Accurate diagnosis is of major importance for
Accurate diagnosis is of major importance for optimizing the treatment and providing the patient and family with proper information regarding ways to cope with the disease and prepare for the future. In this context, many patients are still diagnosed with "Dementia", but not with the specific etiology: Alzheimer's disease, vascular dementia, frontal lobe dementia or dementia with Lewy bodies. The estimated prevalence of these etiologies varies greatly in different studies. Zacci in his review found that in different studies the prevalence of dementia with Lewy bodies is 0-5% in the general population and the prevalence among patients with dementia is 0 to 30.5% (Zaccai). The wide range of these findings, can point to significant differences in diagnosing this medical condition. Differences in data can rate this disease as the common cause of dementia after Alzheimer's disease or as an esoteric rare disease.
97subjects residents of a centrally located unit and 67 residents of a unit in the periphery. Patients in the center were not significantly different in their age from their counterparts in the periphery. Significant differences were found in the following parameters: the pre hospitalization socio-economic status of patients that was significantly higher in the center than in the periphery. In the center patients had significantly more years of education and more in-house leaving employed workers prior to hospital admission (Table 1).
These aspects are related to one another. A patient under close observation and follow up in a memory clinic will most probably have a better chance of being diagnosed correctly and receiving the available treatment. Our results show that significantly fewer patients in the periphery were in a follow-up of a memory clinic. Significantly fewer patients with the diagnosis of probable Alzheimer's disease in the periphery had a CT scan. We see it as a possible indication to the difference in the diagnosis process between center and periphery.
We believe that an appropriate solution for the general population and especially for those living in the periphery is to have a spread-out network of regional memory clinics for the elderly. We should aspire that all patients with dementia should be in a follow up of a memory clinic. In this way disparities will be minimized; more patients will undergo thorough investigation in order to establish as accurate a diagnosis as possible. Choline esterase inhibitors and Memantine will be prescribed to every patient with the proper indication. Atypical neuroleptic drugs should be readily available to each patient with dementia and behavioral problems. The current situation in Israel in which many patients are not in a routine follow-up of memory clinics, probably affects the quality of care these patients receive.
Lancet 2005 ;366(9503):2112-7.Lancet 2005 ;366(9503):2112
A systematic review of prevalence and incidence studies of dementia with Lewy bodies.
Choctaw Indian dementia patients. Alzheimers Dement. 2011;7(6):562-6.
The Israeli Central Bureau of statistics.
Live-in home aid
Table 1. Demographic data: Patients from the center vs. periphry
Fig. (1) MMSE score on admission Center vs. Periphery. Error bars represent confidence limits.
Follow-up by a memory clinic (%)
Fig. (2) Patients who were in a follow-up of a memory clinic prior to admission. Error bars represent confidence limits.
Fig. (3) Patients with Alzheimer's disease who undergo CT scan prior to admission. Error bars represent confidence limits.
Fig. (4) The portion of patients who were treated with atypical neuroleptic among the all patients who were treated with neuroleptics.Error bars represent confidence limits.
Fig. (5) Patients who were not treated with Choline esterase inhibitorr or Memantine