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Title: Alzheimer's disease with cerebrovascular disease: current status in the Asia–Pacific region
Authors: C. Chen
A. Homma
V. C.T. Mok
E. Krishnamoorthy
S. Alladi
K. Meguro
K. Abe
J. Dominguez
S. Marasigan
N. Kandiah
S. Y. Kim
D. Y. Lee
H. A. De Silva
Y. H. Yang
M. C. Pai
V. Senanarong
A. Dash
National University of Singapore
National University Health System
Institute for Dementia Care Research in Tokyo
Chinese University of Hong Kong
Neurokrish Consulting Pvt. Ltd.
Nizam's Institute of Medical Sciences
Tohoku University
Okayama University
St. Luke's Medical Center Quezon City
University of Santo Tomas Hospital
National Neuroscience Institute of Singapore
Seoul National University College of Medicine
Seoul National University Bundang Hospital
Seoul National University
University of Kelaniya
Kaohsiung Medical University Chung-Ho Memorial Hospital
Kaohsiung Medical University
National Cheng Kung University
Mahidol University
Eisai Co., Ltd.
Keywords: Medicine
Issue Date: 1-Oct-2016
Citation: Journal of Internal Medicine. Vol.280, No.4 (2016), 359-374
Abstract: © 2016 The Association for the Publication of the Journal of Internal Medicine Background: There is growing awareness of the coexistence of Alzheimer's disease and cerebrovascular disease (AD+CVD), however, due to lack of well-defined criteria and treatment guidelines AD+CVD may be underdiagnosed in Asia. Methods: Sixteen dementia specialists from nine Asia Pacific countries completed a survey in September 2014 and met in November 2014 to review the epidemiology, diagnosis and treatment of AD+CVD in Asia. A consensus was reached by discussion, with evidence provided by published studies when available. Results: AD accounts for up to 60% and AD+CVD accounts for 10-20% of all dementia cases in Asia. The reasons for underdiagnosis of AD+CVD include lack of awareness as a result of a lack of diagnostic criteria, misdiagnosis as vascular dementia or AD, lack of diagnostic facilities, resource constraints and cost of investigations. There is variability in the tools used to diagnose AD+CVD in clinical practice. Diagnosis of AD+CVD should be performed in a stepwise manner of clinical evaluation followed by neuroimaging. Dementia patients should be assessed for cognition, behavioural and psychological symptoms, functional staging and instrumental activities of daily living. Neuroimaging should be performed using computed tomography or magnetic resonance imaging. The treatment goals are to stabilize or slow progression as well as to reduce behavioural and psychological symptoms, improve quality of life and reduce disease burden. First-line therapy is usually an acetylcholinesterase inhibitor such as donepezil. Conclusion: AD+CVD is likely to be under-recognised in Asia. Further research is needed to establish the true prevalence of this treatable and potentially preventable disease.
ISSN: 13652796
Appears in Collections:Scopus 2016-2017

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