title: The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis: a population validation study.
abstract: BACKGROUND
  The criterion for dementia implicit in DSM-IV is widely used in research but not fully operationalised. The 10/66 Dementia Research Group sought to do this using assessments from their one phase dementia diagnostic research interview, and to validate the resulting algorithm in a population-based study in Cuba.
  
  
  METHODS
  The criterion was operationalised as a computerised algorithm, applying clinical principles, based upon the 10/66 cognitive tests, clinical interview and informant reports; the Community Screening Instrument for Dementia, the CERAD 10 word list learning and animal naming tests, the Geriatric Mental State, and the History and Aetiology Schedule - Dementia Diagnosis and Subtype. This was validated in Cuba against a local clinician DSM-IV diagnosis and the 10/66 dementia diagnosis (originally calibrated probabilistically against clinician DSM-IV diagnoses in the 10/66 pilot study).
  
  
  RESULTS
  The DSM-IV sub-criteria were plausibly distributed among clinically diagnosed dementia cases and controls. The clinician diagnoses agreed better with 10/66 dementia diagnosis than with the more conservative computerized DSM-IV algorithm. The DSM-IV algorithm was particularly likely to miss less severe dementia cases. Those with a 10/66 dementia diagnosis who did not meet the DSM-IV criterion were less cognitively and functionally impaired compared with the DSMIV confirmed cases, but still grossly impaired compared with those free of dementia.
  
  
  CONCLUSIONS
  The DSM-IV criterion, strictly applied, defines a narrow category of unambiguous dementia characterized by marked impairment. It may be specific but incompletely sensitive to clinically relevant cases. The 10/66 dementia diagnosis defines a broader category that may be more sensitive, identifying genuine cases beyond those defined by our DSM-IV algorithm, with relevance to the estimation of the population burden of this disorder.
authors.affiliation: Section of Epidemiology, Health Services Research, King's College London, De Crespigny Park, London SE5 8AF, UK. m.prince@iop.kcl.ac.uk
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Prince
authors.forename: Juan Llibre
authors.initials: JL
authors.lastname: de Rodriguez
authors.forename: L
authors.initials: L
authors.lastname: Noriega
authors.forename: A
authors.initials: A
authors.lastname: Lopez
authors.forename: Daisy
authors.initials: D
authors.lastname: Acosta
authors.forename: Emiliano
authors.initials: E
authors.lastname: Albanese
authors.forename: Raul
authors.initials: R
authors.lastname: Arizaga
authors.forename: John R M
authors.initials: JR
authors.lastname: Copeland
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.forename: Cleusa P
authors.initials: CP
authors.lastname: Ferri
authors.forename: Mariella
authors.initials: M
authors.lastname: Guerra
authors.forename: Yueqin
authors.initials: Y
authors.lastname: Huang
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
authors.forename: E S
authors.initials: ES
authors.lastname: Krishnamoorthy
authors.forename: Paul
authors.initials: P
authors.lastname: McKeigue
authors.forename: Renata
authors.initials: R
authors.lastname: Sousa
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stewart
authors.forename: Aquiles
authors.initials: A
authors.lastname: Salas
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Sosa
authors.forename: Richard
authors.initials: R
authors.lastname: Uwakwa
mesh_terms: D000368:Aged; D000465:Algorithms; D016022:Case-Control Studies; D002391:Catchment Area, Health; D003071:Cognition; D003156:Community Mental Health Services; D003462:Cuba; D003704:Dementia / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011581:Psychological Tests