Accuracy of four clinical diagnostic criteria for the diagnosis of neurodegenerative dementias

Abstract

We found improved inter-rater reliability for the diagnosis of AD among clinicians compared with earlier studies. Similarly, there was a near-perfect and substantial inter-rater agreement for the diagnosis of PSP and FTD. The sensitivity for the diagnosis of AD was high, although clinicians overdiagnosed this condition. However, there was a reasonable accuracy for the diagnosis of PSP and FTD. Heterogeneity of the clinical presentation of DLB significantly affected inter-rater agreement and accuracy. The use of multiple diagnostic criteria for cortical and subcortical dementia increases the level of clinical diagnostic accuracy.

Diagnostic Accuracy of ELISA and xMAP Technology for Analysis of Amyloid β42 and Tau Proteins

“…Currently used clinical diagnostic criteria for AD and VaD have disappointing sensitivity and specificity, often leading to a diagnosis of "mixed dementia", with clinical features of AD but with multiple vascular lesions on brain images or cardiovascular risk factors (24,25 ). CSF A␤ 42 , t-tau, and p-tau 181 concentrations in VaD as measured by ELISA were comparable to those in previously published reports (6,26,27 ).…”

Practice parameter: Diagnosis of dementia (an evidence-based review)

“…The reliability of the diagnosis of AD is moderate (generalized kappa's in the 0.51 to 0.73 range) in Class II studies. [8][9][10] When standardized clinical diagnostic criteria are used, interrater reliability 6 and consistency of diagnosis between the initial visit and 1-year follow-up is high (95% in Forette 11 ). There are 13 studies, 3 Class I 12-14 and 10 Class II, 9,[15][16][17][18][19][20][21][22] that have addressed the diagnostic accuracy of the clinical diagnosis of AD using neuropathologic confirmation as the "gold standard."…”

Non-English speaking background patients in a predominantly English-speaking region may be more likely to present with a dementia other than Alzheimer’s disease

“…However applying the standard clinical criteria for diagnosis is open to a degree of subjectivity [19]. Hence centres of excellence are increasingly moving towards the use of biomarkers like FDG PET to improve accuracy in the diagnostic work-up [20].…”