C Chen1,2, A Homma3, V C T Mok4, E Krishnamoorthy5, S Alladi6, K Meguro7, K Abe8, J Dominguez9, S Marasigan10, N Kandiah11, S Y Kim12,13, D Y Lee14, H A De Silva15, Y-H Yang16,17, M-C Pai18, V Senanarong19, A Dash20. 1. Department of Pharmacology, National University of Singapore, Singapore, Singapore. christopher_chen@nuhs.edu.sg. 2. Memory Aging and Cognition Center, National University Health System, Singapore, Singapore. christopher_chen@nuhs.edu.sg. 3. Research Institute for Dementia Care, Tokyo, Japan. 4. Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. 5. Neurokrish Consulting Pvt Ltd, Chennai, India. 6. Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India. 7. Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, Sendai, Japan. 8. Department of Neurology, Okayama University, Okayama, Japan. 9. Memory Center, St Luke's Medical Center, Quezon City, Philippines. 10. Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines. 11. Department of Neurology, National Neuroscience Institute and Duke-NUS Singapore, Singapore, Singapore. 12. Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. 13. Neurocognitive Behavior Center, Seoul National University Bundang Hospital, Seoul, Korea. 14. Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea. 15. Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. asita@sltnet.lk. 16. Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. 17. Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 18. Division of Behavioral Neurology, Department of Neurology, Alzheimer's Disease Research Center, Medical College and Hospital, National Cheng Kung University, Tainan City, Taiwan. 19. Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 20. Eisai Co. Ltd, Mumbai, India.
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.
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. Dementiapatients 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.
Authors: Liwen Zhang; Geert Jan Biessels; Saima Hilal; Joanna Su Xian Chong; Siwei Liu; Hee Youn Shim; Xin Xu; Eddie Jun Yi Chong; Zi Xuen Wong; Yng Miin Loke; Narayanaswamy Venketasubramanian; Tan Boon Yeow; Christopher Li-Hsian Chen; Juan Helen Zhou Journal: J Cereb Blood Flow Metab Date: 2020-01-27 Impact factor: 6.200
Authors: Victor T T Chan; Tiffany H K Tso; Fangyao Tang; Clement Tham; Vincent Mok; Christopher Chen; Tien Y Wong; Carol Y Cheung Journal: J Vis Exp Date: 2017-11-06 Impact factor: 1.355