Alzheimer's disease with cerebrovascular disease: current status in the Asia–Pacific region

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, Ming-Chyi Pai, V. Senanarong, A. Dash

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)359-374
Number of pages16
JournalJournal of Internal Medicine
Volume280
Issue number4
DOIs
Publication statusPublished - 2016 Oct 1

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Cerebrovascular Disorders
Alzheimer Disease
Dementia
Behavioral Symptoms
Neuroimaging
Psychology
Vascular Dementia
Cholinesterase Inhibitors
Therapeutics
Activities of Daily Living
Diagnostic Errors
Cognition
Consensus
Epidemiology
Tomography
Quality of Life
Magnetic Resonance Imaging
Guidelines
Costs and Cost Analysis
Research

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Chen, C., Homma, A., Mok, V. C. T., Krishnamoorthy, E., Alladi, S., Meguro, K., ... Dash, A. (2016). Alzheimer's disease with cerebrovascular disease: current status in the Asia–Pacific region. Journal of Internal Medicine, 280(4), 359-374. https://doi.org/10.1111/joim.12495
Chen, C. ; Homma, A. ; Mok, V. C.T. ; Krishnamoorthy, E. ; Alladi, S. ; Meguro, K. ; Abe, K. ; Dominguez, J. ; Marasigan, S. ; Kandiah, N. ; Kim, S. Y. ; Lee, D. Y. ; De Silva, H. A. ; Yang, Y. H. ; Pai, Ming-Chyi ; Senanarong, V. ; Dash, A. / Alzheimer's disease with cerebrovascular disease : current status in the Asia–Pacific region. In: Journal of Internal Medicine. 2016 ; Vol. 280, No. 4. pp. 359-374.
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abstract = "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.",
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Chen, C, Homma, A, Mok, VCT, Krishnamoorthy, E, Alladi, S, Meguro, K, Abe, K, Dominguez, J, Marasigan, S, Kandiah, N, Kim, SY, Lee, DY, De Silva, HA, Yang, YH, Pai, M-C, Senanarong, V & Dash, A 2016, 'Alzheimer's disease with cerebrovascular disease: current status in the Asia–Pacific region', Journal of Internal Medicine, vol. 280, no. 4, pp. 359-374. https://doi.org/10.1111/joim.12495

Alzheimer's disease with cerebrovascular disease : current status in the Asia–Pacific region. / Chen, C.; Homma, A.; Mok, V. C.T.; Krishnamoorthy, E.; Alladi, S.; Meguro, K.; Abe, K.; Dominguez, J.; Marasigan, S.; Kandiah, N.; Kim, S. Y.; Lee, D. Y.; De Silva, H. A.; Yang, Y. H.; Pai, Ming-Chyi; Senanarong, V.; Dash, A.

In: Journal of Internal Medicine, Vol. 280, No. 4, 01.10.2016, p. 359-374.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Alzheimer's disease with cerebrovascular disease

T2 - current status in the Asia–Pacific region

AU - Chen, C.

AU - Homma, A.

AU - Mok, V. C.T.

AU - Krishnamoorthy, E.

AU - Alladi, S.

AU - Meguro, K.

AU - Abe, K.

AU - Dominguez, J.

AU - Marasigan, S.

AU - Kandiah, N.

AU - Kim, S. Y.

AU - Lee, D. Y.

AU - De Silva, H. A.

AU - Yang, Y. H.

AU - Pai, Ming-Chyi

AU - Senanarong, V.

AU - Dash, A.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

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