Objective:
Accurate distinction between dementia subtypes is important for patient care and pharmacological
treatment. Continuing systematic comparisons of clinical and neuropathological dementia
diagnoses may provide a basis for further improvement of the diagnostic procedure.
The purpose of this study was to investigate concordance between clinical dementia
diagnosis and neuropathological findings in the specialized dementia care.
Methods:
Inclusion required 1) a clinical dementia disorder diagnosed at a hospital-based memory
clinic and 2) a neuropathological examination within the Department of Pathology at
the University Hospital in Lund, Sweden, during the years 1996–2006. A total of 176
consecutive patients fulfilled the criteria and were thus included. Clinical dementia
diagnoses were obtained from the medical records and compared with the neuropathological
findings.
Results:
The clinical and pathological dementia diagnoses were in full accordance in 86 (49%)
of the patients (κ 0.37). In an additional 24 (14%) cases, the clinical diagnosis
corresponded with some but not all pathological components judged to contribute to
the dementia disorder. Of the patients with clinical Alzheimer disease, 84% (46/55)
had a significant Alzheimer component with or without other significant pathology
at neuropathological examination. The corresponding figure for vascular dementia (VaD)
was 59% (24/41), for frontotemporal dementia 74% (20/27), for combined Alzheimer and
VaD 25% (4/16), and for dementia with Lewy bodies 67% (6/9).
Conclusions:
This study shows that clinical dementia diagnoses do not always correspond with neuropathological
changes. It stresses the importance of neuropathological examination in research and
in daily clinical practice.
Key Words:
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Article info
Publication history
Accepted:
February 18,
2009
Received in revised form:
January 26,
2009
Received:
December 11,
2008
Footnotes
The authors thank the involved memory clinics for the help to access the medical records.
The authors declare no conflict of interest.
This work was supported by the Trolle-Wachtmeister foundation, the Swedish Alzheimer foundation, the Swedish Dementia Association, and the Medical Association in Lund.
Identification
Copyright
© 2009 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
