Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Diagnosing dementia

David C. Wang, Sandra E. Black and Katherine A. Zukotynski
CMAJ May 17, 2016 188 (8) 603; DOI: https://doi.org/10.1503/cmaj.150508
David C. Wang
Faculty of Medicine (Wang) and Department of Medicine (Black), University of Toronto; Sunnybrook Health Sciences Centre (Black), University of Toronto; Institute of Biomaterials and Biomedical Engineering (Black, Zukotynski), University of Toronto, Toronto, Ont.; Departments of Medicine and Radiology (Zukotynski), McMaster University, Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sandra E. Black
Faculty of Medicine (Wang) and Department of Medicine (Black), University of Toronto; Sunnybrook Health Sciences Centre (Black), University of Toronto; Institute of Biomaterials and Biomedical Engineering (Black, Zukotynski), University of Toronto, Toronto, Ont.; Departments of Medicine and Radiology (Zukotynski), McMaster University, Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Katherine A. Zukotynski
Faculty of Medicine (Wang) and Department of Medicine (Black), University of Toronto; Sunnybrook Health Sciences Centre (Black), University of Toronto; Institute of Biomaterials and Biomedical Engineering (Black, Zukotynski), University of Toronto, Toronto, Ont.; Departments of Medicine and Radiology (Zukotynski), McMaster University, Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: katherine.zukotynski@utoronto.ca
  • Article
  • Responses
  • Metrics
  • PDF
Loading

See also page 598 and www.cmaj.ca/lookup/doi/10.1503/cmaj.150663

Dementia is a clinical diagnosis

Patients presenting with suspected cognitive decline should undergo a detailed history, physical examination and cognitive screening to establish functional impairment.1 Laboratory investigations to rule out medical causes of cognitive impairment, such as hypothyroidism, anemia, electrolyte abnormalities, vitamin-B12 deficiency and hyperglycemia, should be initiated. Diagnostic criteria as defined by clinical guidelines has shown a high sensitivity (81%) but lower specificity (70%) for Alzheimer disease.2

Anatomic imaging is the first-line imaging modality in dementia

Computed tomography (CT) of the head is recommended for patients with specific features at presentation (Box 1). Magnetic resonance imaging is more sensitive than CT in detecting atrophy and small-vessel disease, including lobar microbleeds (an index of Alzheimer disease pathology) and may be used to stratify and monitor disease severity.1–3

Box 1:

Indications for computed tomography in patients with cognitive decline*

  • Age < 60 yr

  • Rapid decline in cognition or function (1–2 mo)

  • Duration of dementia < 2 yr

  • Recent head trauma

  • New unexplained neurologic symptoms or localizing signs

  • History of cancer

  • Use of anticoagulants or history of bleeding disorder

  • History of gait disorder or urinary incontinence early in dementia

  • Atypical cognitive symptoms or presentation

  • Current gait disturbance

Nuclear medicine brain scans can be useful in atypical dementia

Perfusion imaging of the brain with a technetium-99m–labelled radiotracer and single-photon emission computed tomography (SPECT) can be helpful in patients with atypical dementia, including early-onset or rapidly progressing dementia, as well as patients with unknown cause of dementia after baseline investigations.1,2 SPECT is safe and noninvasive, with effective radiation doses similar to those of CT of the head.4

Positron emission tomography may be helpful to evaluate brain metabolism or amyloid deposition

Imaging of brain metabolism with positron emission tomography (PET) using fluorine-18–labelled fluorodeoxyglucose is generally superior to perfusion imaging with SPECT for differentiating dementia subtypes, such as Alzheimer disease and Lewy body dementia, and can influence management.5 Amyloid deposition may be detected with PET using fluorine-18–labelled florbetapir, flutemetamol or florbetaben. Recently, PET has also been used to identify the presence of tau protein. In Canada, PET of the brain is currently available in some tertiary centres for clinical use or for clinical research trials.

Cerebrospinal fluid biomarkers are used for investigational purposes

Apart from ruling out infectious or autoimmune causes, cerebrospinal fluid (CSF) biomarkers, such as low CSF amyloid-β 42 and high tau levels, are available for use in investigational studies and clinical trials, and as optional clinical tools.

Footnotes

  • Competing interests: Sandra Black declares personal fees and/or grants from Pfizer, GE Healthcare, Eli Lilly, Eisai, Boehringer Ingelheim, Novartis, Elan and Transition Therapeutics, Roche and Cognoptix. No other competing interests were declared.

  • This article has been peer reviewed.

  • ↵* Adapted from Gauthier et al.1

References

  1. ↵
    1. Gauthier S,
    2. Patterson C,
    3. Chertkow H,
    4. et al
    . 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. Can J Neurol Sci 2012; 39:S1–8.
    OpenUrlPubMed
  2. ↵
    1. Knopman DS,
    2. DeKosky ST,
    3. Cummings JL,
    4. et al
    . Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1143–53.
    OpenUrlCrossRefPubMed
  3. ↵
    1. McKhann GM,
    2. Knopman DS,
    3. Chertkow H,
    4. et al
    . The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011; 7: 263–9.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Mettler FA,
    2. Huda W,
    3. Yoshizumi TT,
    4. et al
    . Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008;248:254–63.
    OpenUrlCrossRefPubMed
  5. ↵
    1. O’Brien JT,
    2. Firbank MJ,
    3. Davison C,
    4. et al
    . 18F-FDG PET and perfusion SPECT in the diagnosis of Alzheimer and Lewy body dementias. J Nucl Med 2014;55:1959–65.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 188 (8)
CMAJ
Vol. 188, Issue 8
17 May 2016
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Diagnosing dementia
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Diagnosing dementia
David C. Wang, Sandra E. Black, Katherine A. Zukotynski
CMAJ May 2016, 188 (8) 603; DOI: 10.1503/cmaj.150508

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Diagnosing dementia
David C. Wang, Sandra E. Black, Katherine A. Zukotynski
CMAJ May 2016, 188 (8) 603; DOI: 10.1503/cmaj.150508
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Dementia is a clinical diagnosis
    • Anatomic imaging is the first-line imaging modality in dementia
    • Nuclear medicine brain scans can be useful in atypical dementia
    • Positron emission tomography may be helpful to evaluate brain metabolism or amyloid deposition
    • Cerebrospinal fluid biomarkers are used for investigational purposes
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Amyloid imaging for dementia in Canada
  • Highlights
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Endometrial osseous metaplasia with secondary infertility
  • Bell palsy
  • The monkeypox virus
Show more Practice

Similar Articles

Collections

  • Article Types
    • Five Things to Know About
  • Topics
    • Dementia & Alzheimer disease
    • Family medicine, general practice, primary care
    • Imaging

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire