The DOI matches its Crossref record, with a small difference in title or year; 137 of the 143 references it cites were found in a registry or an index; 1 of the 159 sources its claims cite were checked for support.
The Alzheimer’s Disease Clinical Spectrum
Open accessAbstract
Alzheimer's disease (AD) care requires timely diagnosis and multidisciplinary management. Evaluation involves structured patient and caregiver history and symptom-function reviews, examination, and testing (laboratory and neuroimaging) to delineate impairment level, determine the cognitive-behavioral syndrome, and diagnose cause. Clinical biomarkers are available to aid high confidence in etiologic diagnosis. Management uses psychoeducation, shared goal setting, and patient-caregiver dyad decision making. When combined, pharmacologic and nonpharmacologic therapies mitigate symptoms and reduce clinical progression and care burden. AD biopathologic processes develop over decades before symptoms manifest; this period is increasingly targeted in research as an opportunity to best delay or prevent AD dementia.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This review summarizes the clinical spectrum, diagnostic evaluation, and multifactorial management of Alzheimer’s disease (AD) and AD-related dementias. It emphasizes structured history, multidomain assessment, tiered testing, and modest but meaningful benefits from FDA-approved cholinesterase inhibitors and memantine alongside nonpharmacologic care.
Key findings
- AD is the most common cause of cognitive impairment/dementia in people older than 65 years; dementia prevalence approximately doubles every 5 years from age 65 to 85, rising from about 1%–2% at 65 years to more than 30%–50% by 85 years. Among Americans older than 60 years, 16% have MCI, equating to 11.6 million individuals.
- Amnestic MCI is greater than 90% associated with underlying AD pathology; MCI increases annual progression to dementia (relative risk 6–8), and MCI with positive AD pathology biomarkers versus negative biomarkers has a 2–3 relative risk of progression (8% vs 17%–22% per year).
- Diagnosis remains clinical, using a 3-step formulation: identify level of impairment, define the cognitive-behavioral syndrome, and establish likely cause(s) with multitiered laboratory and neuroimaging tests. CSF and amyloid PET biomarkers are clinically available but not indicated in most symptomatic individuals; they are reserved for atypical, rapidly progressive, early-onset, or inconclusive cases.
- Management is multifactorial: nonpharmacologic/behavioral approaches are first-line for neuropsychiatric symptoms; FDA-approved anti-AD drugs (donepezil, galantamine, rivastigmine, memantine) provide modest benefits. During initial 6–12 months, cognition/ADL/behavior/global change may improve in 10%–30%, plateau in 30%–50%, or continue to deteriorate in 20%–40%; discontinuation of cholinesterase inhibitors is on aggregate harmful.
Methods
- Review article synthesizing clinical criteria, guidelines, and evidence for AD diagnosis and management; no primary study sample or new data collection is reported.
- Draws on major criteria (2011 NIA-AA, International Working Group, DSM-5, 2018 NIA-AA research framework), randomized controlled trials, meta-analyses, open-label extensions, and prospective observational cohort studies.
- Main analysis is narrative synthesis with clinical recommendations, including tables for risk factors, history/symptom-function review, tiered testing, differential diagnosis, and FDA-approved medication dosing.
Limitations
- The paper does not include a stated limitations section.
- Evident from the text: it is a narrative clinical review without a described systematic search strategy or formal evidence-quality appraisal; recommendations rely on cited guidelines, trials, meta-analyses, and observational cohort studies.
- Evident from the text: the author discloses honoraria for consulting, educational lectures/programs/materials, or advisory boards from multiple pharmaceutical companies and institutional investigational study/trial funding.
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Claims the paper makes
66 Not checked yet · 10 Own interpretation · 2 No basis given · 1 Supported so far
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“MCI and dementia due to AD can be accurately diagnosed by a comprehensive evaluation that integrates pathologic AD biomarkers (cerebrospinal fluid [CSF] and amyloid PET).”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
plaindirect- Asserted: passes — The authors put it forward as true.
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- Based: unclear — It is unclear why the paper says it holds.
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In the paper
“However, clinical use of AD CSF and PET biomarkers are not currently indicated in most symptomatic individuals to include or exclude AD pathology.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
What the sources say
- Not checked yetcites [10] Johnson, 2013, Appropriate use criteria for amyloid PET: a report of the amyloid imaging task force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association, Alzheimers Dement source
- Not checked yetcites [11] Simonsen, 2017, Recommendations for CSF AD biomarkers in the diagnostic evaluation of dementia, Alzheimers Dement source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“AD-related pathological changes often coexist with 1 or more other pathologies, particularly vascular-ischemic cerebral injury and diffuse Lewy body (DLB) disease.1,[6][7][8][9]”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
What the sources say
- Not checked yetcites [1] Livingston, 2017, Dementia prevention, intervention, and care, Lancet source
- Not checked yetcites [6][7][8][9]
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“These tests are reserved for atypical, rapidly progressive, or early-onset syndromes, or when comprehensive evaluation is inconclusive.10,11”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
What the sources say
- Not checked yetcites [10] Johnson, 2013, Appropriate use criteria for amyloid PET: a report of the amyloid imaging task force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association, Alzheimers Dement source
- Not checked yetcites [11] Simonsen, 2017, Recommendations for CSF AD biomarkers in the diagnostic evaluation of dementia, Alzheimers Dement source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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In the paper
“The 2011 National Institute on Aging and Alzheimer's Association (NIA-AA) criteria for AD recognizes nonamnestic AD presentations that include language, visuospatial, and executive dysfunction features.32”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Clinical Features
What the sources say
- Not checked yetcites [32] McKhann, 2011, The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease, Alzheimers Dement source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The new AD biological framework and the model of pathologic AD biomarkers from Jack and colleagues 18 conceptualize a progressive sequence of measurable biochemical, neurophysiological, and neuroanatomical alterations that can be detected years before psychometrically and clinically noticeable deterioration in cognition, behavior, and function.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Epidemiology, Risk Factors, Genetics, and Neuropathology
What the sources say
- Not checked yetcites [18] Jack, 2010, Hypothetical model of dynamic biomarkers of the Alzheimer's pathological cascade, Lancet source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No single biomarker, test, or score can provide the clinical diagnosis; this requires characterization of symptoms and level of impairment into a profile via a clinical evaluation.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: AD clinical syndromes, Cognitive-Behavioral Syndromes (CBS) presumed to be due to AD, are heterogeneous, particularly in younger individuals (65 years of age or younger).
