The added value of neuropsychologic tests and structural imaging for the etiologic diagnosis of dementia in italian expert centers.
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.
Geroldi
Cristina
C
Laboratory of Epidemiology, Neuroimaging and Telemedicine, Scientific Institute for Research and Care (IRCCS) San Giovanni di Dio, FBF, Brescia, Italy. cgeroldi@fatebenefratelli.it
Canu
Elisa
E
Bruni
Amalia C
AC
Dal Forno
Gloria
G
Ferri
Raffaele
R
Gabelli
Carlo
C
Perri
Roberta
R
Iapaolo
David
D
Scarpino
Osvaldo
O
Sinforiani
Elena
E
Zanetti
Orazio
O
Frisoni
Giovanni B
GB
D000368:Aged; D003704:Dementia / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D014057:Tomography, X-Ray Computed