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Clinical variables related to the diagnostic stability of demential syndromes

Published online by Cambridge University Press:  15 June 2017

Fabiano Moulin de Moraes*
Affiliation:
Service of Cognitive and Behavioral Neurology, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo,SP, Brazil
Paulo Henrique Ferreira Bertolucci
Affiliation:
Service of Cognitive and Behavioral Neurology, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo,SP, Brazil
*
Correspondence should be addressed to: Fabiano Moulin de Moraes, Service of Cognitive and Behavioral Neurology of the Department of Neurology and Neurosurgery of the Federal University of São Paulo, Rua Pedro de Toledo, 650, Vila Clementino, CEP 04039002, São Paulo, SP, Brazil. Phone: 55(11)55764848. Email: [email protected].

Abstract

Background:

Assigning a diagnosis to a patient with dementia is important for the present treatment of the patient and caregivers, and scientific research. Nowadays, the dementia diagnostic criteria are based on clinical information regarding medical, history, physical examination, neuropsychological tests, and supplementary exams and, therefore, subject to variability through time.

Methods:

A retrospective observational study to evaluate variables related to clinical diagnostic stability in dementia syndromes in at least one year follow up. From a sample of 432 patients, from a single university center, data were collected regarding sociodemographic aspects, Clinical Dementia Rating, physical examination, neuropsychological tests, and supplementary exams including a depression triage scale.

Results:

From this sample, 113 (26.6%) patients have their diagnosis changed, most of them adding a vascular component to initial diagnosis or depression as comorbidity or main disease. Our findings show that many factors influence the diagnostic stability including the presence of symmetric Parkinsonism, initial diagnosis of vascular dementia, presence of diabetes and hypertension, the presence of long term memory deficit in the neuropsychological evaluation, and normal neuroimaging. We discuss our findings with previous findings in the literature.

Conclusion:

Every step of the clinical diagnosis including history, vascular comorbidities and depression, physical examination, neuropsychological battery, and neuroimaging were relevant to diagnosis accuracy.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Almeida, O. P. et al. (1999). Reliability of the Brazilian version of the Geriatric Depression Scale (GDS) short form. Arquivos de Neuropsiquiatria, 57, 421426.CrossRefGoogle ScholarPubMed
Alzheimer's Association. (2016). Alzheimer's disease facts and figures. Alzheimers and Dementia, 12, 459509.CrossRefGoogle Scholar
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Washington, DC: American Psychiatric Association Google Scholar
Bertolucci, P. H. F. et al. (1994). The mini-mental state examination in an outpatient population: influence of literacy. Arquivos de Neuropsiquiatria, 52, 17.Google Scholar
Bertolucci, P. H. F. et al. (2001). Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arquivos de Neuropsiquiatria, 59, 532536.Google Scholar
British HIV Association, British Association of Sexual Health and HIV, British Infection Society. (2008). UK National Guidelines for HIV Testing. [Online]. Available at: http://www.thehealthwell.info/node/553652; last accessed 09th March 2016.Google Scholar
Brucki, S. M. D. et al. (1997). Dados normativos sobre o teste de fluência verbal categoria animais em nosso meio. Arquivos de Neuropsiquiatria, 55, 5761.Google Scholar
Camozzato, A. et al. (2008). Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. International Psychogeriatrics, 20, 383393. doi: 10.1017/S1041610207006254 Google Scholar
Carr, D. B. et al. (2000). The value of informant versus individual's complaints of memory impairment in early dementia. Neurology, 55, 17241726.Google Scholar
Cooper, B. et al. (1994). Health-care policy and planning for the demented: an international perspective. In Huppert, F. A. et al. (eds.), Dementia and Normal Aging (pp. 519551). London: Cambridge University Press Google Scholar
Fuzikawa, C. et al. (2003). A population based study on the intra and inter-rater reliability of the clock drawing test in Brazil: the Bambui health and ageing study. International Journal of Geriatric Psychiatry, 18, 450456.Google Scholar
Han, J. W. et al. (2012). Predictive validity and diagnostic stability of mild cognitive impairment subtypes. Alzheimers and Dementia, 8, 553559.Google Scholar
Knopman, D. S. et al. (2001). CME Practice parameter: diagnosis of dementia (an evidence-based review) report of the quality standards subcommittee of the American academy of neurology. Neurology, 56, 11431153.CrossRefGoogle Scholar
Koepsell, T. D. et al. (2013). Stability of clinical etiologic diagnosis in dementia and mild cognitive impairment: results from a multicenter longitudinal database. American Journal of Alzheimers Disease and Other Dementias, 28, 750758. doi: 10.1177/1533317513504611.Google Scholar
Larner, A. J. (2014). Neurological signs of possible diagnostic value in the cognitive disorders clinic. Practical Neurology, 0, 14. doi:10.1136/practneurol-2013-000792 Google Scholar
Meng, X., and D'Arcy, C. (2012). Education and dementia in the context of the cognitive reserve hypothesis: a systematic review with Meta-Analyses and Qualitative Analyses. PLoS ONE, 7 (6), e382684. http://doi.org/10.1371/journal.pone.0038268.Google Scholar
Mok, W. et al. (2004). Clinicopathological concordance of dementia diagnoses by community versus tertiary care clinicians. American Journal of Alzheimers Disease and Other Dementias, 19, 161165.CrossRefGoogle ScholarPubMed
Montaño, M. B. et al. (2005). Validity of the Portuguese version of clinical dementia rating. Revista de Saude Publica, 39, 912917.CrossRefGoogle ScholarPubMed
Neary, D. et al. (2002). Sorting out the dementias. Practical Neurology, 2, 328339.Google Scholar
NICE guidelines CG42 Dementia. (2006). Available at: http://www.nice.org.uk/nicemedia/live/10998/30318/30318.pdf; last accessed 27th July 2015.Google Scholar
Nightingale, S. et al. (2013). Test them all; an easily diagnosed and readily treatable cause of dementia with life-threatening consequences if missed. Practical Neurology, 13, 354356 Google Scholar
Nitrini, R. et al. (2005). Diagnosis of Alzheimer's disease in Brazil: diagnostic criteria and auxiliary tests. Recommendations of the scientific department of cognitive neurology and aging of the Brazilian academy of neurology. Arquivos de Neuropsiquiatria, 63, 713719.Google Scholar
Oliveira, M. et al. (2004). Rey complex figure validation for the Brazilian population. Avaliação Psicologica, 3, 3338.Google Scholar
Panegyres, P. K. et al. (2007). Course and causes of suspected dementia in young adults: a longitudinal study. American Journal of Alzheimers Disease and Other Dementias, 22, 4856.CrossRefGoogle ScholarPubMed
Prince, M. et al. (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer's and Dementia, 9, 6375.e2.CrossRefGoogle ScholarPubMed
Travassos, C. et al. (2004). The concept and measurement of race and their relationship to public health: a review focused on Brazil and the United States. Cadernos de Saude Publica, 20, 660678.Google Scholar
Verhey, F. R. et al. (1993). Diagnosing dementia: a comparison between a monodisciplinary and a multidisciplinary approach. Journal of Neuropsychiatry and Clinical Neuroscience, 5, 7885.Google Scholar
Verstraeten, E. et al. (2007). Neurocognitive effects of obstructive sleep apnea syndrome. Current Neurology and Neuroscience Reports, 7, 161166.CrossRefGoogle ScholarPubMed
Waldemar, G. et al. (2007). Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. European Journal of Neurology, 14, e1–26.Google Scholar
Warren, J. D. (2013). Molecular nexopathies: a new paradigm of neurodegenerative disease. Trends in Neurosciences, 36, 561569. Epublished 2013 July 19, doi: 10.1016/j.tins.2013.06.007.Google Scholar
Weyerer, S. et al. (2003). The assessment of quality of life in dementia. International Psychogeriatrics, 15, 213218.Google Scholar
Weytingh, M. D. et al. (1995). Reversible dementia: more than 10% or less than 1%? A quantitative review. Journal of Neurology, 242, 466471.Google Scholar
Zimmermann, N. et al. (2015). Brazilian preliminary norms and investigation of age and education effects on the modified Wisconsin card sorting test, stroop color and word test and digit span test in adults. Dementia & Neuropsychologia, 9, 120127.Google Scholar