Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-04T16:33:26.109Z Has data issue: false hasContentIssue false
  • English
  • Français

The validity of the diagnosis of mild dementia

Published online by Cambridge University Press:  09 July 2009

Stephen Rosenman
Stephen Rosenman*
Affiliation:
NH & MRC Social Psychiatry Research Unit, Australian National University, Canberra, Australia
*
1Address for correspondence: Dr Stephen Rosenman, NH & MRC Social Psychiatry Research Unit, Australian National University, GPO Box 4, Canberra, ACT 2601, Australia.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Five operational methods for clinical diagnosis of mild dementia were compared to find out their diagnostic concordance when applied to a single group of seventy-five subjects. The clinical validity of the diagnoses was assessed in terms of their capacity to predict continued cognitive deterioration over three years after diagnosis and their capacity to reject the diagnostic influence of ‘non-dementia’ factors (that is, the cognitive consequences of depression, poor intellect, limited education and non-neurological physical illness). By all criteria of clinical validity the diagnostic methods for mild dementia performed poorly. Kappas measuring agreement between methods averaged only 0·15 and up to 57% of diagnostic deviance was explained by ‘non-dementia’ factors. Prediction of continued deterioration was poor, with a false positive rate which was too high for the diagnoses to be clinically usable. By no criterion of validity did the diagnostic methods exceed the performance of a clinician's judgement of the presence of pathological cognitive impairment or diagnosis by a cutpoint on the Mini-Mental State Examination.

