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EEG as an easy diagnostic tool in differentiation of Alzheimer and non-Alzheimer dementia.

Dementia is a common progressive disease, and Alzheimer type dementia (AD) is the most frequently diagnosed dementia among dementia subgroups. Other types of dementia can be classified as non-Alzheimer dementia (NAD) including Lewy bodies, fronto-temporal, Pick’s, Creutzfeldt-Jacob, vascular, genetic, metabolic, toxic, constitutional, and idiopathic types. 1 The Clinical Dementia Rating (CDR) scale is used to characterize the level of cognitive and functional performance in patients at risk or suspected of having AD or another dementing disorder. 2 Objective, raterindependent, cost-effective, quantitative methods that can be used in place of, or with, CDR are needed as CDR is: i) time-consuming involving interview with at least 2 people, ii) subjective due to potential unreliable data gathered from the patient or informant, iii) inapplicable in several situations such as aphasia, deafness or loss of hearing, and finally iv) results are rater-dependent. Conventional visual analyses of the EEG in AD patients have demonstrated a diffuse slowing of the brain rhythms. However, quantitative EEG (QEEG) analysis may be a useful adjunct to interpretation of the routine EEG. 3 Clinical use of QEEG techniques by practitioners, who are not physicians, highly skilled and properly trained in clinical EEG interpretation, or without reviewing the original record, may give misleading results. Despite these difficulties, computer analysis should be the method of preference since it is more observerindependent. The EEG software and systems have not yet been sufficiently investigated for simple diagnosing and differentiation of AD and other dementia types. In this study, we aimed to investigate whether there is a difference in EEG recordings in patients with AD, NAD, and healthy subjects; if a difference is present, which variable can be used to discriminate these groups and whether there is a relation between EEG findings and severity of clinical dementia, with the use of simple digital EEG recording. Eight AD, and 16 NAD patients, and 16 healthy volunteers were included in the study, which took place in 2005. All AD and NAD patients were selected among the dementia patients who are in follow up at the neurology outpatient clinic of the Research Hospital of Duzce University, Duzce, Turkey. Informed consent was obtained from all participants or their caregivers or close relatives, according to the Code of Ethics of the World Medical Association (Declaration of Helsinki) and standards established by the Institutional Review Boards. The AD patients were diagnosed according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) diagnostic criteria and DSM-IV criteria. The CDR scale was used to determine dementia severities, as it has broad valuation ability, and contains the Mini Mental Test. The categories of the CDR scale from normal to severe were: normal, CDR=0; very mild, CDR=0.5; mild, CDR=1; moderate CDR=2; and severe, CDR=3. Volunteer control subjects were chosen between patients’ companions at the hospital. The following criteria for the control group was established: age and gender matched, and no disturbances of memory or other cognitive functions, and no deficits in the neurological examination. Exclusion criteria for all groups were those receiving neuroleptic, antidepressant, or sedative drugs, and having systemic or other disorders such as cerebrovascular diseases, diabetes, arterial hypertension, coronary disease, hypercholesterolemia (above 250 mg%), epilepsy, migraine, or psychiatric disorders. The EEG data were collected by a digital system (PowerLab/8sp, ADInstruments, Sydney, Australia), which included Chart 5.v3 software for recording through an isolated bio-amplifier (BIOamp, ADInstruments, Sydney, Australia). Precisely the same acquisition parameters and procedures were employed on all individuals included in the study. The pair of electrodes was located according to the International 10-20 system on the scalp at F3-F7, T3-P3, and O1O2 points for left frontal, left temporo-parietal and occipital regions. We selected these pairs as previous studies showed that left hemisphere is are affected more in dementia. The EEG data were recorded in resting state subjects with eyes-closed. Subjects were kept awake as much as possible during the recording. In all subjects, EEG recordings were performed for 10 minutes in the