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In relatively typical cases, an individualized approach to history, examination, and selected laboratory tests and neuroimaging (see later discussion) can provide a high-confidence diagnosis.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: AD clinical syndromes, Cognitive-Behavioral Syndromes (CBS) presumed to be due to AD, are heterogeneous, particularly in younger individuals (65 years of age or younger).
In the paper
“MCI with negative biomarkers versus 1 or more AD pathology biomarkers (ie, AD pattern in CSF, high amyloid load in amyloid PET) or biomarkers of neurodegeneration (eg, AD pattern on structural MRI or fluorodeoxyglucose [FDG]-PET; high CSF tau and phospho-tau levels) has a 2 to 3 relative risk of progression to dementia (8% vs 17%-22% per year 33 ).”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Clinical Features
What the sources say
- Not checked yetcites [33] Petersen, 2013, Criteria for mild cognitive impairment due to Alzheimer's disease in the community, Ann Neurol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“With age, accumulation of greater experience and knowledge can allow for better performance on measures of crystallized intelligence.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > According to recent preliminarily announced multidisciplinary US national guidelines, the Alzheimer's Association Best Clinical Practice Guidelines for the
What the sources say
- Not checked yetcites [134] Salthouse, 2009, When does age-related cognitive decline begin?, Neurobiol Aging source
- Not checked yetcites [135] Weintraub, 2013, Cognition assessment using the NIH Toolbox, Neurology
plainconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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- It may state two separate claims as one. 29
- Probably not a substantial claim. 18
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Co-existent AD and vascular-ischemic pathology (causing the clinical spectrum of VCI, which includes dementia), and AD with DLB pathology (causing AD-DLB The Alzheimer's Clinical Spectrum variants), are prevalent in older individuals.9,49,50”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > DIFFERENTIAL DIAGNOSIS
What the sources say
- Supportedcites [9] Kapasi, 2017, Impact of multiple pathologies on the threshold for clinically overt dementia, Acta Neuropathol source
The Introduction says that many older people harbor multiple brain pathologies and that additional vascular and neurodegenerative pathologies are found in most cases of AD dementia. The “Mixed Vascular and AD Pathologies” and “Mixed Lewy Body and AD Pathologies” sections specifically describe both combinations as common in aging. Page numbers were not supplied. (LLM, conf=0.92)
- Not checked yetcites [49] Jellinger, 2008, Prevalence and impact of vascular and Alzheimer pathologies in Lewy body disease, Acta Neuropathol source
- Not checked yetcites [50] Schneider, 2007, Mixed brain pathologies account for most dementia cases in community-dwelling older persons, Neurology source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
- Supported
In the paper
“AD is the sixth leading cause of death in the United States and the only top-10 cause still significantly increasing.4”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
What the sources say
- Not checked yetcites [4] Alzheimer’s Association, 2018, 2018 Alzheimer's disease facts and figures, Alzheimers Dement source
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Alzheimer's disease (AD) is the most common cause of cognitive impairment or dementia in individuals older than 65 years”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
What the sources say
- Not checked yetcites [1][2][3][4][5]
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“with rising longevity, a worldwide pandemic of mild cognitive impairment (MCI), AD, and AD-related dementia (ADRD) is anticipated.[1][2][3][4][5]”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
What the sources say
- Not checked yetcites [1][2][3][4][5]
plainconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Symptoms too often go undiagnosed, misattributed, or dismissed and ignored, which causes distressing, costly, and potentially harmful delays in receiving appropriate care.1,4,5”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > INTRODUCTION
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“The new 2018 NIA-AA research framework dissociates AD symptoms or phenotypes from the pathologic process.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > DIAGNOSIS
What the sources say
- Not checked yetcites [2] Deschaintre, 2009, Treatment of vascular risk factors is associated with slower decline in Alzheimer's disease, Neurology source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“It defines AD, for research purposes, purely in terms of a biopathologic construct with the AD biomarkers of amyloid, tau, and neurodegeneration (ATN) criteria, which aids in defining the disease stages. 2”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > DIAGNOSIS
What the sources say
- Not checked yetcites [2] Deschaintre, 2009, Treatment of vascular risk factors is associated with slower decline in Alzheimer's disease, Neurology source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In the dementia stages of AD, many patients have cortical or cortico-subcortical microhemorrhages due to cerebral amyloid angiopathy-related vasculopathy and leakage 19 ; hemosiderin microdeposition from microhemorrhages are seen on gradient-echo or susceptibility-weighted MRI sequences in 15% to 20% of patients.20”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Epidemiology, Risk Factors, Genetics, and Neuropathology
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“Prevailing models posit a central role of accumulation of synaptic neurotoxic forms of Aß to induce inflammatory and microglial cascades, broad ionic and neurotransmitter abnormalities, mitochondrial dysfunction, oxidative stress, and hyperphosphorylation of the microtubule stabilizing protein tau and formation of tangles.[26][27][28][29][30][31]”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Epidemiology, Risk Factors, Genetics, and Neuropathology
What the sources say
- Not checked yetcites [26][27][28][29][30][31]
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“APOE-ε4 alleles are associated with accelerated Aß-deposition and earlier onset and higher risk of developing AD symptoms.21,23”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Epidemiology, Risk Factors, Genetics, and Neuropathology
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Patterns of change may overlap but are not part of normal cognitive aging, as manifested by differential aging and AD effects on cognitive networks.34”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Clinical Characteristics of Alzheimer's Disease: Symptoms and Signs
What the sources say
- Not checked yetcites [34] Chhatwal, 2018, Preferential degradation of cognitive networks differentiates Alzheimer's disease from ageing, Brain source
hedged- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The 3 major clinical criteria for the AD spectrum are the revised 2011 NIA-AA criteria, 32,39 the International Working Group (Dubois and colleagues 39,40 ) 2010 revised new lexicon criteria, and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria.41”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > DIAGNOSIS
What the sources say
- Not checked yetcites [32] McKhann, 2011, The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease, Alzheimers Dement source
- Not checked yetcites [39] Dubois, 2010, Revising the definition of Alzheimer's disease: a new lexicon, Lancet Neurol source
- Not checked yetcites [40] Dubois, 2007, Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria, Lancet Neurol source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Performance on measures of fluid intelligence, such as speed of mental processing; working memory; recall and retention of verbal and visual information (learning and memory), in particular visuospatial memory; and reasoning begin to decline in many individuals from age 20 to 30 years.134,135”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > DIAGNOSIS
What the sources say
- Not checked yetcites [134] Salthouse, 2009, When does age-related cognitive decline begin?, Neurobiol Aging source
- Not checked yetcites [135] Weintraub, 2013, Cognition assessment using the NIH Toolbox, Neurology
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In the most common form of AD, sporadic late-onset AD, many genetic variations contribute to increase or lower risk; greater than 20 have been identified (AlzGene Database; www.alzgene.org).22”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Epidemiology, Risk Factors, Genetics, and Neuropathology
What the sources say
- Not checked yetcites [22] Bertram, 2007, Systematic meta-analyses of Alzheimer disease genetic association studies: the AlzGene database, Nat Genet source
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“dementia-level impairment requires cognitive or behavioral symptoms”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > DIAGNOSIS
What the sources say
- Not checked yetcites [32] McKhann, 2011, The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease, Alzheimers Dement source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“AD is a dual proteinopathy disease defined by a widespread but regionally specific pattern of intraparenchymal diffuse and neuritic ß-amyloid (Aß) plaques and intracytoplasmic (initially), then extracellular, neurofibrillary tangles with synaptic and neuronal loss and gliosis.[14][15][16][17]”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Epidemiology, Risk Factors, Genetics, and Neuropathology
What the sources say
- Not checked yetcites [14][15][16][17]
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Familial autosomal dominant AD is rare (<1%), usually manifests in early-onset AD (onset age <65 years; <4% of AD), and is caused by mutations in presenilin 1, amyloid precursor protein, or presenilin 2. 21”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Epidemiology, Risk Factors, Genetics, and Neuropathology
What the sources say
- Not checked yetcites [21] Loy, 2014, Genetics of dementia, Lancet source
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“MCI diagnosis is a matter of”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > DIAGNOSIS
What the sources say
- Not checked yetcites [32] McKhann, 2011, The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease, Alzheimers Dement source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Rests on an assumption: AD clinical syndromes, Cognitive-Behavioral Syndromes (CBS) presumed to be due to AD, are heterogeneous, particularly in younger individuals (65 years of age or younger).
None of the sources cited for this claim have been checked yet.
In the paper
“which are associated with more rapid decline, earlier institutionalization, higher distress, worse quality of life, and greater health care utilization and costs.53,54”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Nonpharmacologic Management: Behavioral Interventions and Coping Strategies
What the sources say
- Not checked yetcites [53] Okura, 2012, Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study, J Am Geriatr Soc source
- Not checked yetcites [54] Kales, 2005, Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression, Am J Geriatr Psychiatry source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“The AD-8 screening instrument provides a practical symptoms questionnaire for changes in thinking and memory that can be a red flag for ADc syndromes.43”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > The Alzheimer's Clinical Spectrum
What the sources say
- Not checked yetcites [43] Galvin, 2005, The AD8: a brief informant interview to detect dementia, Neurology source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Presence of pathologic AD does not exclude other pathologies causing or contributing to the patient's CBS; for example, 70% to 80% of individuals with DLB are also amyloid-positive on PET.46”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Approach to Multitiered Testing: Laboratory Studies
What the sources say
- Not checked yetcites [46] Gomperts, 2008, Imaging amyloid deposition in Lewy body diseases, Neurology source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Short-term and long-term antipsychotic use is associated with substantial risk of cognitive decline, morbidity (eg, parkinsonism, falls, pneumonia, or cardiovascular and cerebrovascular events), and mortality.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Antipsychotics: use with extreme caution under strict specific circumstances
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“A recent systematic review and meta-analysis by Tricco and colleagues 64 included 110 studies and 23,432 subjects supports efficacy, effectiveness, and safety.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Approved anti-Alzheimer disease medications: cholinesterase inhibitors and memantine
What the sources say
- Not checked yetcites [64] Tricco, 2018, Comparative effectiveness and safety of cognitive enhancers for treating alzheimer's disease: systematic review and network metaanalysis, J Am Geriatr Soc source
plaindirectn = 23,432- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“ChEIs and memantine also have complementary mechanisms of action, potentially additive effects, and demonstrate acceptable tolerability and safety profiles.63”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Approved anti-Alzheimer disease medications: cholinesterase inhibitors and memantine
What the sources say
- Not checked yetcites [63] Atri, 2013, Memantine in patients with Alzheimer's disease receiving donepezil: new analyses of efficacy and safety for combination therapy, Alzheimers Res Ther source
boosted- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Cholinesterase inhibitors (ChEIs) (donepezil, galantamine, rivastigmine) and the N-methyl-D-aspartate (NMDA)-antagonist, memantine, are the only FDA-approved treatments for AD dementia and are recommended broadly in consensus guidelines and practice parameters.1,52,61,62”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Approved anti-Alzheimer disease medications: cholinesterase inhibitors and memantine
What the sources say
- Not checked yetcites [1] Livingston, 2017, Dementia prevention, intervention, and care, Lancet source
- Not checked yetcites [52] National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97). NICE, UK, June 20, 2018.
