DIAGNOSTIC AND THERAPEUTIC PROCEDURES OF THE ITALIAN ALZHEIMER
EVALUATION UNITS
May 2004
The following questionnaire is meant to report the diagnostic and therapeutic
procedures that the Italian Alzheimer Evaluation Units (UVAs) adopts on the
national area. The time required for filling is about 40 minutes. Preferable,
the Head of Unit (the physician visiting the patient) should complete the
questionnaire. We invite you to send back the questionnaire as an attachment to
the following e-mail address uva@oh-fbf.it, thank you.
The supplied data will be considered closely confidential and they will be
examined in relation to the italian law 675/96 (Privacy protection). The
“Istituto di Ricovero e Cura a Carattere Scientifico San Giovanni di Dio”
warrants the nameless data and their use for scientific purposes only.
INFORMATIONS ABOUT THE ALZHEIMER EVALUATION UNIT
1. Name of the Head of the UVA
2. Head’s e-mail address (if different than the
current address)
3. Name of Operative Manager (if different than the
Head of the Unit)
4. Operative Manager’s e-mail address (if different
than current address)
5. Speciality of Operative Manager of the UVA Geriatrician Psychiatrist
Neurologist
Other
6.Number of Patients recluted on CRONOS project* at
December 31st, 2003
7.How many new patients with cognitive impairment come to your ambulatory
without any etiologic diagnosis (such as with Alzheimer’s disease,
vascular dementia) or with unspecific diagnosis (as senile dementia, %
neurodegenerative syndrome)?
8.Where do you make the diagnosis for the above mentioned patients
(patients with cognitive impairment without any diagnosis or with
unspecific diagnosis)?
In Ambulatory %
In Day Hospital or Admission %
*Cronos project (Progetto Cronos, in italian) is an initiative from the Ministero della
Salute to refund the european approved drugs for the patients with Alzheimer’s disease on
the National UVAs.
In the following questions, please answer separately for ambulatory and for dh/admission
situations.
CLINICAL EVALUATION: Questions in this section are about the new patients that require a
visit for their cognitive impairment
AMBULATORY DH/ADMISSION
9. How old the new patients are on average?
yrs yrs
10. How long does the anamnestic interview take on average
(data-gathering about the past and recent family history)?
min. min.
11. For how many patients (percentage) do you administer:
MMSE % %
Barthel or another scale BADL % %
GDS or another scale for depression % %
NPI or another scale for NON cognitive complaints % %
12. To how many patients (percentage) do you prescribe:
ECG % %
Serum Vitamin B12 and folate % %
VDRL % %
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Test about the functionality of thyroid % %
13. In how many patients (percentage) do you make the
neurological objective check? % %
AMBULATORY DH/ADMISSION
14. Among these, how many show a monolateral or
bilateral Babinski’s sign? % %
15. … and a limb plastic hypertonia? % %
16. To how many patients (percentage) do you administer
an extended neuropsychological battery (such as MODA,
ADAS-Cog, etc)? % %
If the answer is 0% go to the question 18.
17. Which neuropsychological battery do you administer?
ADAS-Cog Yes /no yes /no
MODA yes /no yes /no
Camcog yes /no yes /no
Other (please specify ) yes /no yes /no
18. Which is the frequency (percentage) of the
following diagnosis?
Alzheimer’s disease % %
Multi-infarctual vascular disease % %
Subcortical vascular disease % %
Mixed Dementia (Alzheimer and vascular Dementia) % %
Dementia with lewy bodies % %
Frontotemporal dementia or Pick’s disease % %
Curable Dementias (normotensive hydrocephalus, % %
Iatrogenic, etc.)
Dementia due to depression % %
The total has to be 100 % 100 %
IMAGING
AMBULATORY DH/ADMISSION
19. Is the center where you work provided of a scanner
for:
CT Yes /no
MR Yes /no
SPECT Yes /no
PET Yes /no
20. How long is the average waiting time in the Radiology
or Nuclear Medicine ward where you usually require for
instrumental analysis for your patients with cognitive
impairment?
Cerebral CT days
Cerebral MR days
Cerebral SPECT days
Cerebral PET days
21. For how many patients (percentage) with cognitive
impairment do you prescribe the following tests?
Cerebral TC % %
Cerebral MR % %
Cerebral SPECT % %
Cerebral PET % %
22. In which clinical conditions do you prescribe the
structural imaging tests (CT, MR) to the new patients with
cognitive impairment?
