The Accuracy of Short Clinical Rating Scales in Neuropathologically Diagnosed Dementia

Department of Geriatric Psychiatry, Clinical Sciences, Lund, Lund University, Sweden.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 4.24). 03/2010; 18(9):810-20. DOI: 10.1097/JGP.0b013e3181cdef7a
Source: PubMed


The overall aim was to evaluate to what extent the diagnosis of dementia subtypes, obtained by three clinical rating scales, concurred with postmortem neuropathologic (NP) diagnosis of Alzheimer disease (AD), frontotemporal dementia (FTD), vascular dementia (VaD) and mixed AD/VaD.
A prospective longitudinal clinical work-up with postmortem NP examination.
Two hundred nine patients with dementia referred for clinical evaluation and follow-up.
The diagnostic scores in a set of three short clinical rating scales for AD, FTD, and VaD were evaluated against NP diagnoses.
The sensitivity and specificity of the AD scale were 0.80 and 0.87, respectively, of the FTD scale 0.93 and 0.92, respectively, and of the Hachinski Ischemic Score (HIS, VaD diagnosis) 0.69 and 0.92, respectively. Cases with mixed AD/VaD generally presented a combination of high AD and ischemic scores. A preferred cutoff score of six was identified for both the AD and FTD scales.
All three clinical rating scales showed a high sensitivity and specificity, in close agreement with final NP diagnosis-for the HIS a moderate sensitivity. These scales may thus be considered good diagnostic tools and are recommended for clinical and research center settings.

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    • "Patients who developed clinical dementia, which was neuropathologically verified upon death as AD, VaD or mixed AD/VaD, and who had been followed-up with clinical records including detailed information on previous psychiatric history before the onset of dementia, were included in the present study. For the years 1967–1998 consecutive cases included in the Lund Longitudinal Dementia Study (Brun & Gustafson, 1993; Gustafson et al., 2010) were selected, while for the years 1999–2008 consecutive cases referred to the Department of Psychogeriatrics were included. This study was conducted in adherence with the Helsinki Declaration as well as national ethical guidelines. "
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    ABSTRACT: The aim of this study was to analyze the medical history, with regards to previous remote depression, in patients with neuropathologically verified Alzheimer's disease (AD), vascular dementia (VaD) and mixed AD/VaD. The 201 patients included (115 AD, 44 VaD and 42 mixed AD/VaD) had been referred to the Psychogeriatric/Psychiatric Department, Lund University Hospital, for psychogeriatric investigation and were followed-up with clinical records and detailed information on psychiatric history prior to the onset of dementia. Depression was considered to exist when the patient had consulted a psychiatrist or physician and had been diagnosed with a "depressive episode" or "depression" and when anti-depressants and/or other specific treatments had been prescribed. Twenty patients (10%) had suffered from depression earlier in life well before the onset of dementia. Eight of the 9 AD patients with a previous diagnosis of depression had suffered from only one depressive episode and all had responded well to treatment, with complete recovery. In the VaD group, 8 out of 9 patients suffered two or more depressive episodes and only two recovered completely. Events with a possible significant relationship to depression were seen in 8 of the 9 AD patients but in only 1 of the 9 VaD patients. Psychotic symptoms were more common in VaD than in the AD group. The treatment modality of depression was similar in the groups. In conclusion, a history of depression prior to dementia is more common and more therapy-resistant in VaD than in AD.
    Archives of gerontology and geriatrics 10/2012; 56(1). DOI:10.1016/j.archger.2012.10.008 · 1.85 Impact Factor

  • The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 09/2010; 18(9):755-8. DOI:10.1097/JGP.0b013e3181eb5a8b · 4.24 Impact Factor
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    ABSTRACT: Previous publications have shown a high diagnostic sensitivity and specificity of three short clinical rating scales for Alzheimer's disease (AD), frontotemporal dementia (FTD), and vascular dementia (VaD) validated against neuropathological (NP) diagnoses. In this study, the aim was to perform an exploratory factor analysis of the items in these clinical rating scales. The study included 190 patients with postmortem diagnoses of AD (n = 74), VaD (n = 33), mixed AD/VaD (n = 31), or FTD (n = 52). The factor analysis produced three strong factors. Factor 1 contained items describing cerebrovascular disease, similar to the Hachinski Ischemic Score. Factor 2 enclosed major clinical characteristics of FTD, and factor 3 showed a striking similarity to the AD scale. A fourth symptom cluster was described by perception and expression of emotions. The factor analyses strongly support the construct validity of the diagnostic rating scales.
    International Journal of Alzheimer's Disease 12/2010; 2011(5):632604. DOI:10.4061/2011/632604
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