Type
Original Articles
Information
Psychological Medicine , Volume 21 , Issue 4 , November 1991 , pp. 923 - 934
Copyright
Copyright © Cambridge University Press 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd edn). American Psychiatric Association: Washington.Google Scholar
Anthony, J. C., Le Resch, L., Niaz, U., von Korff, M. R. & Folstein, M. (1982). Limits of the ‘Mini-Mental State’ as a screening test for dementia and delerium among hospital patients. Psychological Medicine 12, 397–408.CrossRefGoogle Scholar
Bergmann, K. W., Kay, D. W. K., Foster, E. M., McKechnie, A. A. & Roth, M. (1973). A follow-up study of randomly selected community residents to assess the effects of chronic brain syndrome and cerebrovascular disease.In New Prospects in the Study of Mental Disorders in Old Age. Proceedings of the Vth World Congress of Psychiatry,Mexico,1971 (ed. de le Fuente, R. and Weisman, M. N.), pp. 856–865. Excerpta Medica: Amsterdam.Google Scholar
Berg, L., Miller, J. P., Storandt, M., Duckek, J., Morris, J. C., Rubin, E. H., Burke, W. J. & Coben, L. A. (1988). Mild senile dementia of the Alzheimer type: 2. Longitudinal assessment. Annals of Neurology 23, 477–484.CrossRefGoogle ScholarPubMed
Brayne, C. & Calloway, P. (1988). Normal ageing, impaired cognitive function and senile dementia of the Alzheimer's types: a continuum? Lancet, i, 1265–1267.CrossRefGoogle Scholar
Broe, G. A., Williamson, M., Tate, R. L., Locke, M., McFarlane, A. & Mitchell, R. (1984). Senescent gait disorder and forgetfulness – normal aging or early dementia.In Brain Impairment: Proceedings of the 1983 Brain Impairment Conference (ed. Fenelon, B. and Pfister, H. P.), pp. 269–277. Australian Society for the Study of Brain Impairment: Newcastle, (Australia).Google Scholar
Brockington, I. F., Kendell, R. E. & Leff, J. P. (1978). Definitions of schizophrenia: concordance and prediction of outcome. Psychological Medicine 8, 387–398.CrossRefGoogle ScholarPubMed
Copeland, J., Kelleher, M., Duckworth, G. & Smith, A. (1976). Reliability of psychiatric assessment in older patients. International Journal of Aging and Human Development 7, 313–322.CrossRefGoogle ScholarPubMed
Creasey, H. & Rapoport, S. I. (1985). The aging human brain. Annals of Neurology 17, 2–10.CrossRefGoogle ScholarPubMed
Copeland, J. R. M., Kelleher, M. J., Kellett, J. M., Gourlay, A. J., Gurland, B. J., Fleiss, J. L. & Sharpe, L. (1976). A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule – 1. Development and reliability. Psychological Medicine 6, 439–448.CrossRefGoogle Scholar
Fleiss, J. L. (1981). Statistical Methods for Rates and Proportions. New York: Wiley.Google Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Goldfarb, A. I. (1964). The evaluation of Geriatric patients following treatment. In The Evaluation of Psychiatric Treatment (ed. Hoch, P. and Zubim, J.), pp. 271–307. Grune and Stratton: New York.Google Scholar
Gruenberg, E. M. (1978). Epidemiology of senile dementia. In Advances of Neurology 19 (ed. Schoenberg, B. S.), pp. 437–457. Raven Press: New York.Google Scholar
Gurland, B. J., Kuriansky, J. B., Sharpe, L., Simon, R., Stiller, P. & Birkett, P. (1977). The Comprehensive Assessment and Referral Evaluation (CARE) – rationale, development and reliability. International Journal of Aging and Human Development 8, 9–42.CrossRefGoogle ScholarPubMed
Gurland, B. J., Dean, L. L., Copeland, J., Gurland, R. & Golden, R. (1982). Criteria for the diagnosis of dementia in the community elderly. The Gerontologist 22, 180–186.CrossRefGoogle ScholarPubMed
Henderson, A. S. & Huppert, F. A. (1984). The problem of mild dementia. Psychological Medicine 14, 5–11.CrossRefGoogle ScholarPubMed
Henderson, A. S., Duncan-Jones, P. & Finlay-Jones, R. A. (1983). The reliability of the Geriatric Mental State (Community Survey Version). Acta Psychiatrica Scandinavica 67, 281–289.CrossRefGoogle ScholarPubMed
Homer, A. C., Honavar, M., Lantos, P. L., Hastie, I. R., Kellet, J. M. & Millard, P. H. (1988). Diagnosing dementia: do we get it right? British Medical Journal 297, 894–896.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. & Martin, R. L. (1985). A new clinical scale for the staging of dementia. British Journal of Psychiatry 140, 566–572.CrossRefGoogle Scholar
Jöreskog, K. G. & Sörbom, D. (1988). Prelis; a program for multivariate data screening and data summarisation. Scientific Software: Mooresville Indiana.Google Scholar
Kay, D. W. K., Henderson, A. S., Scott, R., Wilson, J., Rickwood, D. & Grayson, D. A. (1985). Dementia and depression among the elderly living in the Hobart community: the effect of the diagnostic criteria on the prevalence rates. Psychological Medicine 15, 771–788.CrossRefGoogle ScholarPubMed
Kendell, R. E. (1989). Clinical validity. Psychological Medicine 19, 45–55.CrossRefGoogle ScholarPubMed
Kittner, S. J., White, L. R., Farmer, M. E., Wolz, M., Kaplan, E., Moss, E., Brody, J. R. & Feinleib, M. (1986). Methodological issues in screening for dementia: the problem of education adjustment. Journal of Chronic Disease 39, 163–170.CrossRefGoogle ScholarPubMed
La Rue, A. & Jarvik, L. E. (1987). Cognitive function and prediction of dementia in old age. International Journal of Aging and Human Development 25, 79–89.CrossRefGoogle ScholarPubMed
McAllister, T. W. (1981). Cognitive functioning in the affective disorders. Comprehensive Psychiatry 22, 572–586.CrossRefGoogle ScholarPubMed
Mowry, B. J. & Burvill, P. W. (1988). A study of mild dementia in the community using a wide range of diagnostic criteria. British Journal of Psychiatry 153, 328–334.CrossRefGoogle ScholarPubMed
Nelson, H. E. (1982). National Adult Reading Test (NART): Test Manual. NFER-Nelson: Windsor, Berks.Google Scholar
Perry, E. K. & Perry, R. H. (1988). Aging and dementia: neurochemical and neuropathological comparisons. In Etiology of Dementia of Alzheimer's Type (ed. Henderson, A. S. and Henderson, J. H.), pp. 213–228. J. Wiley and Sons: Chichester.Google Scholar
Reisberg, B., Ferris, S. H., De Leon, M. J. & Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry 139, 1136–1139.Google ScholarPubMed
Roth, M., Tym, E., Mountjoy, C. Q., Huppert, F. A., Hendrie, H., Verma, S. & Goodard, R. (1986). CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry 149, 698–709.CrossRefGoogle Scholar
Storandt, M., Aufdembrinke, B., Backman, L., Baltes, M. M., Blass, J. P., Braak, H., Lutzmann, H., Hauw, J. J., Hoyer, S., Jorm, A. F., Kauss, J., Kliegl, R. & Mountjoy, C. Q. (1988). Group report: Relationship of normal aging and dementing diseases in later life. In Etiology of Dementia of Alzheimer's Type (ed. Henderson, A. S. and Henderson, J. H.), pp. 231–239. Wiley and Sons: Chichester.Google Scholar
Wechsler, D. (1981). Wechsler Adult Intelligence Scale – Revised. The Psychological Corporation, Harcourt Brace Jovanowich: New York.Google Scholar
Weissman, M. M., Myers, J. K., Tischler, G. L., Holzer, C. E., Leaf, P. J., Orvaschel, H. & Brody, J. A. (1985). Psychiatric Disorders (DSM-III) and cognitive impairment among the elderly in a US urban community. Acta Psychiatrica Scandinavica 71, 36–379.CrossRefGoogle Scholar