Always, in each patient with cognitive complaint or yes /no yes /no
memory’s complaint.
only if when I suspect that the cause is a curable yes /no yes /no
intracranial problem(meningioma, normal pressure
hydrocephalus, etc.)
23. Which is the proportion of CT and MR prescribed to the
new patients with cognitive impairment?
(e.g. 1:2 as 1 TC every 2 MR, 5:1 as 5 TC every 1 MR, : :
etc.)
24. Which of the following factors has greatest influence
on your choice, when you choose to prescribe a CT? (give
an evaluation from 0 to 10 where 0= very low or not useful
2
and 10 is very good or decisive)
Available neuroimaging scanner
The waiting time is shorter in CT than in MR
Elder age of the patient
High severity of cognitive impairment
Lack of suspect of cerebral vascular disease
Greater familiarity with CT than MR
Lower cost of CT than MR
AMBULATORY DH/RICOVERO
25. Which of the following factors has greatest influence
on your choice, when you choose to prescribe a MR? (give
an evaluation from 0 to 10 where 0= very low or not useful
and 10 is very good or decisive)
Available neuroimaging scanner
The waiting time is shorter in MR than in CT
Young age of the patient
Mild severity of cognitive impairment
Lack of suspect of cerebral vascular disease
Greater familiarity with MR than CT
26. When you prescribe to the radiologist a cerebral TC o
MR for a patient with cognitive complaints or memory’s
complaints:
you require a standard test Yes /no
you require the examination of a specific area (such as Yes /no
medial temporal area, white matter, basal ganglia)
you don’t apply any specific test because the radiologist Yes /no
will make a decision about what to do
27. In which clinical conditions do you prescribe the
functional imaging tests (SPECT or PET) to the new
patients with cognitive impairment?
For the differential diagnosis of AD in unclear clinical Yes /no Yes /no
cases
In order to confirm a clinical diagnosis of frontotemporal Yes /no Yes /no
dementia
When the patient is young Yes /no Yes /no
when the cognitive impairment is mild Yes /no Yes /no
When the suspect of cerebral vascular disease is present Yes /no Yes /no
28. How do you consider the clinical benefit of the
exhibit of the radiologist? (give an evaluation from 0 to
10 where 0= very low or not useful and 10 is very good or
decisive)
29. The radiological CT exhibit of "hypoperfusion" or
"chronic hypoperfusion" or “leukomalacia” of white matter,
etc. indicates a vascular disease of the white matter.
(give an evaluation from 0 to 10 about this statement
where 0= totally wrong and 10= totally right).
30. The MR data of ischemic lacunes in white matter
indicates a vascular white matter’s damage of vascular
origin (give an evaluation from 0 to 10 about this
statement where 0= totally wrong and 10= totally right).
ADDED DIAGNOSTIC VALUE
31. How much do you consider the following techniques
useful in the differential diagnostic procedures?
(give an evaluation from 0 to 10 where 0= totally useless
and 10= needful. Don’t give the same valuation to two
techniques).
Anamnesis, objective medical test, basic
neuropsychological evaluation (MMSE, Clock Drawing Test)
extended neuropsychological battery (MODA, ADAS-Cog, etc.)
Laboratory test
Structural neuroimaging tests (TC, MR)
Functional Neuroimaging tests (SPECT, PET)
32.In how many patients (percentage) the technique that
you judge best allows you to formulate the correct
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diagnosis by itself? %
33. How much the second your favourite technique increases
the previous percentage?
(e.g. if the extended neuropsychological battery by itself
can help you to obtain the correct diagnosis in 60% of %
patients- question 32- the structural imaging tests would
increase 20% more patients - question 33)
MILD COGNITIVE IMPAIRMENT (MCI)
AMB DH/RICOVERO
34. Which score your patients with MCI obtain in the MMSE?
35. How many (percentage)of your patients with MCI have
cerebral vascular signs? % %
36. How much the following factors make you foresee that a
MCI patient will convert to dementia? (please give an
evaluation from 0 to 10 where 0= totally not predictive
and 10= very predictive or decisive. If you don’t use the
technique= I DON’T USE IT).
Medial temporal atrophy on CT or MR
Perfusion/metabolic variations in parietotemporal area on
SPECT or PET
Tau or abeta variations on liquor
37. Do you use to split the group of patients with MCI
into subtypes (such as amnesic or not amnesic MCI)?
