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Alzheimer's disease: the problem of incorrect clinical diagnosis
L D McDaniel1, T Lukovits, K D McDaniel
1Department of Psychiatry, University of Rochester School of Medicine and Dentistry, NY.
Abstract:
We reviewed the medical records of eight patients clinically diagnosed with Alzheimer's disease who were found on autopsy to have neuropathologic findings inconsistent with Alzheimer's disease. The clinical criteria for the diagnosis of probable Alzheimer's disease from the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) were retrospectively applied to these patients. The patients presented with clinical features atypical for Alzheimer's disease early in the course of the disease, including focal neurologic findings, gait abnormalities, motor speech abnormalities, and extrapyramidal features. Attention to these clinical red flags may decrease the likelihood of misdiagnosis of Alzheimer's disease in a patient with a non-Alzheimer's disease cause of dementia.
Insights
Clinical diagnosis of Alzheimer's disease can be mistaken. Early atypical symptoms like gait issues may indicate other dementias, prompting careful evaluation to avoid misdiagnosis.
Area of Science:
- Neurology
- Pathology
- Geriatrics
Background:
- Alzheimer's disease (AD) diagnosis relies on clinical criteria and post-mortem confirmation.
- Misdiagnosis can occur when clinical presentation deviates from typical AD.
- Accurate differential diagnosis is crucial for appropriate patient management.
Purpose of the Study:
- To identify clinical features in patients misdiagnosed with Alzheimer's disease.
- To evaluate the utility of National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) criteria in atypical cases.
- To highlight red flags that may suggest non-Alzheimer's dementia.
Main Methods:
- Retrospective review of medical records for eight patients.
- Application of NINCDS/ADRDA probable Alzheimer's disease diagnostic criteria.
- Analysis of clinical presentation and autopsy-confirmed neuropathology.
Main Results:
- Eight patients diagnosed with probable Alzheimer's disease showed non-Alzheimer's neuropathology at autopsy.
- These patients exhibited early atypical clinical features, including focal neurological deficits, gait disturbances, motor speech problems, and extrapyramidal signs.
- The NINCDS/ADRDA criteria were applied retrospectively.
Conclusions:
- Clinical diagnosis of Alzheimer's disease may be inaccurate in some cases.
- Atypical early symptoms are critical indicators for considering alternative dementia diagnoses.
- Recognizing these clinical red flags can improve diagnostic accuracy and prevent misdiagnosis of Alzheimer's disease.