de la 2e Conférence Canadienne sur le Développement des Traitements de la Démence, tenue en 2004, et également à la lumière de la littérature récente jusqu'à début 2006. Dans un futur non lointain il faut s'attendre à ce que ces critères de démence pour des fins de recherche et d'essai clinique soient à nouveau révisés pour inclure les sous-groupes cliniques, les marqueurs biologiques ainsi que les données d'imagerie structurale et fonctionnelle.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue S1 , March 2007 , pp. S11 - SS18
Copyright
Copyright © The Canadian Journal of Neurological 2007

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