(please give an evaluation from 0 to 10 where 0= never and
10= always).
38. The cause of cognitive deficit is often vascular or
mixed disease(neurodegenerative or vascular). How much do
you consider the following cerebral vascular markers as
strong causes of cognitive impairment? (Please give an
evaluation from 0 to 10 where 0= not strong and 10= very
strong).
Cerebrovascular risk factors (hypertension, cardiopathy,
etc.)
Major stroke markers showed by CT or MR
Injury’s markers of white matter (hyperintensity)or of
basal ganglia (lacunes) showed by CT or MR
Other (please specify)
39.Do you usually follow a different diagnostic procedure
with patients with MCI compared to the patient with
suspect dementia? If yes go to question 40, if not go to yes /no yes /no
question 41.
40. Is The diagnostic procedure for patients with MCI
different from that for patients with dementia in your
practice? If yes, please specify in what it’s different
(i.e. extended neuropsychological battery, preferential
use of MR, etc.) If not= IT’S NOT DIFFERENT.
Anamnesis, objective medical test, basic
neuropsychological evaluation (MMSE, Clock Drawing Test)
Please specify yes /no yes /no
extended neuropsychological battery (MODA, ADAS-Cog, etc.)
Please specify yes /no yes /no
Laboratory test
Please specify yes /no yes /no
Structural neuroimaging tests (CT, MR)
Please specify
yes /no yes /no
Functional Neuroimaging tests (SPECT, PET)
Please specify yes /no yes /no
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PHARMACHOLOGICAL THERAPY
41. To how many patients (percentage) with Alzheimer’s
disease do you prescribe the following drugs:
Vitamin E %
Donepezil %
Rivastigmine %
Galantamine %
Ginko-biloba %
Antiaggregants o vasodilatators (nimodipin, hydergine) %
Nootropics (acetil-carnitine, piracetam, ecc.) %
SSRIs %
Traditional neuroleptics %
Atypical neuroleptics %
Benzodiazepines for anxiety complaint (not for sleep %
complaint)
42. To how many patients (percentage) with vascular
disease do you prescribe the following drugs
Vitamin E %
Donepezil %
Rivastigmine %
Galantamine %
Ginko-biloba %
Antiaggregants o vasodilatators (nimodipin, hydergine) %
Nootropics (acetil-carnitine, piracetam, ecc.) %
SSRIs %
Traditional neuroleptics %
Atypical neuroleptics %
Benzodiazepines for anxiety complaint (no for sleep %
complaint)
43. To how many patients (percentage) with dementia with
lewy bodies do you prescribe the following drugs:
Vitamin E %
Donepezil %
Rivastigmine %
Galantamine %
Ginko-biloba %
Antiaggregants o vasodilatators (nimodipin, hydergine) %
Nootropics (acetil-carnitine, piracetam, ecc.) %
SSRIs %
Traditional neuroleptics %
Atypical neuroleptics %
Benzodiazepines for anxiety complaint (no for sleep %
complaint)
44. To how many patients (percentage) with frontotemporal
demnetia do you prescribe the following drugs:
Vitamin E %
Donepezil %
Rivastigmine %
Galantamine %
Ginko-biloba %
Antiaggregants o vasodilatators (nimodipin, hydergine) %
Nootropics (acetil-carnitine, piracetam, ecc.) %
SSRIs %
Traditional neuroleptics %
Atypical neuroleptics %
Benzodiazepines for anxiety complaint (no for sleep %
complaint)
45. To how many patients (percentage) with MCI do you
prescribe the following drugs:
Vitamin E %
Donepezil %
Rivastigmine %
Galantamine %
Ginko-biloba %
5
Antiaggregants o vasodilatators (nimodipin, hydergine) %
Nootropics (acetil-carnitine, piracetam, ecc.) %
SSRIs %
Traditional neuroleptics %
Atypical neuroleptics %
Benzodiazepines for anxiety complaint (no for sleep %
complaint)
46. To how many patients with Alzheimer’s disease
(percentage) do you change a cholinesterase inhibitors
with another one (e.g. from donepezil to rivastigmine or %
vice versa)?
