title: Analyses of diagnostic patterns at 30 Alzheimer's disease centers in the US.
abstract: BACKGROUND
  The US Alzheimer's Disease Centers (ADCs) (n = 30) recently created a uniform data set. We sought to determine which variables were most important in making a diagnosis, and how these differed across ADCs.
  
  
  METHODS
  A cross-sectional analysis of first visits to ADCs via polytomous logistic regression. We analyzed subjects with complete data (n = 7,555, 89%), and also used multiple imputation to infer missing data.
  
  
  RESULTS
  There were 8,495 subjects; 50, 26, and 24% were diagnosed as normal, having mild cognitive impairment (MCI), or mild Alzheimer's disease [Clinical Dementia Rating (CDR) score <1], respectively. The model using 7,555 subjects was 86% accurate in predicting diagnosis. Important predictors were physician-reported decline and the CDR sum of boxes, followed by 4 cognitive tests (Mini Mental State Examination, Category Fluency Tests, Logical Memory Test, Boston Naming Test). Multiple imputation revealed Trail Making Test B to be additionally important. Consensus versus single-clinician diagnoses were 2-3 times more likely to result in MCI than normal diagnoses. Excluding clinical judgment variables, functional assessment and psychiatric symptoms were important additional predictors; model accuracy remained high (78%). There were significant differences between centers in the use of different cognitive tests in making diagnoses.
  
  
  CONCLUSIONS
  We recommend creating a hypothetic data set to use across ADCs to improve diagnostic consistency, and a survey on the use of raw or adjusted cognitive test scores by different ADCs.
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. nsteenl@sph.emory.edu
authors.forename: Kyle
authors.initials: K
authors.lastname: Steenland
authors.forename: Jessica
authors.initials: J
authors.lastname: Macneil
authors.forename: Scott
authors.initials: S
authors.lastname: Bartell
authors.forename: James
authors.initials: J
authors.lastname: Lah
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis*; D003072:Cognition Disorders / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D006801:Humans; D009483:Neuropsychological Tests; D010818:Practice Patterns, Physicians'; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D014481:United States