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Clinicopathological concordance of dementia diagnoses by community versus tertiary care clinicians

Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

T. W. Chow, MD

The Rotman Research Institute, University of Toronto, Toronto, Canada.

L. Zheng, MS

W. J. Mack, PhD

C. Miller, MD

University of Southern California Alzheimer's Disease Research Center, Los Angeles, California.

Subjects enrolled in the Autopsy Program at the University of Southern California Alzheimer's Disease Research Center may receive clinical diagnoses from primary care providers in the community or from specialists in neurology. We reviewed the autopsy concordance rates for 463 subjects for diagnoses made by both groups of clinicians. Seventy-seven percent of the sample met neuropathological criteria for Alzheimer's disease (AD). The overall diagnostic accuracy for this sample was 81 percent. Neurologists assessed 200 of the subjects (43 percent). The diagnostic accuracy for any clinical diagnosis among the non-neurologists was 84 percent, and 78 percent (p = 0.07) among neurologists. For AD, non-neurologists had a diagnostic concordance rate of 91 percent and neurologists 87 percent. Where neuropathological AD was missed, non-neurologists had failed to detect any cognitive impairment; neurologists had diagnosed Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). Erroneous clinical diagnoses of AD missed dementia with Lewy bodies (DLB) or AD concurrent with Parkinson's disease (PD). Our findings identify specific foci for improving clinical diagnosis of dementia among all physicians managing dementia.

Key Words: Alzheimer's disease • autopsy • cerebrovascular disease • clinical audit • dementia • diagnostic accuracy

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