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March 4, 1998

Consensus Statement on Alzheimer Disease—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(9):655-656. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-9-jbk0304

In Reply.—Drs Ania and Suarez-Almenara argue for the traditional view that Alzheimer disease is primarily a diagnosis of exclusion. By contrast, the consensus conference concluded that the diagnosis of Alzheimer disease must be primarily one of inclusion. We agree that excluding other possible causes of dementia is necessary, but the consensus group emphasized that a general medical and psychiatric evaluation, using standardized criteria based on a typical pattern of clinical features, yields diagnostic accuracy rates approaching 90%.1 Other potentially reversible causes uncovered from routine laboratory testing are rare.2 Although physical illness is common in patients with Alzheimer disease, it rarely is the immediate cause of dementia. Vascular dementia, moreover, is probably overdiagnosed,3 often from overinterpretation of computed tomography or magnetic resonance imaging results.