title: The added value of neuropsychologic tests and structural imaging for the etiologic diagnosis of dementia in italian expert centers.
abstract: 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.
authors.affiliation: Laboratory of Epidemiology, Neuroimaging and Telemedicine, Scientific Institute for Research and Care (IRCCS) San Giovanni di Dio, FBF, Brescia, Italy. cgeroldi@fatebenefratelli.it
authors.forename: Cristina
authors.initials: C
authors.lastname: Geroldi
authors.forename: Elisa
authors.initials: E
authors.lastname: Canu
authors.forename: Amalia C
authors.initials: AC
authors.lastname: Bruni
authors.forename: Gloria
authors.initials: G
authors.lastname: Dal Forno
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ferri
authors.forename: Carlo
authors.initials: C
authors.lastname: Gabelli
authors.forename: Roberta
authors.initials: R
authors.lastname: Perri
authors.forename: David
authors.initials: D
authors.lastname: Iapaolo
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Scarpino
authors.forename: Elena
authors.initials: E
authors.lastname: Sinforiani
authors.forename: Orazio
authors.initials: O
authors.lastname: Zanetti
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Frisoni
mesh_terms: 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