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Neuropsychological Differentiation of Alzheimers Disease and Vascular Dementia: A MetaAnalysis

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The differential diagnosis of Alzheimer's Disease (AD) and vascular ... Cognitive tests must be used cautiously and in conjunction with other diagnostic ... – PowerPoint PPT presentation

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Title: Neuropsychological Differentiation of Alzheimers Disease and Vascular Dementia: A MetaAnalysis


1
Neuropsychological Differentiation of
Alzheimers Disease and Vascular Dementia A
Meta-Analysis
  • Jennifer Burke
  • University of Adelaide
  • Associate Professor Jane Mathias
  • University of Adelaide

2
Background
  • The differential diagnosis of Alzheimers Disease
    (AD) and vascular dementia (VaD) is difficult
  • Cognitive assessments play an important role in
    differential diagnosis
  • There is a lack of clear evidence regarding which
    cognitive tests accurately discriminate between
    AD and VaD

3
Aim
  • Undertake a meta-analytic review of research
    comparing the cognitive deficits of persons with
    AD and VaD

4
Literature search
  • Comprehensive search
  • PsycINFO and PubMed databases
  • January 1989 to September 2006.

5
Inclusion criteria
  • Examined groups with AD VaD
  • Cognitive tests were administered to both groups
  • These tests were not used for diagnosis
  • Data enabling the calculation of effect sizes
  • Participants did not have any other neurological
    or psychiatric disorder
  • Was published in English

6
Data collection
  • The data extracted from each study included
  • study characteristics
  • participants characteristics
  • cognitive tests
  • test data for AD VaD groups

7
Effect size calculations
  • Cohens d effect sizes were calculated for every
    cognitive test in every study
  • d measures the standardised mean difference
    between two groups
  • small effect d .2medium effect d
    .5 large effect d .8

8
Calculations
  • Mean effect sizes were then calculated for all
    studies that used a given measure
  • Effect sizes were weighted to take into account
    sample size

9
Calculations
  • Percentage overlap in scores (OL)
  • 95 confidence intervals
  • Fail-safe N measures the number of studies with
    small effects that are required to overturn a
    finding
  • Heterogeneity was tested

10
Data interpretation
  • For a test to be useful for differential
    diagnosis, it had to
  • d gt .8 (large effect)
  • 95 CI ? 0
  • a large Nfs score

11
Demographics
  • N 81 studies
  • 119 cognitive tests were used
  • Participant recruitment hospital inpatient
    outpatients (34)
  • AD 68 females, VaD 53 females
  • AD and VaD groups were comparable education,
    time since diagnosis, depression
  • AD group was younger and had lower MMSE
  • Majority of studies used published diagnostic
    criteria

12
Tests examined by gt one study
13
Results
  • d ranged from 0 to 1.1
  • OL ranged from 40 to 100
  • At best, cognitive tests are limited in their
    ability to discriminate between AD VaD

14
Results
  • Tests examined by one study
  • 13 cognitive tests showed large group differences
  • Commonly used tests did not effectively
    discriminate between AD and VaD patients

15
Conclusions
  • Cognitive tests must be used cautiously and in
    conjunction with other diagnostic information
  • Inadequate diagnostic criteria
  • VaD is a heterogeneous disease
  • Overlapping aetiologies
  • There are a number tests that may prove suitable
    for assisting with differential diagnosis
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