Difficulties of Diagnosing Alzheimer's Disease: The Application of Clinical Decision Support Systems

Masoud Amanzadeh, Hamid Moghaddasi, Reza Rabiei, Ali Amini Harandi, Hassan Haghighi



Introduction: Alzheimer's disease is one of the most common causes of dementia, which gradually causes cognitive impairment. Diagnosis of Alzheimer's disease is a complicated process performed through several tests and examinations. Design and development of Clinical Decision Support System (CDSS) could be an appropriate approach for eliminating the existing difficulties of diagnosing Alzheimer's disease. Materials and Methods: This study reviews the current problems in the diagnosis of Alzheimer's disease with an approach to the application of CDSS. The study reviewed the articles published from 1990 to 2016. The articles were identified by searching electronic databases such as PubMed, Google Scholar, Science Direct. Considering the relevance of articles with the objectives of the study, 29 papers were selected. According to the performed investigations, various reasons cause difficulty in Alzheimer's diagnosis. Results: The complexity of diagnostic process and  the similarity of Alzheimer's disease with other causes of dementia are the most important of them. The results of studies about the application of CDSSs on Alzheimer's disease diagnosis indicated that the implementation of these systems could help to eliminate the existing difficulties in the diagnosis of Alzheimer's disease. Conclusion: Developing CDSSs based on diagnostic guidelines could be regarded as one of the possible approaches towards early and accurate diagnosis of Alzheimer's disease. Applying of computer-interpretable guideline (CIG) models such as GLIF, PROforma, Asbru, and EON can help to design CDSS with the capability of minimizing the burden of diagnostic problems with Alzheimer's disease.


Alzheimer's disease, Dementia, Diagnosis, Clinical Decision Support System, Computer-Assisted Diagnosis,

Full Text:




Department of Economic and Social Affairs Population Division, United Nations. World Population Ageing 2015. United Nations. New York, 2015.

Seixas F.L and et al.A Bayesian network decision model for supporting the diagnosis of dementia, Alzheimer's disease and mild cognitive impairment. Comput Biol Med. 2014; 51.140–158.

Prince MJ. World Alzheimer Report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost and trends. Alzheimer's Disease International; 2015.

Sanchez E.Semantically Steered Clinical Decision Support Systems[thesis]. The University of the Basque Country.2014.

Duthey B. Priority medicines for europe and the world “a public health approach to innovation”, Alzheimer Disease and other dementias . WHO Background paper. 2013;6.

Alzheimer’s A. 2015 Alzheimer's disease facts and figures. Alzheimers Dement. 2015 Mar;11(3):332.

Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL. Bradley's Neurology in Clinical Practice.Elsevier.2016.

Department of social change and mental health, WHO. Alzheimer's disease international, help for caregivers.WHO.2006.

National Institute in Aging, National Institute of Health.About Alzheimer's Disease: Symptoms [internet].2017.Available from: https://www.nia.nih.gov/alzheimers/topics/symptoms.

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrisons manual of medicine. McGraw-Hill Medical Publishing Division; 2016 May 22.

Geldmacher DS, Kerwin DR. Practical diagnosis and management of dementia due to Alzheimer’s disease in the primary care setting: an evidence-based approach. Prim Care Companion CNS Disord. 2013;15(4).

National Institute in Aging, National Institute of Health. Symptoms and diagnosis of alzheimer’s disease, How Is Alzheimer's Disease Diagnosed?[internet]. 2017. Available from: https://www.nia.nih.gov/health/how-alzheimers-disease-diagnosed.

Brasil A and et al.Towards the Early Diagnosis of Alzheimer’s Disease Through the Application of a Multicriteria Classification Model. InTech, 2012.

Wikipedia. Dementia. Wikipedia, the free encyclopedia. Available at: https://en.wikipedia.org/wiki

Matila J. Disease State Index and Disease State Fingerprint, Supervised learning applied to clinical decision support in Alzheimer’s disease [thesis]. Tampere University of Technology. 2014.

Hauser S. Harrison's Neurology in Clinical Medicine. Josephson SA, editor. McGraw-Hill Medical Publishing Division; 2016 Sep 22.

Lindgren H. Decision support systems and diagnosing cognitive disorders [thesis]. University of Umeå, Sweden. 2000.

Soininen H and et al.Software Tool for Improved Prediction of Alzheimer’s Disease. Neurodegenerative Dis 2012;10:149–152.

Sanchez E and et al. A Knowledge-based Clinical Decision Support System for the diagnosis of Alzheimer Disease. Ine-Health Networking Applications and Services (Healthcom), 2011 13th IEEE International Conference on 2011 Jun 13 (pp. 351-357).

Bethune K. Diagnosis and Treatment of Alzheimer’s Disease: Current Challenges [thesis].Outstanding Honors.2010.

García-Pérez E, Violante A, Cervantes-Pérez F. Using neural networks for differential diagnosis of Alzheimer disease and vascular dementia. Expert Syst Appl. 1998 Jan 1;14(1-2):219-25.

Yin Z and et.al. A Hybrid Intelligent Diagnosis Approach for Quick Screening of Alzheimer’s Disease Based on Multiple Neuropsychological Rating Scales. Comput Math Methods Med.2015; Article ID 258761, 13 pages.

Oteniya L and et al.DemNet: A Clinical Decision Support System To Aid The Diagnosis Of Dementia. In Proceedings of the 22nd HealthCare Computing Conference.2005.289–297.