47. Please give an opinion about the drugs’s efficacy on
cognitive symptoms of Alzheimer’s disease (please give an
evaluation between 0 to 10 where 0= not effective and 10=
strongly effective)
Donepezil
Rivastigmine
Galantamine
48. Please give an opinion about the following drugs on
basic or instrumental disability of Alzheimer’s
disease(please give an evaluation between 0 to 10 where 0=
not efficacy and 10= strong efficacy)
Donepezil
Rivastigmine
Galantamine
49. Please give an opinion about the drugs’s efficacy on
NON cognitive symptoms of Alzheimer’s disease (please give
an evaluation between 0 to 10 where 0= not effective and
10= strongly effective)
Donepezil
Rivastigmine
Galantamine
50. How often the cholinesterase inhibitors have the
following effect in Alzheimer’s disease according to your
experience?
Worsening %
No benefit %
Benefits communicated by the patient’s family but without
confirmation on cognitive tests %
Benefits either on cognitive tests made by the patient and
communicated by patient’s family %
51.To how many patients with vascular disease (percentage)
do you change a cholinesterase inhibitor with another one
(e.g. from donepezil to rivastigmine or vice versa)? %
52. Please give an opinion about the drugs’s efficacy on
cognitive symptoms of vascular disease (please give an
evaluation between 0 to 10 where 0= not effective and 10=
strongly effective)
Donepezil
Rivastigmine
Galantamine
53. Please give an opinion about the following drugs on
basic or instrumental disability of vascular disease
(please give an evaluation between 0 to 10 where 0= not
efficacy and 10= strong efficacy)
Donepezil
Rivastigmine
Galantamine
54. Please give an opinion about the drugs’s efficacy on
NON cognitive symptoms of vascular disease (please give an
evaluation between 0 to 10 where 0= not effective and 10=
strongly effective)
Donepezil
6
Rivastigmine
Galantamine
55. How often the cholinesterase inhibitors have the
following effect in vascular disease according to your
experience?
Worsening %
No benefit %
Benefits communicated by the patient’s family but without
confirmation on cognitive test %
Benefits either on cognitive tests made by the patient and
communicated by patient’s family %
56. To how many patients with Dementia with lewy bodies
(percentage) do you change a cholinesterase inhibitors
with another one (e.g. from donepezil to rivastigmine or %
vice versa)?
57. Please give an opinion about the drugs’s efficacy on
cognitive symptoms of dementia with lewy bodies (please
give an evaluation between 0 to 10 where 0= not effective
and 10= strongly effective)
Donepezil
Rivastigmine
Galantamine
58. Please give an opinion about the following drugs on
basic or instrumental disability of dementia with lewy
bodies (please give an evaluation between 0 to 10 where 0=
not efficacy and 10= strong efficacy)
Donepezil
Rivastigmine
Galantamine
59. Please give an opinion about the drugs’s efficacy on
NON cognitive symptoms of dementia with lewy bodies
(please give an evaluation between 0 to 10 where 0= not
effective and 10= strongly effective)
Donepezil
Rivastigmine
Galantamine
60. How often the cholinesterase inhibitors have the
following effect in dementia with lewy bodies according to
your experience?
Worsening %
No benefit %
Benefits communicated by the patient’s family but without
confirmation on cognitive test %
Benefits either on cognitive tests made by the patient and
communicated by patient’s family %
61. To how many patients with frontotemporal dementia or
Pick’s disease (percentage) do you change a cholinesterase
inhibitors with another one (e.g. from donepezil to %
rivastigmine or vice versa)?
62. Please give an opinion about the drugs’s efficacy on
cognitive symptoms of frontotemporal dementia or Pick’s
disease (please give an evaluation between 0 to 10 where
0= not effective and 10= strongly effective)
Donepezil
Rivastigmine
Galantamine
63. Please give an opinion about the following drugs on
basic or instrumental disability of frontotemporal
dementia or Pick’s disease (please give an evaluation
between 0 to 10 where 0= not efficacy and 10= strong
efficacy)
Donepezil
Rivastigmine
7
Galantamine
64. Please give an opinion about the drugs’s efficacy on
NON cognitive symptoms of frontotemporal dementia or
Pick’s disease (please give an evaluation between 0 to 10
where 0= not effective and 10= strongly effective)
Donepezil
Rivastigmine
Galantamine
65. How often the cholinesterase inhibitors have the
following effect in frontotemporal dementia and Pick’s
disease according to your experience?
Worsening %
No benefit %
Benefits communicated by the patient’s family but without
confirmation on cognitive test %
Benefits either on cognitive tests made by the patient and
communicated by patient’s family %
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