Diagnosis of Alzheimer type dementia [ATD]

The international diagnostic criteria of ATD presents the appearance of the exclusion diagnosis. In other words, the thing left to the patient without a symptom of Pick's and DLB is a negative diagnostic method to be ATD. Most of the patients who have low Pick score, Lewy score when Dr. Kono performs the work by the system of the Kono method crisply are ATD.

Diagnosis of Alzheimer type dementia.JPG

Refer to
CDT(Clock Drow Test), Pick Score, Lewy Score

In progress of Alzheimer's disease (AD), it is characterized by "progression of slow onset and sustained cognitive impairment", and it is expected that diagnosis itself called Alzheimer's disease is suspicious when progress is not confirmed. When progress is very slow; neurofibril change type old age (period) dementia (senile dementia of the neurofibrillary tangle type).

It is necessary to take SD-NFT into consideration. SD-NFT is one subtype of neurofibril change type dementia. Neurofibril change type dementia is a generic name of dementia that a neurofibril change occupies the main seat of the lesion.
SD-NFT limbic system neurofibril change dementia (LNTD, limbic neurofibrillary tangle dementia). It develops for forgetfulness, and it leads to dementia via mild cognitive impairment(MCI), but progress is slow, and the cognitive functional disorder is relatively light, and old-old has characteristic that it is kept a ratio the personality level mainly.

In the CT views, the localized atrophy of the sea lion domain is characteristic. In the pathology views, innumerable neurofibril changes limited to the sea lion domain are seen and are distinguished from AD because there are few senile plaques. SD-NFT becomes the important disease concept in deepening the understanding about all MCI not leading to AD.

Argyrophilic grain disease (AGD) is a sporadic, very late-onset tauopathy, accounting for approximately 4-13% of neurodegenerative dementias. AGD may manifest with a range of symptoms such as cognitive decline and behavioral abnormalities.

As a result of Aricept being released, and having given it to 700 patients with ATD in one year, Dr. Kono understood the propensity of Aricept well. Anyway, it becomes irritable.
Only an average of 3.6 mg was usable and couldn't but use a tiapride together in 41%. The teacher does not take the trouble of the family kindly so much if there is a doctor to think not to have possibilities to need to prescribe it.

Aricept of 3.6mg.JPG

Generally all the doctors of the university hospital are so. It is called the sympathy threshold. It is people to prescribe it for that what happens to a patient if said that I do not make less than 5 mg.

Because such people are the directors of the society, there is no campaign to say that taking out Aricept less in a society.
It was 14 years that it was for profit of Eisai earnestly. However, fell silent, and the spot disappeared when DLB and Pick's disease increased. The side effect of Aricept cannot be ignored. The person who died in braducardia came out. Because Eisai let generic drug measures accept 10 mg of use, the damage spread.

The ratio of  dementia types reported by clinicians.JPG

When doctors diagnose dementia, LPC cannot be ignored.
I, an editor of this blog, want to point it out daringly. Only ATD is not dementia. The doctor who cannot diagnose LPC and FTLD precisely should not do  medical treatment for dementia.

Misdiagnosis Course of ATD [ATD]

ATD is sometimes, or more, misdiagnosed with FTD(Pick's disease). Therefore ATD is a diagnosis by exclusion, it is important that ATD should be correctly distinguished from FTD.

Donepezil is like a litmus paper.  Prescribing donepezil means finding out that a patient is ATD or not. If donepezil side effect leads to anger, it is a probability of Pick desiase of 70%. If donepezil side effect leads to gait disorder, it is a probability of DLB of 100%
In case that a donepezil has no merit, prescribing a rivastigmine is the best choice.

It is presumed that doctors, who do not FTD, might misdiagnose ATD.

Misdiagnosis Course of ATD.JPG