Obi JC and Imainvan AA. Decision Support System for the Intelligient Identification of Alzheimer using Neuro Fuzzy logic. International Journal on Soft Computing ( IJSC),2011; .2(2).

Galvin JE., Sadowsky CH. Practical Guidelines for the Recognition and Diagnosis of Dementia. J Am Board Fam Med 2012; 25:367–382.

Salloway S, Correia S. Alzheimer disease: time to improve its diagnosis and treatment. Cleve Clin J Med. 2009 Jan;76(1):49-58.

Phillips J, Pond D, Goode S. Timely diagnosis of dementia: can we do better. Canberra: Alzheimer’s Australia. 2011 Sep.

Aminoff M.J and et al. Clinical Neurology. Translated By Shoraka and et al.Arjmandpub.2009.

Gregory JW, Li M, Qi Q. A knowledge management solution to the difficulties of dementia diagnosis. Citeseerx. 2004.

Cummings JL, Frank JC, Cherry D, Kohatsu ND, Kemp B, Hewett L, Mittman B. Guidelines for managing Alzheimer's disease: part I. Assessment. Am Fam Physician. 2002 Jun 1;65(11):2263-76.

Lee J, Jang J, Shim B, Kim S, Kim J, Kim H, Song S, Kim J, Cho I, Kim Y. A workflow based clinical decision support system through integration of clinical workflow and knowledge processing. Int. J. Innov. Comp. Inf. Control. 2011;8:5251-64.

Dinevski D and et al. Clinical Decision Support Systems, Telemedicine Techniques and Applications, Prof. InTech. 2011.

Omididan Z, Hadianfar, AM. The role of clinical decision support systems in healthcare (1980-2010): A systematic review study. Jentashapir Sceintific-Research Quarterly. 2011; 2(3): 125-34 [Persian].

Shahsavarani AM, Abadi EA, Kalkhoran MH, Jafari S, Qaranli S. Clinical Decision Support Systems (CDSSs): State of the art Review of Literature. International Journal of Medical Reviews. 2015 Dec 22;2(4).

Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Jama. 2005 Mar 9;293(10):1223-38.

Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. Bmj. 2005 Mar 31;330(7494):765.

Wright A, Sittig DF. A framework and model for evaluating clinical decision support architectures. J. Biomed. Inform. 2008 Dec 31;41(6):982-90.

Coiera E. Guide to health informatics. CRC press; 2015 Mar 6.

Berner ES. Clinical decision support systems. New York: Springer Science+ Business Media, LLC; 2007.

Alther M, Reddy CK. Clinical Decision Support Systems.2015. Available from: http://dmkd.cs.vt.edu/papers/HDA-CDSS.pdf

Oluwafemi A.J and Ibrahim J.A. Expert System for Diagnosis Neurodegenerative Diseases. IJCEIT. 2015 ; 4(4).

Lindgren H. Towards personalized decision support in the dementia domain based on clinical practice guidelines. Springer ,User Model User-Adap Inter (2011) 21:377–406.

Do Amaral M and et.al. A psychiatric diagnostic system integrating probabilisticand categorical reasoning. Methods Inf. Med. 1996;34, 232–243.

Iliffe S, Austin T, Wilcock J, Bryans M, Turner S, Downs M. Design and implementation of a computer decision support system for the diagnosis and management of dementia syndromes in primary care. Methods Archive. 2002;41(2):98-104.

French B and et al. Classification and staging of dementia of the Alzheimer type: a comparison between neural networks and linear discriminant analysis.Arch Neurol. 1997;54(8):1001-9

Shree SB, Sheshadri HS. Diagnosis of Alzheimer’s Disease using Rule based Approach. Indian J Sci Technol. 2016 May 4;9(13).

Bennasar M. Clinical decision support system for early detection and diagnosis of dementia [thesis]. Cardiff University. 2014.

Duchesne, S., Crépeault, B. &Hudon, C. Knowledge-based discrimination in Alzheimer’s disease. Medical Content-Based Retrieval for Clinical DecisionSupport, Lecture Notes in Computer Science. 2010; 5853(1), 89–96.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013 May 22.

Hort J and et al. EFNS guidelines for the diagnosis and management of Alzheimer’sdisease. Eur J Neurol. 2010, 17: 1236–1248.

Clifford J.R. and et al. Introduction to Revised Criteria for the Diagnosis of Alzheimer’s Disease: National Institute on Aging and the Alzheimer Association Workgroups. Alzheimers Dement. 2011; 7(3): 257–262.

Fox J, Patkar V, Chronakis I, Begent R. From practice guidelines to clinical decision support: closing the loop. J. Royal Soc. Med. 2009 Nov 1;102(11):464-73.

Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999 Feb 20;318(7182):527.

Peleg M. Computer-interpretable clinical guidelines: a methodological review. J. Biomed. Inform. 2013 Aug 31;46(4):744-63.

De Clercq P, Kaiser K, Hasman A. Computer-interpretable guideline formalisms. Stud Health Technol Inform. 2008;139:22.

De Clercq PA, Blom JA, Korsten HH, Hasman A. Approaches for creating computer-interpretable guidelines that facilitate decision support. Artif Intell Med. 2004 May 31;31(1):1-27.

DOI: https://doi.org/10.22037/jps.v9i4.20966


  • There are currently no refbacks.

"Journal of Paramdedical Sciences", is a publication of "School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences" and "Iranian Society of Medical Proteomics".

"Journal of Paramdedical Sciences" is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


EISSN: 2008-4978

PISSN: 2008-496X