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Alzheimer s v Vascular Dementia Can you tell the difference

Alzheimer's v Vascular. PlaquesTanglesInsidious onsetProgressive deterioration. Infarction Sudden onsetStepwise deterioration Focal signs and symptomsPathological emotionalism. Hachinski Score. Abrupt onset 2Stepwise deterioration1Fluctuating course2Nocturnal confusion 1Personality preservation1Depression1Somatic complaints1 .

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Alzheimer s v Vascular Dementia Can you tell the difference

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    1. Alzheimer’s v Vascular Dementia Can you tell the difference? Jonathan Waite Lings Bar Hospital Nottingham

    2. Alzheimer’s v Vascular Plaques Tangles Insidious onset Progressive deterioration Infarction Sudden onset Stepwise deterioration Focal signs and symptoms Pathological emotionalism

    3. Hachinski Score Abrupt onset 2 Stepwise deterioration 1 Fluctuating course 2 Nocturnal confusion 1 Personality preservation 1 Depression 1 Somatic complaints 1 Emotional incontinence 1 Hypertension 1 Strokes 2 Vascular disease 1 Focal signs 2 Focal symptoms 2

    4. Evidence for mixed disorders Dementia in absence of cerebral infarction requires 8x greater tangle burden (Snowden et al 1997) Only 13% patients clinically diagnosed as having VaD had pure VaD at PM (50% pure AD, 37% mixed) (Nolan et al 1998) >40% of patients meeting vascular dementia criteria have AD pathology (Kalaria 2003) Only 21% of Alzheimer cases have pure AD pathology (MRC-CFANS Ince 2004)

    5. Pathology in MRC-CFANS

    6. MRC-CFANS - Vascular

    7. But… “the lack of clear blue water between Alzheimer disease and vascular dementia is plainly acknowledged” British Journal of Psychiatry (2002) 180 97-98

    8. Unimodal v Bimodal

    9. Sir Martin Roth FRS 1917- Roth (1955) The natural history of metal disorder in old age Blessed, Tomlinson & Roth (1968) The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects Roth & Wischik (1985) Heterogeneity in senile dementia

    10. Sir Martin Roth FRS 1917- Carney Roth & Garside (1955) The diagnosis of depressive symptoms and the prediction of ECT response

    11. Endogenous v Reactive

    12. Bob Kendell 1935-2002 The Role of Diagnosis in Psychiatry (Oxford: Blackwell 1975)

    13. Psychotic v Endogenous Depression Roth Bimodal distribution Two separate disorders Kendell Unimodal distribution Single disorder with distinctive psychopathology at extremes of continuum

    14. Alzheimer’s v Vascular

    15. Risk factors for Alzheimer’s Disease Diabetes (Stewart 1998) Midlife hypertension (Elias et al 1993) Smoking (Ott et al 1998, Launer et al 1999) Atrial fibrillation (Stewart et al 1999) Stroke (Kalaria & Skoog 2000) Cholesterol (Notkola et al 1998, Kivipelto et al 2001)

    16. Risk factors for Vascular Dementia Diabetes (Desmond et al 1993) Midlife hypertension (Lindsay et al 1997) Smoking (Meyer et al 1988) Atrial fibrillation (Stewart et al 1999) Stroke (Blessed et al 1968) Cholesterol (Moroney et al 1999)

    17. Cholinesterase Inhibitors Response to ChEI in vascular dementia Galantamine (Erkinjuntti et al 2002) Donepezil (Black et al 2003)

    18. Natural History ? Recent studies Christie (1985) – no significant differences between diagnostic groups

    19. Understanding Vascular Dementia Hearts & Brains Mind Your Head www.alzheimers.org.uk

    20. Conclusions Consider vascular risk factors in Alzheimer’s Disease Consider Alzheimer’s Disease in patients with vascular disorders

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