J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-304479
  • Editorial commentary

Alzheimer's disease: charting the crossroads between neurology and psychology

  1. Martin Herbst2
  1. 1Service de Médecine Gériatrique, Centre Hospitalo-Universitaire Lyon-Sud, Pierre Bénite Cedex, France
  2. 2Department of Neurology, Charité University Medicine, Berlin, Germany
  1. Correspondence to Dr Thomas Gilbert, Servic de Médecine Gériatrique, Centre Hospitalo-Universitaire Lyon-Sud, 165 chemin du grand Revoyet, Pierre Bénite Cedex 69495, France; thomas.gilbert{at}
  • Received 3 December 2012
  • Revised 14 January 2013
  • Accepted 21 January 2013
  • Published Online First 16 February 2013

Neurodegenerative disorders such as Alzheimer's disease (AD) are increasingly recognised to have a long prodromal stage before the onset of symptoms defining the dementia syndrome. This phase may last up to years or even decades. An intensive search has been initiated for signs or symptoms that might enable prediction of dementia development.1 The motivation for identifying such predictors comes from the assumption that disease-modifying treatment might be more effective in early or even presymptomatic stages when the pathogenic mechanisms have not progressed, and irreversible damage to neurons and neural networks is still limited. Therefore, early recognition of imminent dementia may play an important role in the future.

In addition, a definition of dementia that focuses on cognitive symptoms might conceal early non-cognitive symptoms. In fact, we have learned from diverse recent studies that dementia is often preceded by depressive symptoms years before the onset of cognitive decline. It remains unclear, however, whether depression actually represents an early disease symptom, a psychological reaction to cognitive deterioration perceived by the affected individual, or whether it is a true risk factor for dementia …

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