- Not checked yetcites [61] Schmidt, 2015, EFNS-ENS/EAN guideline on concomitant use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer's disease, Eur J Neurol source
- Not checked yetcites [62] Gauthier, 2012, Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4), Can Geriatr J source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“and to delay nursing home placement without prolongation of time to death.64,65”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Approved anti-Alzheimer disease medications: cholinesterase inhibitors and memantine
What the sources say
- Not checked yetcites [64] Tricco, 2018, Comparative effectiveness and safety of cognitive enhancers for treating alzheimer's disease: systematic review and network metaanalysis, J Am Geriatr Soc source
- Not checked yetcites [65] Rountree, 2013, Effectiveness of antidementia drugs in delaying Alzheimer disease progression, Alzheimers Dement source
boosteddirectn = 23,432- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sustained treatments provide a modest expectation of short-term stabilization or improvement, and longer-term slowing of clinical decline.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Approved anti-Alzheimer disease medications: cholinesterase inhibitors and memantine
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the long run, current treatments of AD dementia mitigate decline but do not prevent it.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Approved anti-Alzheimer disease medications: cholinesterase inhibitors and memantine
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In more than 40 short-term randomized controlled trials (RCTs) using placebos over 24 to 52 weeks investigating efficacy, and in meta-analyses of RCTs, all 3 ChEIs have demonstrated small to medium effect size treatment benefits at the sibject-group level in terms of improving, stabilizing, or delaying decline in cognition, ADL, and global status, and in ameliorating BPSD and caregiver burden.35,”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > ChEIs efficacy and effectiveness
What the sources say
- Not checked yetcites [35] Farlow, 2007, Effective pharmacologic management of Alzheimer's disease, Am J Med source
- Not checked yetcites [65] Rountree, 2013, Effectiveness of antidementia drugs in delaying Alzheimer disease progression, Alzheimers Dement source
- Not checked yetcites [70] Farlow, 2000, A 52-week study of the efficacy of rivastigmine in patients with mild to moderately severe Alzheimer's disease, Eur Neurol source
- Not checked yetcites [71] Howard, 2012, Donepezil and memantine for moderate-to-severe Alzheimer's disease, N Engl J Med source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Level II or equivocal level I evidence suggest donepezil treatment may be beneficial in very mild stage AD or for subgroups with MCI due to AD (ie, carriers of APOE-ε4 allele, 96 those with depression or depressive symptoms 97 ).”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > ChEIs efficacy and effectiveness
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Even temporary discontinuation is associated with irreversible declines and greater risk of nursing home placement.[67][68][69][70][71][72]”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Approved anti-Alzheimer disease medications: cholinesterase inhibitors and memantine
What the sources say
- Not checked yetcites [67] Raskind, 2000, Galantamine in AD: a 6-month randomized, placebo-controlled trial with a 6-month extension. The Galantamine USA-1 study group, Neurology source
- Not checked yetcites [68] Courtney, 2004, Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial, Lancet source
- Not checked yetcites [69] Doody, 2001, Open-label, multicenter, phase 3 extension study of the safety and efficacy of donepezil in patients with Alzheimer disease, Arch Neurol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Treatment benefits include improvement, stabilization, or reduced decline in the domains of cognition, function (ADLs), and global status; and by amelioration of BPSD and caregiver burden.63,71,73,[98][99][100][101][102][103][104][105][106][107][108][109][110][111]”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > N-methyl-D-aspartate antagonists (memantine)
What the sources say
- Not checked yetcites [63] Atri, 2013, Memantine in patients with Alzheimer's disease receiving donepezil: new analyses of efficacy and safety for combination therapy, Alzheimers Res Ther source
- Not checked yetcites [71] Howard, 2012, Donepezil and memantine for moderate-to-severe Alzheimer's disease, N Engl J Med source
- Not checked yetcites [73] Weycker, 2007, Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil, Curr Med Res Opin source
- Not checked yetcites [98] McShane, 2006, Memantine for dementia, Cochrane database Syst Rev
- Not checked yetcites [99] Winblad, 1999, Memantine in severe dementia: results of the 9M-Best Study (Benefit and efficacy in severely demented patients during treatment with memantine), Int J Geriatr Psychiatry source
- Not checked yetcites [100] Reisberg, 2003, Memantine in moderate-to-severe Alzheimer's disease, N Engl J Med source
- Not checked yetcites [101] Bullock, 2006, Efficacy and safety of memantine in moderate-to-severe Alzheimer disease: the evidence to date, Alzheimer Dis Assoc Disord source
- Not checked yetcites [102] Doody, 2004, Specific functional effects of memantine treatment in patients with moderate to severe Alzheimer's disease, Demenr Geriatr Cogn Disord source
- Not checked yetcites [103] Grossberg, 2009, Memantine therapy of behavioral symptoms in community-dwelling patients with moderate to severe Alzheimer's disease, Dement Geriatr Cogn Disord source
- Not checked yetcites [104] Schmitt, 2006, Cognitive response to memantine in moderate to severe Alzheimer disease patients already receiving donepezil: an exploratory reanalysis, Alzheimer Dis Assoc Disord source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Short-term (6 months or less) memantine treatment effect sizes are small to medium in size and clinically significant at the moderate to severe stages of AD. 109,110,112,113”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > N-methyl-D-aspartate antagonists (memantine)
What the sources say
- Not checked yetcites [109] Winblad, 2007, Memantine in moderate to severe Alzheimer's disease: a meta-analysis of randomised clinical trials, Dement Geriatr Cogn Disord source
- Not checked yetcites [110] Livingston, 2004, The place of memantine in the treatment of Alzheimer's disease: a number needed to treat analysis, Int J Geriatr Psychiatry source
- Not checked yetcites [112] Abbott, 2009, All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data, Phys Rev Lett source
- Not checked yetcites [113] Wilkinson, 2009, Effectiveness of donepezil in reducing clinical worsening in patients with mild-to-moderate Alzheimer's disease, Dement Geriatr Cogn Disord source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The benefits may also extend to reducing antipsychotic use.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > The Alzheimer's Clinical Spectrum
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Persistence, higher dosage (in later dementia stages), and duration of treatment are associated with better outcomes, even in those with advanced dementia.92,95,114,115,130”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Practical recommendations for implementation of pharmacotherapy
What the sources say
- Not checked yetcites [92] Wattmo, 2011, Long-term outcome and prediction models of activities of daily living in Alzheimer disease with cholinesterase inhibitor treatment, Alzheimer Dis Assoc Disord source
- Not checked yetcites [95] Wallin, 2011, Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting, Neuropsychiatr Dis Treat source
- Not checked yetcites [114] Atri, 2008, Long-term course and effectiveness of combination therapy in Alzheimer disease, Alzheimer Dis Assoc Disord source
- Not checked yetcites [115] Rountree, 2009, Persistent treatment with cholinesterase inhibitors and/or memantine slows clinical progression of Alzheimer disease, Alzheimers Res Ther source
- Not checked yetcites [130] Wattmo, 2011, Predictors of long-term cognitive outcome in Alzheimer's disease, Alzheimers Res Ther source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The FDA-approved anti-AD pharmacotherapies; the ChEIs donepezil, galantamine, and rivastigmine; and the NMDA antagonist memantine can reduce progression of clinical symptoms and disability.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > SUMMARY OR FUTURE CONSIDERATIONS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Unfortunately, large RCTs have failed to support benefits from ginkgo biloba, high-dose vitamin B 12 or folic acid combinations, omega-3 fatty acid or fish oil components or preparations, nonsteroidal anti-inflammatory drugs, and statin medications at the dementia stage of AD. 76,81”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Add-on dual combination therapy with acetylcholinesterase inhibitors and memantine
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The rates of discontinuation due to adverse events for ChEIs and memantine combination treatment are low, between 5% to 10%, and not generally significantly different from placebo.100,120,121,125,126”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Add-on dual combination therapy with acetylcholinesterase inhibitors and memantine
What the sources say
- Not checked yetcites [100] Reisberg, 2003, Memantine in moderate-to-severe Alzheimer's disease, N Engl J Med source
- Not checked yetcites [120] Tariot, 2004, Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial, JAMA source
- Not checked yetcites [121] Porsteinsson, 2008, Memantine treatment in patients with mild to moderate Alzheimer's disease already receiving a cholinesterase inhibitor: a randomized, double-blind, placebo-controlled trial, Curr Alzheimer Res source
- Not checked yetcites [125] Choi, 2011, Tolerability and efficacy of memantine add-on therapy to rivastigmine transdermal patches in mild to moderate Alzheimer's disease: a multicenter, randomized, open-label, parallel-group study, Curr Med Res Opin source
- Not checked yetcites [126] Grossberg, 2013, The safety, tolerability, and efficacy of once-daily memantine (28 mg): a multinational, randomized, double-blind, placebo-controlled trial in patients with moderate-to-severe Alzheimer's disease taking cholinesterase inhibitors, CNS Drugs source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“there were no concerning safely signals or increased mortality with high-dose vitamin E. 127,128”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > Add-on dual combination therapy with acetylcholinesterase inhibitors and memantine
What the sources say
- Not checked yetcites [127] Sano, 1997, A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study, N Engl J Med source
- Not checked yetcites [128] Dysken, 2014, Effect of vitamin E and memantine on functional decline in Alzheimer disease: the TEAM-AD VA cooperative randomized trial, JAMA source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Anti-AD medications can be maintained in late-stages to support basic psychomotor processes, praxis, functional communication, the behavioral responses required to assist caregivers to deliver basic ADL care, and the elementary processes of movement and eating.”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > The Alzheimer's Clinical Spectrum
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper relies on this without support.
