We conducted a survey regarding the medical care of patients with dementia in expert settings in Belgium. Open, unrestricted and motivated answers were centralized, blindly interpreted and structured into categories. The report of the results was then submitted to the participants in subsequent plenary meetings and through email. Fourteen experts responded to the questionnaire, confirming that recent propositions to modify Alzheimer’s disease (AD) diagnostic criteria and options have stirred up debate among well-informed and dedicated experts in the field. The opinions were not unanimous and illustrate how difficult it is to find a standardized method of diagnosing this disease. The responses to the survey suggest that application of a step-by-step pragmatic method is used in practice. Only when the combination of clinical findings and classical structural neuro-imaging is insufficient for a diagnosis or suggests an atypical presentation, additional biomarkers are considered. Interestingly, few differences, if any, were observed between the use of biomarkers in MCI and in AD. In conclusion, the Belgian experts consulted in this survey were generally in agreement with the new diagnostic criteria for AD, although some concern was expressed about them being too “amyloidocentric”. Although the clinical examination, including a full neuropsychological evaluation, is still considered as the basis for diagnosis, most experts also stated that they use biomarkers to help with diagnosis.
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This work was supported by the University of Antwerp Research Fund and the Alzheimer Research Foundation (SAO-FRA).
Conflict of interest
The authors declare that they have no conflict of interest.
Boller F, Forbes MM (1998) History of dementia and dementia in history: an overview. J Neurol Sci 158(2):125–133CrossRefPubMedGoogle Scholar
Jack CR Jr, Albert MS, Knopman DS et al (2011) Introduction to the recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7:257–262PubMedCentralCrossRefPubMedGoogle Scholar
Petersen RC, Smith GE, Waring SC et al (1999) Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 56:03–08CrossRefGoogle Scholar
Dubois B, Feldman HH, Jacova C et al (2010) Revising the definition of Alzheimer’s disease: a new lexicon. Lancet Neurol 9:1118–1127CrossRefPubMedGoogle Scholar
Dubois B, Feldman HH, Jacova C et al (2014) Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. Lancet Neurol 13:614–629CrossRefPubMedGoogle Scholar
Sperling RA, Aisen PS, Beckett LA et al (2011) Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7(3):280–292PubMedCentralCrossRefPubMedGoogle Scholar
Albert MS, DeKosky ST, Dickson D et al (2011) The diagnosis of mild cognitive impairment 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 7:270–279PubMedCentralCrossRefPubMedGoogle Scholar
McKhann GM, Knopman DS, Chertkow H et al (2011) 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 7:263–269PubMedCentralCrossRefPubMedGoogle Scholar
Jiha GA, Rentz DM (2013) Cognitive and brain reserve and the diagnosis and treatment of preclinical Alzheimer disease. Neurology 80:1–2CrossRefGoogle Scholar
Vuoksimaa E, Panizzon MS, Chen CH et al (2013) Cognitive reserve moderates the association between hippocampal volume and episodic memory in middle age. Neuropsychologia 51(6):1124–1131PubMedCentralCrossRefPubMedGoogle Scholar
Montine TJ, Phelps CH et al (2012) National Institute on Aging-Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease: a practical approach. Acta Neuropathol 123:1–11PubMedCentralCrossRefPubMedGoogle Scholar
Bennett DA, Schneider JA, Arvanitakis Z et al (2006) Neuropathology of older persons without cognitive impairment from two community-based studies. Neurology 66(12):1837–1844CrossRefPubMedGoogle Scholar
Vandenberghe R, Adamczuk K, Dupont P et al (2013) Amyloid PET in clinical practice: its place in the multidimensional space of Alzheimer’s disease. Neuroimage Clin 2:497–511PubMedCentralCrossRefPubMedGoogle Scholar
Biomarkers definitions working group (2001) Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther 69(3):89–95CrossRefGoogle Scholar
Scheltens P, van der Pol L (2012) Impact commentaries. Atrophy of medial temporal lobes on MRI in “probable” Alzheimer’s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 83(11):1038–1040CrossRefPubMedGoogle Scholar
Klunk WE, Engler H, Nordberg A et al (2004) Imaging brain amyloid in Alzheimer’s disease with Pittsburgh Compound-B. Ann Neurol 55(3):306–319CrossRefPubMedGoogle Scholar
Vandenberghe R, Van Laere K, Ivanoiu A et al (2010) 18F-flutemetamol amyloid imaging in Alzheimer disease and mild cognitive impairment: a phase 2 trial. Ann Neurol 68:319–329CrossRefPubMedGoogle Scholar