He was forgetful and his gait shuffling and unstable. CASE #1Ī 72-year-old man had progressive decline in gait and cognition following a fall 10 months earlier. Finally, we suggest analogies from Frank Baum’s novel “The Wonderful Wizard of Oz” to help the reader (without trivializing) remember the phenotypic differences between them. We then discuss the features in the history, examination and ancillary testing that may have helped distinguishing these entities. We present three patients with pathology-proven AD presenting with cognitive and behavioral impairment in the context of parkinsonian features, initially diagnosed as bvFTD. FvAD is an under-recognized form of AD, often misdiagnosed as more common frontal lobe syndromes such as the behavioral variant of frontotemporal dementia (bvFTD) or vascular dementia affecting frontal networks. These include the posterior cortical atrophy syndrome, corticobasal syndrome, logopenic variant of primary progressive aphasia, and frontal variant (fvAD). While an amnestic syndrome is the most common presentation of Alzheimer’s disease (AD), atypical variants have been recognized.
Moca scoring criteria license#
An Oz-inspired creative license may help the clinician recognize the differential disease progression, caregiver burden, and treatment response of fvAD compared with bvFTD. The Yellow Brick Road to diagnosing these disorders may be served by the metaphor of fvAD as the irritable, paranoid, and tremulous Scarecrow and bvFTD the heartless, ritualistic, and rigid Tin Man. Here we present three pathology-proven cases of Alzheimer’s disease initially misdiagnosed as bvFTD and discuss the distinctive or less overlapping historical, examination, and laboratory findings of fvAD and bvFTD, deriving analogies for mnemonic endurance from the Wizard of Oz worldview. Recognizing fvAD from bvFTD-related pathologies is a diagnostic challenge and a critical need in the management and counseling of these patients. The most common are the behavioral variant of frontotemporal dementia (bvFTD) and the frontal variant of Alzheimer’s disease (fvAD), which are particularly challenging to disentangle. Given the wide range of cognitive, behavioral and motor processes in which the frontal lobes are involved, there can be a great variety of manifestations depending on the pathology distribution. A cut-off value of 24 provided the best balance between sensitivity (98.0 7%) and specificity (79.6 %).Ĭonclusion MoCA-S is a valid and reliable instrument which can be used as a brief screening instrument for dementia in Sri Lanka.Disruption of the frontal lobes and its associated networks are a common consequence of neurodegenerative disorders. There was a high, positive correlation between MoCA-S total scores and MMSE total scores.
Moca scoring criteria serial#
Attention (digit span, sustained attention, and the serial 7 calculation task) had the highest discriminant ability followed by visuospatial skills (trail making, cube drawing and clock drawing). Cronbach’s alpha of 0.818 indicated good internal consistency. Results Mean MoCA scores between NC (26.71, SD 2.4) and AD group (16.78, SD 5.9) were significantly different (t=10.8, p<0.001). Criterion validity was assessed using receiver operating characteristic (ROC) analysis. Concurrent validity was assessed using Pearson correlation coefficients between the MoCA-S scores and MMSE scores. All subjects were administered the Mini Mental State Examination (MMSE) and MoCA Sinhala version (MoCA-S). Sample consisted of 49 participants diagnosed with dementia of the Alzheimer’s type (AD) according to DSM-IV criteria and 49 normal controls (NC) aged ≥50 years. Sample size was calculated to detect a targeted sensitivity of 85% and a specificity of 85%. Methods The MoCA translation and cultural adaptation was carried using a combined qualitative and quantitative approach. Objectives To validate the Sinhala version of the Montreal Cognitive Assessment (MoCA) scale in screening for dementia.
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