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Constellation of Symptoms Help Diagnose Early Alzheimer's

There is a constellation of symptoms that doctors can keep in mind to evaluate geriatric patients for early Alzheimer's Disease dementia.

This constellation includes six basic items. These are difficulty in calculation, repetition, getting lost while driving, forgetting relatives' names, poor judgment and missing recall items on the Mini-Mental State Examination (MMSE) for Alzheimer criteria from the Diagnostic and Statistical Manual of Mental Disorders IV.

"If primary care physicians keep the constellation of symptoms in mind while evaluating their geriatric population, they will have greater ability to suspect, diagnose and treat Alzheimer disease," say researchers from the University of Cincinnati in Ohio.

They point out that the elderly component in the general population is booming and the prevalence of dementia is soaring. "It becomes imperative that primary care physicians recognize early dementia within their own practices," they suggest.

Researchers conducted a retrospective medical-record review of the out-patient referral populations at two geriatric centres.
A total of 1,025 patient records were reviewed and 50 patients were selected. Basis of selection was having MMSE scores of 23 or higher, geriatric depression scale scores of less than five, age older than 60 years and education of at least grade eight.

Researchers report that 40 patients (80 percent) missed at least two, if not all three, of the MMSE recall items. Also, 30 patients (60 percent) had difficulty managing their finances or balancing a checkbook.

A total of 16 patients (32 percent) repeated stories and statements frequently, 15 (30 percent) became lost while driving, ten (20 percent) frequently forgot relatives' names and ten (20 percent) had poor judgment.

"These results demonstrated a high correlation with recall as a diagnostic factor in diagnosing early Alzheimer's disease," the researchers concluded.

Investigators also found that Alzheimer's symptoms overlapped in the areas of learning and retaining new information, handling complex tasks, reasoning and spatial ability and orientation.
Archives of Family Medicine, 2000; 9: 1066-1070. "Clues to Early Alzheimer Dementia in the Outpatient Setting"

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