AD clinical syndromes, Cognitive-Behavioral Syndromes (CBS) presumed to be due to AD, are heterogeneous, particularly in younger individuals (65 years of age or younger).
“AD clinical (ADc) syndromes, Cognitive-Behavioral Syndromes (CBS) presumed to be due to AD, are heterogeneous, particularly in younger individuals (65 years of age or younger).”
The paper relies on this without support.
Amnestic-MCI is greater than 90% associated with underlying AD pathology.
“Amnestic-MCI is greater than 90% associated with underlying AD pathology.”
The paper relies on this without support.
MCI significantly increases risk of annual progression to dementia (relative risk 6-8).
“MCI significantly increases risk of annual progression to dementia (relative risk [RR] 6-8).”
The paper relies on this without support.
Pathologic tangle findings correlate best with symptoms.
“Pathologic tangle findings correlate best with symptoms.”
The paper relies on this without support.
The MoCA is a good initial choice for detection; it takes approximately 8 to 12 minutes to administer, has good psychometric properties, acceptable sensitivity to detection of mild impairment, and is available in several forms and languages.
“The MoCA is a good initial choice for detection; it takes approximately 8 to 12 minutes to administer, has good psychometric properties, acceptable sensitivity to detection of mild impairment, and is available in several forms and languages.”
The paper relies on this without support.
Creutzfeldt-Jakob disease is on the differential diagnosis of atypical Alzheimer disease clinical spectrum syndromes when there is rapid onset and progression of symptoms over weeks to months.
“Prion diseases are very rare but Creutzfeldt-Jakob disease is on the DDx of atypical ADc syndromes when there is rapid onset and progression of symptoms (over weeks to months).”
The paper relies on this without support.
Overall poor and problem behaviors by the demented individual are not intentional but are due to disease, brain injury or damage, and diminished capacities.
“It is important for caregivers to appreciate that overall poor and problem behaviors by the demented individual are not intentional (eg, to be mean, ornery, or vindictive) but are due to disease, brain injury or damage, and diminished capacities.”
The paper relies on this without support.
Without accurate diagnosis and appropriate disclosure no care can be provided.
“because without accurate diagnosis and appropriate disclosure no care can be provided”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Low levels of cognitive, social, and physical activity may be linked to a greater risk of developing neurodegenerative diseases [3,83].”
From Alzheimer's Disease: Treatment Strategies and Their Limitations. (2022) · cites this paper as [83]
Experimental — accuracy not yet measuredIn the citing paper
“Despite the diverse additional mechanism of action, no high-quality data evidenced significant differences in their efficacy [27].”
From Multi-Target Mechanisms of Phytochemicals in Alzheimer’s Disease: Effects on Oxidative Stress, Neuroinflammation and Protein Aggregation (2022) · cites this paper as [27]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > N-methyl-D-aspartate antagonists (memantine)
“Short-term (6 months or less) memantine treatment effect sizes are small to medium in size and clinically significant at the moderate to severe stages of AD. 109,110,112,113”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > References
“112. Abbott BP, Abbott R, Adhikari R, et al. All-sky LIGO search for periodic gravita- tional waves in the early fifth-science-run data. Phys Rev Lett 2009;102(11): 111102.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > DIAGNOSIS
“The new 2018 NIA-AA research framework dissociates AD symptoms or phenotypes from the pathologic process.It defines AD, for research purposes, purely in terms of a biopathologic construct with the AD biomarkers of amyloid, tau, and neurodegeneration (ATN) criteria, which aids in defining the disease stages. 2”
§ The Alzheimer's Disease Clinical Spectrum Diagnosis and Management > References
“2. Deschaintre Y, Richard F, Fau-Leys D, et al. Treatment of vascular risk factors is associated with slower decline in Alzheimer's disease. Neurology 2009;73(9): 674-80.”
Citations
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When does age-related cognitive decline begin?
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Vitamin E and Donepezil for the Treatment of Mild Cognitive Impairment
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“caregiver dyad preferences may warrant a discussion between clinicians, patients, and caregivers about this possibility.(96)”
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“tine combination treatment are low, between 5% to 10%, and not generally significantly different from placebo.(100,120,121,125,126)”
Cognition assessment using the NIH Toolbox
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“Antipsychotics carry a US Food and Drug Administration (FDA) black-box warning in dementia; they must be used with extreme caution, ongoing monitoring, and only when strict conditions are met.(55,56) Short-term and long-term antipsychotic use is associated with substantial risk of cognitive decline, morbidity (eg, par…”
InfluentialVision assessment using the NIH Toolbox
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“questionnaire for changes in thinking and memory that can be a red flag for ADc syndromes.(43)”
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“In the end or terminal stages of AD, when personhood has disintegrated and when there is no meaningful communication or interaction, patients should only receive care (pharmacologic or otherwise) that is directed to provide palliation and comfort.(131)”
Delirium in Older Persons: Advances in Diagnosis and Treatment
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“The deliriumdementia link has been reviewed in the literature.(59,60) Tier 1 to 2 CBS or dementia assessment laboratory tests or studies (see Table 4) can help identify common conditions that exacerbate symptoms, including dehydration, electrolyte and metabolic derangements, anemia, cardiac or cerebral ischemia, hypox…”
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“pain relief; other sedative-hypnotics; and medications for anxiety (eg, benzodiazepines) or urinary incontinence (antimuscarinic) are relatively contraindicated in elderly and cognitively vulnerable persons.(44,58)”
Donepezil and memantine for moderate-to-severe Alzheimer's disease
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“variants), are prevalent in older individuals.(9,49,50) The DDx of atypical or variant ADc syndromes is broad and depends on the particular CBS characterized by the most prominent presenting domain of impairment.”
