Abstract
Subjects enrolled in the Autopsy Program at the University of Southern California Alzheimer's Disease Research Center may receive clinical diagnoses from primary care providers in the community or from specialists in neurology. We reviewed the autopsy concordance rates for 463 subjects for diagnoses made by both groups of clinicians. Seventy-seven percent of the sample met neuropathological criteria for Alzheimer's disease (AD). The overall diagnostic accuracy for this sample was 81 percent. Neurologists assessed 200 of the subjects (43 percent). The diagnostic accuracy for any clinical diagnosis among the non-neurologists was 84 percent, and 78 percent (p = 0.07) among neurologists. For AD, non-neurologists had a diagnostic concordance rate of 91 percent and neurologists 87 percent. Where neuropathological AD was missed, non-neurologists had failed to detect any cognitive impairment; neurologists had diagnosed Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). Erroneous clinical diagnoses of AD missed dementia with Lewy bodies (DLB) or AD concurrent with Parkinson's disease (PD). Our findings identify specific foci for improving clinical diagnosis of dementia among all physicians managing dementia.
Keywords: Alzheimer's disease, autopsy, cerebrovascular disease, clinical audit, dementia, diagnostic accuracy
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Contributor Information
W. Mok, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China..
T. W. Chow, The Rotman Research Institute, University of Toronto, Toronto, Canada..
C. Miller, University of Southern California Alzheimer's Disease Research Center, Los Angeles, California..
References
- Lim A, Tsuang D, Kukull W, et al.: Clinico-neuropathological correlation of Alzheimer's disease in a community-based case. J Am Geriatr Soc. 1999; 47(5): 564-569. [DOI] [PubMed] [Google Scholar]
- Rasmusson DX, Brandt J, Steele C, et al.: Accuracy of clinical diagnosis of Alzheimer's disease and clinical features of patients with non-Alzheimer's disease neuropathology. Alzheimer Dis Assoc Disord. 1996; 10(4): 180-188. [DOI] [PubMed] [Google Scholar]
- Larson EB, Edwards JK, Meara EO, et al.: Neuropathologic diagnostic outcomes from a cohort of outpatients with suspected dementia. J Gerontol Med Sci.1996; 51A(6): M313-M318. [DOI] [PubMed] [Google Scholar]
- Petrovitch H, White LR, Ross GW, et al.: Accuracy of clinical criteria for AD in the Honolulu-Asia Aging Study, a population-based study. Neurology. 2001; 57(2): 226-234. [DOI] [PubMed] [Google Scholar]
- Pearl GS: Diagnosis of Alzheimer's disease in a community hospital-based brain bank program. South Med J. 1997; 90(7): 720-722. [DOI] [PubMed] [Google Scholar]
- Nagy Z, Esiri MM, Hindley NJ, et al.: Accuracy of clinical operational diagnostic criteria for Alzheimer's disease in relation to different pathological diagnostic protocols. Dement Geriatr Cogn Disord. 1998; 9(4): 219-226. [DOI] [PubMed] [Google Scholar]
- McKhann G, Drachman D, Folstein M, et al.: Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services task force on Alzheimer's disease. Neurology. 1984; 34(7): 939-944. [DOI] [PubMed] [Google Scholar]
- Chui HC, Victoroff JI, Margolin D, et al.: Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology. 1992; 42(3 Pt 1): 473-480. [DOI] [PubMed] [Google Scholar]
- Mirra SS, Heyman A, McKeel D, et al.: The consortium to establish a registry for Alzheimer's disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease. Neurology. 1991; 41(4): 479-486. [DOI] [PubMed] [Google Scholar]
- Petersen RC, Smith GE, Waring SC, et al.: Aging, memory and mild cognitive impairment. Int Psychogeriatr. 1997; 9(Suppl 1): 65-69. [DOI] [PubMed] [Google Scholar]
- Newell KL, Hyman BT, Growdon JH, et al.: Application of the National Institute on Aging (NIA)-Reagan Institute criteria for the neuropathological diagnosis of Alzheimer disease. J Neuropathol Exp Neurol.1999; 58(11): 1147-1155. [DOI] [PubMed] [Google Scholar]
- Hohl U, Tiraboschi P, Hansen LA, et al.: Diagnostic accuracy of Dementia with Lewy bodies. Arch Neurol. 2000; 57(12): 347-351. [DOI] [PubMed] [Google Scholar]
- Ferman TJ, Smith GE, Boeve BF, et al.: DLB fluctuations: Specific features that reliably differentiate DLB from AD and normal aging. Neurology. 2004; 62(2): 181-187. [DOI] [PubMed] [Google Scholar]
- Hamilton RL: Lewy bodies in Alzheimer's disease: A neuropathological review of 145 cases using alpha-synuclein immunohistochemistry. Brain Pathol.2000; 10(3): 378-384. [DOI] [PMC free article] [PubMed] [Google Scholar]