Clinical utility of computed tomography in the assessment of dementia: a memory clinic study

Condefer, Kelly A.; Haworth, Judith; Wilcock, Gordon

doi:10.1002/gps.1028

Cited by 15 publications

(11 citation statements)

References 26 publications

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“…As in our study, the availability of neuroimaging examination and neuropsychologic battery allowed to further change the diagnosis in comparison with the initial clinical diagnosis 22 : 26% of patients had the expert diagnosis changed in comparison with initial clinical diagnosis after neuropsychologic and MR imaging investigations. An added value of similar extent has been reported for the brain CT scan only by Condefer and colleagues 23 in a study carried out in European and American memory clinics. They demonstrated that brain CT examination impacted on diagnosis of dementia in an average of 12%, and on treatment plan in 11% of cases.…”

Section: Discussionsupporting

confidence: 51%

The Added Value of Neuropsychologic Tests and Structural Imaging for the Etiologic Diagnosis of Dementia in Italian Expert Centers

Geroldi¹,

Canu

Bruni³

et al. 2008

Alzheimer Disease &Amp; Associated Disorders

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Aim of the study was to assess the added diagnostic value of neuropsychologic tests and structural neuroimaging (computed tomography or magnetic resonance) in the routine clinical assessment of demented patients in Italian expert centers. Nine centers were involved, located across the whole country (3 in Northern, 3 in Central, and 3 in Southern Italy). Diagnostic pathways were tracked for 474 patients with an expert diagnosis of neurodegenerative or vascular dementia (age 76+/-8; 62% females; Mini-Mental State Examination 17.70+/-5.7). The contribution of neuropsychology and structural neuroimaging to diagnosis was estimated as "number needed to test" (NNT), denoting the number of patients who need to undergo such procedures to improve expert diagnosis of 1 unit. Expert physicians reached their diagnosis without resorting to structural imaging examinations and neuropsychologic tests in 93% of Alzheimer disease (AD) and 76% of non-AD dementias. The completion of the extended assessment led to improvement of diagnostic accuracy in both cases: the NNT was 15.3 (95% confidence interval: 10.4-29.1) and 4.1 (3.0 to 6.5) for AD and non-AD diagnoses. The added value of structural imaging and neuropsychologic testing in the routine clinical assessment of demented patients is substantial in both AD and non-AD cases.

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Section: Discussionsupporting

confidence: 51%

The Added Value of Neuropsychologic Tests and Structural Imaging for the Etiologic Diagnosis of Dementia in Italian Expert Centers

Geroldi¹,

Canu

Bruni³

et al. 2008

Alzheimer Disease &Amp; Associated Disorders

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“…In contrast to results on the clinical utility of CT in the assessment of dementia (Condefer et al, 2004), there are as yet no data available on the utility of problem-oriented MRI protocols for the assessment of dementia. Furthermore, advanced statistical methods have not been applied to estimate the individual contribution of MRI and NP to the diagnosis of patients in a memory clinic setting.…”

Section: Discussionmentioning

confidence: 97%

“…We quantified, how much MRI contributed to the final clinical diagnosis. In comparison with the data by Condefer et al (2004), we aimed at formulating recommendations for the inclusion of structural imaging into the diagnosis of dementias.…”

Section: Introductionmentioning

confidence: 99%

The clinical utility of structural neuroimaging with MRI for diagnosis and differential diagnosis of dementia: a memory clinic study

Hentschel

Kreis

Damian

et al. 2005

Int. J. Geriat. Psychiatry

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“…This suggests that functional neuroimaging, at least as applied in the “expert” setting of a memory disorders clinic, reduces ambiguity in the clinical diagnosis, raises alternative diagnostic possibilities, and should be considered an important part of the dementia evaluation. Conceptually similar studies evaluating computed tomography (CT) alone 29 or CT accompanied by a detailed neurocognitive assessment 30 have reported, respectively, that CT influenced approximately 12% of dementia diagnostic assessments and that the number of persons needed to assess using CT and neurocognitive testing to change one clinical diagnosis was nine.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging in the Clinical Diagnosis of Dementia: Observations from a Memory Disorders Clinic

Borghesani

DeMers

Manchanda

et al. 2010

J American Geriatrics Society

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OBJECTIVES To determine how often neuroimaging confirms, clarifies, or contradicts initial diagnoses of late life cognitive disorders. DESIGN Retrospective case review. SETTING An outpatient clinic specializing in memory disorders. PARTICIPANTS 193 consecutively referred, cognitively impaired patients. MEASUREMENTS Diagnoses using research criteria were developed for each patient at the first visit, and ranged from cognitive impairment without dementia to dementias of single, complex, or indeterminate etiology. Structural (non-contrast MRI) and perfusion (Tc-99m ECD SPECT) images were categorized together as normal, suggestive of specific diseases, or abnormal/not diagnostic. RESULTS When a single neurodegenerative disease was suspected clinically (n=94) imaging confirmed the diagnosis in 50, contradicted the diagnosis in 32, and was abnormal/not diagnostic in 12. When more than one neurodegenerative etiology was clinically suspected (n=21) imaging assigned a single diagnosis in 13 and only cerebrovascular disease in 1, and was abnormal/not diagnostic in 7. In dementia NOS (n=33), imaging suggested a specific etiology in 23 and was abnormal/not diagnostic in 10. Abnormal/not diagnostic images were more common in cognitive disorder NOS (n=25) than in other clinical groups (68% vs. 22%, χ2 = 22.8 p < 0.001). Neuroimaging indicators of cerebrovascular disease were common (60% prevalence) but not predicted by the presence of vascular risk factors alone. CONCLUSION Overall, neuroimaging confirmed, clarified, or contradicted the initial clinical diagnosis in >80% of patients while < 20% had abnormal/not diagnostic patterns. Imaging suggested a complex dementia etiology in 21% of cases clinically thought to be caused by a single process, while 46% of complex clinical differential diagnoses appeared to reflect a single causal pattern. Further work is needed to determine whether refinement of clinical diagnoses by specialized neuroimaging improves clinical decision-making and patient outcomes.

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Clinical utility of computed tomography in the assessment of dementia: a memory clinic study

Abstract: In the outpatient setting, CT may be expected to impact on diagnosis and treatment of dementia in 10% to 15% of cases. Memory clinic physicians recognise and treat cerebrovascular risk factors with reasonable sensitivity and specificity without the input of CT.

Cited by 15 publications

References 26 publications

The Added Value of Neuropsychologic Tests and Structural Imaging for the Etiologic Diagnosis of Dementia in Italian Expert Centers

The Added Value of Neuropsychologic Tests and Structural Imaging for the Etiologic Diagnosis of Dementia in Italian Expert Centers

The clinical utility of structural neuroimaging with MRI for diagnosis and differential diagnosis of dementia: a memory clinic study

Neuroimaging in the Clinical Diagnosis of Dementia: Observations from a Memory Disorders Clinic

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