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“were no concerning safely signals or increased mortality with high-dose vitamin E.(127,128) There is no compelling evidence that Souvenaid, a prescription nutritional supplement (ie, medical food) containing Fortasyn Connect provides additional benefits in patients with AD dementia treated with anti-AD medications.”
Johnson, K. A., Minoshima, S., Bohnen, N. I., Donohoe, K. J., Foster, N. L., Herscovitch, P., Karlawish, J. H., Rowe, C. C., Carrillo, M. C., Hartley, D. M., et al. (2013) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2013.01.002 · Cited by 603 · cited 1×
“These tests are reserved for atypical, rapidly progressive, or early-onset syndromes, or when comprehensive evaluation is inconclusive.(10,11) In relatively typical cases, an individualized approach to history, examination, and selected laboratory”
The interface between delirium and dementia in elderly adults
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“The deliriumdementia link has been reviewed in the literature.(59,60) Tier 1 to 2 CBS or dementia assessment laboratory tests or studies (see Table 4) can help identify common conditions that exacerbate symptoms, including dehydration, electrolyte and metabolic derangements, anemia, cardiac or cerebral ischemia, hypox…”
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A 1-year, placebo-controlled preservation of function survival study of donepezil in AD patients
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Nonpharmacologic Management of Behavioral Symptoms in Dementia
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“Environmental modification, maintaining consistency, and simple routines can also be very helpful.(56,57)”
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Isolation of Low‐Molecular‐Weight Proteins from Amyloid Plaque Fibers in Alzheimer's Disease
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“to the patient’s CBS; for example, 70% to 80% of individuals with DLB are also amyloid-positive on PET.(46) In 2016, Atri(47) reviewed neuroimaging in CBS, AD, or ADRD.”
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“The genetics and cause of AD are complex and incompletely understood.(2,21) AD-risk attributable to genetic factors is estimated at 70%.”
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“tine combination treatment are low, between 5% to 10%, and not generally significantly different from placebo.(100,120,121,125,126)”
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“variants), are prevalent in older individuals.(9,49,50) The DDx of atypical or variant ADc syndromes is broad and depends on the particular CBS characterized by the most prominent presenting domain of impairment.”
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Mild cognitive impairment due to Alzheimer disease in the community
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Memantine in Moderate to Severe Alzheimer’s Disease: a Meta-Analysis of Randomised Clinical Trials
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“When to start and stop anti-Alzheimer disease medications Per FDA prescribing information, clinicians may start a ChEI in mild, moderate, or severe AD, and memantine in moderate or severe AD.”
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“When to start and stop anti-Alzheimer disease medications Per FDA prescribing information, clinicians may start a ChEI in mild, moderate, or severe AD, and memantine in moderate or severe AD.”
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Treatment of vascular risk factors is associated with slower decline in Alzheimer disease
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“onset of symptoms.(2) The new AD biological framework and the model of pathologic AD biomarkers from Jack and colleagues(18) conceptualize a progressive sequence of measurable biochemical, neurophysiological, and neuroanatomical alterations”
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“Persistence, higher dosage (in later dementia stages), and duration of treatment are associated with better outcomes, even in those with advanced dementia.(92,95,114,115,130)”
Self-citationEffective Pharmacologic Management of Alzheimer’s Disease
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World Alzheimer Report 2013: Journey of Caring: An analysis of long-term care for dementia
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Amyloid-Dependent and Amyloid-Independent Stages of Alzheimer Disease
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Amyloid Protein and Alzheimer's Disease
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Combination Therapy in Alzheimer???s Disease: A Review of Current Evidence
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“Persistence, higher dosage (in later dementia stages), and duration of treatment are associated with better outcomes, even in those with advanced dementia.(92,95,114,115,130)”
Okura, T., Plassman, B. L., Steffens, D. C., Llewellyn, D. J., Potter, G. G., & Langa, K. M. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03314.x · Cited by 174 · cited 2×
“such as noncognitive behavioral symptoms and behavioral and psychological symptoms of dementia (BPSD), which are associated with more rapid decline, earlier institutionalization, higher distress, worse quality of life, and greater health care utilization and costs.(53,54) Treatment of BPSD using pharmacology alone has…”
Quantitative neuropathological changes in presymptomatic Huntington's disease
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P1–160: Olfactory identification as a potential marker of presymptomatic Alzheimer's disease
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Donepezil Therapy in Clinical Practice
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Donepezil delays progression to AD in MCI subjects with depressive symptoms
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An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom
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“treatments for AD dementia and are recommended broadly in consensus guidelines and practice parameters.(1,52,61,62) ChEIs and memantine also have complementary mechanisms of action, potentially additive effects, and demonstrate acceptable tolerability and safety profiles.”
Recommendations for CSF AD biomarkers in the diagnostic evaluation of dementia
Simonsen, A. H., Herukka, S.-K., Andreasen, N., Baldeiras, I., Bjerke, M., Blennow, K., Engelborghs, S., Frisoni, G. B., Gabryelewicz, T., Galluzzi, S., et al. (2017) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2016.09.008 · Cited by 138 · cited 1×
“These tests are reserved for atypical, rapidly progressive, or early-onset syndromes, or when comprehensive evaluation is inconclusive.(10,11) In relatively typical cases, an individualized approach to history, examination, and selected laboratory”
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“treatments for AD dementia and are recommended broadly in consensus guidelines and practice parameters.(1,52,61,62) ChEIs and memantine also have complementary mechanisms of action, potentially additive effects, and demonstrate acceptable tolerability and safety profiles.”
