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differential diagnosis of Alzheimer's disease

Laboratory: - CSF biomarkers & ratios - specificities (0.57-0.66) & sensitivities (0.65-0.83) in distinguishing neuropathologically confirmed AD from non-AD [2] - CSF amyloid-beta42/phosphorylated tau (CSF Abeta42/p-tau) ratio & CSF p-tau may be more accurate [2] - CSF p-tau - sensitivity (0.75) & specificity (0.70) in distinguishing AD from LBD (Lewy body dementia) [2] - sensitivity (0.86) *& specificity (0.79) for distinguishing AD from FTD (frontotemporal dementia) - CSF Abeta42/p-tau & total CSF tau/Abeta42 ratios may be more accurate Radiology: - amyloid positron emission tomography (PET) imaging - sensitivity (0.91) & specificity (0.92) for distinguishing AD from non-AD [2] - fluorodeoxyglucose positron emission tomography (FDG-PET) - sensitivity (0.89) & specificity (0.74) for distinguishing AD from non-AD [2] - sensitivity (0.97) & specificity (0.66) in distinguishing AD from FTD (frontotemporal dementia) [2] - magnetic resonance imaging (MRI) - medial temporal lobe atrophy sensitivity (0.91) & specificity (0.89) in distinguishing AD from non-AD [2] - sensitivity (0.64) & specificity (0.68) for distinguishing between AD & Lewy body disease (LBD) & is more accurate when AD is defined using neurofibrillary tangle criteria [2] - single photon emission computed tomography (SPECT) - sensitivity (0.64) & specificity (0.83) in distinguishing AD from non-AD [2] Differential diagnosis: 1) delirium 2) depression 3) other neurodegenerative disease a) multi-infarct (vascular) dementia b) diffuse Lewy body disease (Lewy body dementia) c) Parkinson's dementia d) frontotemporal dementia e) alcohol-associated dementia f) mesial temporal lobe sclerosis; hippocampal sclerosis [1] g) limbic-predominant age-related TDP-43 encephalopathy 4) medications 5) normal-pressure hydrocephalus 6) toxins: alcohol 7) metabolic disorders: hyperthyroidism or hypothyroidism 8) nutritional disorders: vitamin B12 deficiency 9) intestinal lipodystrophy (Whipple's disease)

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Alzheimer's disease (AD) dementia; Alzheimer's disease & related dementias (ADRD)

General

differential diagnosis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18 American College of Physicians, Philadelphia 2015, 2018 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Fink HA, Linskens EJ, Silverman PC et al Accuracy of biomarker testing for neuropathologically defined Alzheimer disease in older adults with dementia: A systematic review. Ann Intern Med 2020 May 19; 172:669. PMID: 32340038 https://www.acpjournals.org/doi/10.7326/M19-3888