Vascular Dementia Factors Influencing Diagnostic Accuracy Ranjan Duara, M.D. Wien Center for Alzheimer’s Disease & Memory Disorders, Miami Beach.

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Vascular Dementia Factors Influencing Diagnostic Accuracy Ranjan Duara, M.D. Wien Center for Alzheimer’s Disease & Memory Disorders, Miami Beach

Collaborators Wien Center, Mount Sinai, Miami Beach –Ranjan Duara, MD, David Loewenstein, PhD –Amarilis Acevedo, PhD, Warren Barker, MS –Debbie Hurwitz, MSW, Marina Bravo, MSW –Mercy Luis, MSW, Cheryl Luis, PhD Mayo Clinic, Jacksonville –Dennis Dickson, MD

Frequency of AD & Vascular Dementia by Age in Florida Brain Bank Onset Age (yrs) <60 (n=33) (n=97) (n=129) 80+ (n=48) AD (pure) 73% (42%) 77% (45%) 75% (48%) 75% (58%) VaD* (pure) 6% (0%) 9% (1%) 24% (8%) 15% (4%) *Significant change in frequency with age (p<.05)

Frequency of Postmortem Diagnoses by Age & Gender in Florida Brain Bank PM DiagnosisAge: <70 yrs Fem Male Age: 70+ yrs Fem Male AD (mixed+pure)81% 73%82%* 66% LBD (mixed+pure) 25% 42%* 14% 29%* VaD (mixed+pure)7% 10%23% 20% *Significant difference in frequency by gender (p<.05)

Frequency of VaD in Dementia Autopsy Series Study (n) VaD  (Pure) Population Brun 1994 (175)70% (34%)Dem Study Galasko 1994(170)9% (2%)AD Res Ctrs Drach 1997 (59)27% (12%)Nursing Home Nolan 1998 (87)37% (0%)Dem Clinic Lim 1999 (134)34%+ (3%)Dem Register Duara 2000 (307)16% (4%)Brain Bank

Accuracy of Clinical VaD in Dementia Autopsy Series Study (n)Sen/SpecPopulation Victoroff 1995 (196)45% / 97%University Sevush 1995 (92)53% / 86%Brain Bank Massoud 1997 (312)83% / 91%Meta-Analysis Gold 1997 (113) ADDTC HIS AIREN 63% / 64% 43% / 88% 58% / 80% Geriatric Hospital Duara (307)9% / 93%Brain Bank

Mixed Pathology in AD & VaD State of Florida Brain Bank (n=307) Alzheimer’s DiseaseVascular Dementia

Bayesian Analysis Sensitivity – proportion of affected with positive test Specificity – proportion of unaffected with negative test PPV – proportion with positive test who are affected NPV – proportion with negative test who are unaffected

Positive Predictive Value and Prevalence of AD and VaD Vascular Dementia Alzheimer’s