Tricco, A. C., Ashoor, H. M., Soobiah, C., Rios, P., Veroniki, A. A., Hamid, J. S., Ivory, J. D., Khan, P. A., Yazdi, F., Ghassemi, M., et al. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15069 · Cited by 137 · cited 3×
“dividuals, ChEIs are generally tolerated well and have an acceptable adverse effect profile.(64) The most common adverse effects, including nausea, vomiting, anorexia, flatulence, loose stools, diarrhea, salivation, and abdominal cramping, are related to”
Size of the treatment effect on cognition of cholinesterase inhibition in Alzheimer's disease
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“ChEIs and memantine also have complementary mechanisms of action, potentially additive effects, and demonstrate acceptable tolerability and safety profiles.(63) A recent systematic review and meta-analysis by Tricco and colleagues(64) included 110 studies and 23,432 subjects supports efficacy, effectiveness, and safet…”
Self-citationThe Natural History of Alzheimer's Disease: A Brain Bank Study
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Chronic donepezil treatment is associated with slowed cognitive decline in Alzheimer's disease
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“There is no compelling evidence that Souvenaid, a prescription nutritional supplement (ie, medical food) containing Fortasyn Connect provides additional benefits in patients with AD dementia treated with anti-AD medications.(129) Unfortunately,”
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Preferential degradation of cognitive networks differentiates Alzheimer’s disease from ageing
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“Patterns of change may overlap but are not part of normal cognitive aging, as manifested by differential aging and AD effects on cognitive networks.(34)”
Effectiveness of antidementia drugs in delaying Alzheimer's disease progression
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“function, retard the emergence and impact of neuropsychiatric symptoms, and to delay nursing home placement without prolongation of time to death.(64,65) Viewed from the social perspective, anti-AD pharmacotherapy (donepezil, memantine, galantamine, rivastigmine) can reduce the economic burden of the illness, even in…”
Self-citationCombination Therapy for Alzheimerʼs Disease
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“such as noncognitive behavioral symptoms and behavioral and psychological symptoms of dementia (BPSD), which are associated with more rapid decline, earlier institutionalization, higher distress, worse quality of life, and greater health care utilization and costs.(53,54) Treatment of BPSD using pharmacology alone has…”
All-Sky LIGO Search for Periodic Gravitational Waves in the Early Fifth-Science-Run Data
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“When to start and stop anti-Alzheimer disease medications Per FDA prescribing information, clinicians may start a ChEI in mild, moderate, or severe AD, and memantine in moderate or severe AD.”
InfluentialEfficacy and Safety of Memantine in Moderate-to-Severe Alzheimer Disease: The Evidence to Date
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Predictors of long-term cognitive outcome in Alzheimer's disease
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“Persistence, higher dosage (in later dementia stages), and duration of treatment are associated with better outcomes, even in those with advanced dementia.(92,95,114,115,130)”
The Evaluation of Rapidly Progressive Dementia
Rosenbloom, M. H., & Atri, A. (2011) · The Neurologist · doi:10.1097/nrl.0b013e31820ba5e3 · Cited by 77 · cited 1×
“0, excessive and widespread binding of an amyloid PET agent in the brain) and exclusion of other less common cognitive or behavior-impairing conditions.(3,45) FDG-PET or single-photon emission CT (SPECT), and MRI or CT, do not directly measure AD-related pathology but suggest neurodegeneration and can support that AD…”
Self-citationCost Effectiveness of Donepezil in the Treatment of Mild to Moderate Alzheimerʼs Disease
Getsios, D., Blume, S., Ishak, K. J., & Maclaine, G. D. H. (2010) · PharmacoEconomics · doi:10.2165/11531870-000000000-00000 · Cited by 76
Burns, A., Gauthier, S., & Perdomo, C. (2007) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1746 · Cited by 71
Choi, S. H., Park, K. W., Na, D. L., Han, H. J., Kim, E., Shim, Y. S., Lee, J., & The EXPECT Study Group (2011) · Current Medical Research and Opinion · doi:10.1185/03007995.2011.582484 · Cited by 69 · cited 1×
“tine combination treatment are low, between 5% to 10%, and not generally significantly different from placebo.(100,120,121,125,126)”
Long-term progression of Alzheimer's disease in patients under antidementia drugs
Gillette‐Guyonnet, S., Andrieu, S., Nourhashemi, F., Gardette, V., Coley, N., Cantet, C., Gauthier, S., Ousset, P., Vellas, B., & REAL.FR study group (2011) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2011.02.009 · Cited by 64
Schmitt, F. A., van Dyck, C. H., Wichems, C. H., & Olin, J. T. (2006) · Alzheimer Disease & Associated Disorders · doi:10.1097/01.wad.0000213860.35355.d4 · Cited by 62
Grossberg, G. T., Pejović, V., Miller, M. L., & Graham, S. M. (2009) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000200013 · Cited by 59
The Pharmacoeconomics of Cognitive Enhancers in Moderate to Severe Alzheimerʼs Disease
Cappell, J., Herrmann, N., Cornish, S., & Lanctôt, K. L. (2010) · CNS Drugs · doi:10.2165/11539530-000000000-00000 · Cited by 57 · cited 1×
“Viewed from the social perspective, anti-AD pharmacotherapy (donepezil, memantine, galantamine, rivastigmine) can reduce the economic burden of the illness, even in later stages of illness.(66)”
Pharmacological Treatment of Dementia: A Scoping Review of Systematic Reviews
van de Glind, E. M. M., van Enst, W. A., Munster, B. C. V., Rikkert, M. G. M. O., Scheltens, P., Scholten, R. J. P. M., & Hooft, L. (2013) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000353892 · Cited by 55
The place of memantine in the treatment of Alzheimer's disease: a number needed to treat analysis
Livingston, G., & Katona, C. (2004) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1166 · Cited by 54 · cited 9×
“When to start and stop anti-Alzheimer disease medications Per FDA prescribing information, clinicians may start a ChEI in mild, moderate, or severe AD, and memantine in moderate or severe AD.”
