Stability of clinical etiologic diagnosis in dementia and mild cognitive impairment: results from a multicenter longitudinal database.
Am J Alzheimers Dis Other Demen
; 28(8): 750-8, 2013 Dec.
Article
em En
| MEDLINE
| ID: mdl-24363072
ABSTRACT
Many new therapies for dementia target a specific pathologic process and must be applied early. Selection of specific therapy is based on the clinical etiologic diagnosis. We sought to determine the stability of the clinical etiologic diagnosis over time and to identify factors associated with instability. We identified 4141 patients with dementia or mild cognitive impairment who made at least 2 visits approximately a year apart to a dementia research center, receiving a clinical etiologic diagnosis on each visit. We assessed concordance of etiologic diagnoses across visits, κ-statistics, and transition probabilities among diagnoses. The primary clinical etiologic diagnosis remained stable for 91% of patients but with a net shift toward dementia with Lewy bodies and Alzheimer's disease. Lower diagnostic stability was significantly associated with older age, nonwhite race, milder disease at presentation, more underlying conditions contributing to cognitive decline, lack of a consistent spouse/partner informant, and being evaluated by different clinicians on different visits. Multistate Markov modeling generally confirmed these associations. Clinical etiologic diagnoses were generally stable. However, several readily ascertained characteristics were associated with higher instability. These associations may be useful to clinicians for anticipating when an etiologic diagnosis may be more prone to future change.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença de Parkinson
/
Demência Vascular
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Afasia Primária Progressiva
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Doença por Corpos de Lewy
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Demência
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Demência Frontotemporal
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Doença de Alzheimer
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Disfunção Cognitiva
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
Limite:
Aged
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Aged80
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Female
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Humans
/
Male
Idioma:
En
Revista:
Am J Alzheimers Dis Other Demen
Assunto da revista:
NEUROLOGIA
Ano de publicação:
2013
Tipo de documento:
Article
País de publicação:
EEUU
/
ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA