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Use of laboratory and imaging investigations in dementia
  1. W M van der Flier,
  2. P Scheltens
  1. Department of Neurology and Alzheimer Center, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
  1. Correspondence to:
 W M van der Flier
 Department of Neurology and Alzheimer Center, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands; wm.vdfliervumc.nl

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The diagnosis of dementia is a complicated enterprise. This is partly caused by the insidious onset of most diseases that cause dementia. The difficulty is clearly captured in the question: “Where does ageing stop and dementia begin?”. The availability of symptomatic treatment (for example, acetyl cholinesterase inhibitors) and the development of new disease modifying drugs emphasises the need for improved diagnostic accuracy. Patients that are in the earliest stages of the disease may potentially profit most from disease modifying drugs. This further underlines the importance of a correct clinical diagnosis early in the course of the disease. During lifetime, with careful evaluation and the application of well defined, clinical criteria, “probable” diagnoses can be made with a relatively high level of accuracy. A definite diagnosis of Alzheimer’s disease (AD) or most other diseases that cause dementia can only be made post mortem, after necropsy.

Neuropathology accumulates gradually, and it has been shown that neuropathological features, eventually leading to the clinical syndrome of dementia, may be present as early as 20 years before the first symptoms become overt. Therefore, based on clinical criteria alone, the diagnosis cannot be made until the disease is in a relatively far advanced stage. There is a clear need for sensitive and reliable biologic markers that are able to demonstrate the presence of neuropathology before a patient has reached the stage of clinical dementia. Although as yet there are no biomarkers that can diagnose AD or most other dementias with certainty, neuroimaging and laboratory markers may add positive evidence for the presence of neuropathology.

In this article, an overview will be given of the possibilities of diagnosing dementia. The first part consists of a short description of the general diagnostic work-up of dementia. Due to the general character of this overview, we will not go into …

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