InfluentialWattmo, C., Wallin, Å. K., Londos, E., & Minthon, L. (2011) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e3181f5dd97 · Cited by 52 · cited 1×
“Persistence, higher dosage (in later dementia stages), and duration of treatment are associated with better outcomes, even in those with advanced dementia.(92,95,114,115,130)”
Doody, R., Wirth, Y., Schmitt, F., & Möbius, H. J. (2004) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000079833 · Cited by 52
Weycker, D., Taneja, C., Edelsberg, J., Haim Erder, M., Schmitt, F. A., Setyawan, J., & Oster, G. (2007) · Current Medical Research and Opinion · doi:10.1185/030079907x188071 · Cited by 52
Wallin, Å., Minthon, & Wattmo, C. (2011) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s24196 · Cited by 50 · cited 1×
“Persistence, higher dosage (in later dementia stages), and duration of treatment are associated with better outcomes, even in those with advanced dementia.(92,95,114,115,130)”
Progression of Alzheimer disease in Europe: data from the European ICTUS study
Vellas, B., Hausner, L., Frolich, L., Cantet, C., Gardette, V., Reynish, E., Gillette, S., Aguera-Morales, E., Auriacombe, S., Boada, M., et al. (2012) · Current Alzheimer Research · doi:10.2174/156720512803251066 · Cited by 50
Wilkinson, D. G., Schindler, R. J., Schwam, E. M., Waldemar, G., Jones, R. W., Gauthier, S. G., López, O. L., Cummings, J. L., Xu, Y., & Feldman, H. (2009) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000241877 · Cited by 48 · cited 9×
“When to start and stop anti-Alzheimer disease medications Per FDA prescribing information, clinicians may start a ChEI in mild, moderate, or severe AD, and memantine in moderate or severe AD.”
InfluentialWallin, Å. K., Gustafson, L., Sjögren, M., Wattmo, C., & Minthon, L. (2004) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000079201 · Cited by 45
A Very Incomplete Comprehensive Theory of Alzheimer's Disease
Davies, P. (2000) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2000.tb05553.x · Cited by 43
Outcome of Alzheimer's disease: potential impact of cholinesterase inhibitors
Gillette-Guyonnet, S., Andrieu, S., Cortes, F., Nourhashemi, F., Cantet, C., Ousset, P.-J., Reynish, E., Grandjean, H., & Vellas, B. (2006) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/61.5.516 · Cited by 41
Prevalence and Effects of Lobar Microhemorrhages in Early-Stage Dementia
Atri, A., Locascio, J. J., Lin, J. M., Yap, L., Dickerson, B. C., Grodstein, F., Irizarry, M. C., Growdon, J. H., & Greenberg, S. M. (2005) · Neurodegenerative Diseases · doi:10.1159/000092317 · Cited by 40 · cited 1×
“In the dementia stages of AD, many patients have cortical or cortico-subcortical microhemorrhages due to cerebral amyloid angiopathy-related vasculopathy and leakage(19); hemosiderin microdeposition from microhemorrhages are seen on gradient-echo or susceptibility-weighted MRI sequences in 15% to 20% of patients.(20)…”
Self-citationPrescription of antipsychotics in people with dementia
Ballard, C., Corbett, A., & Howard, R. (2014) · British Journal of Psychiatry · doi:10.1192/bjp.bp.113.128710 · Cited by 27 · cited 3×
“Antipsychotics carry a US Food and Drug Administration (FDA) black-box warning in dementia; they must be used with extreme caution, ongoing monitoring, and only when strict conditions are met.(55,56) Short-term and long-term antipsychotic use is associated with substantial risk of cognitive decline, morbidity (eg, par…”
Atri, A., Rountree, S. D., López, O. L., & Doody, R. S. (2012) · Neurodegenerative Diseases · doi:10.1159/000335156 · Cited by 23
Self-citationHsiung, G. R., & Puangthong, U. (2009) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s5021 · Cited by 22
Mortality Risk With the Use of Atypical Antipsychotics in Later-Life Bipolar Disorder
Bhalerao, S., Seyfried, L. S., Kim, H. M., et al. (2012) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988712436687 · Cited by 20 · cited 1×
“Nonpharmacologic interventions and behavioral strategies should be used as the firstline option to ameliorate neuropsychiatric symptoms (eg, agitation, apathy, delusions, and disinhibition) and problem behaviors (eg, resistance to care, caregiver shadowing, hoarding, and obsessive-compulsive behaviors) in AD dementia.…”
Imaging of neurodegenerative cognitive and behavioral disorders
Atri, A. (2016) · Handbook of clinical neurology · doi:10.1016/b978-0-444-53486-6.00050-8 · Cited by 19
Self-citationAlzheimer’s Disease and Alzheimer’s Dementia
Atri, A. (2014) · Oxford University Press eBooks · doi:10.1093/med/9780199928453.003.0016 · Cited by 8 · cited 1×
“0, excessive and widespread binding of an amyloid PET agent in the brain) and exclusion of other less common cognitive or behavior-impairing conditions.(3,45) FDG-PET or single-photon emission CT (SPECT), and MRI or CT, do not directly measure AD-related pathology but suggest neurodegeneration and can support that AD…”
Self-citationMemantina: el valor de la terapia combinada
Guix, J. L. M. (2011) · Revista de Neurología · doi:10.33588/rn.5202.2010602 · Cited by 7
Atri, A., Knopman, D. S., Norman, M., Karlawish, J. H., Sano, M., Onyike, C. U., Lin, P., Clevenger, C. K., Scanland, S., Hendrix, J. A., et al. (2018) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2018.07.110 · Cited by 6
Self-citationWinblad (1999) · doi:10.1002/(sici)1099-1166(199902)14:2
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Lecanemab: Appropriate Use Recommendations
Cummings, J., Apostolova, L., Rabinovici, G. D., Atri, A., Aisen, P., Greenberg, S., Hendrix, S., Selkoe, D., Weiner, M., Petersen, R. C., et al. (2023) · The Journal of Prevention of Alzheimer's Disease · doi:10.14283/jpad.2023.30 · Cited by 961
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Metadata
- Authors
- Atri, A.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Atri, Alireza
- ORCID
- Atri, Alireza
- Venue
- Medical Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 103
- Issue
- 2
- Pages
- 263-293
- ISSN
- 0025-7125 (ISSN-L)
- OpenAlex
- W2912556930
- Semantic Scholar
- 14850f3937650b950a4f0acf73d3f53c6a2e1147
- Cited by
- 623
- References
- 143
- Citations by year
- 2026: 61 · 2025: 111 · 2024: 131 · 2023: 122 · 2022: 90 · 2021: 65 · 2020: 34 · 2019: 7
- FWCI
- 8.28
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Medical Clinics of North America (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Novartis
- The American College of Radiology
- AbbVie
- Avid
- Biogen
- Lilly
- Lundbeck
- Merck
- vTV
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
- Keywords
- Alzheimer's disease, clinical spectrum, dementia diagnosis, clinical biomarkers, patient-caregiver dyads, shared decision-making, psychoeducation, pharmacotherapy, non-pharmacological treatment, disease progression, preclinical Alzheimer's disease, dementia prevention
- MeSH terms
- Alzheimer Disease, Diagnosis, Differential, Humans, Parkinson Disease, Biomarkers, Disease Progression, Neuroimaging
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