How does additional diagnostic testing influence the initial diagnosis in patients with cognitive complaints in a memory clinic setting?
BACKGROUND
patients suspected of dementia frequently undergo additional diagnostic testing (e.g. brain imaging or neuropsychological assessment) after standard clinical assessment at a memory clinic. This study investigates the use of additional testing in an academic outpatient memory clinic and how it influences the initial diagnosis.


METHODS
the initial diagnosis after standard clinical assessment (history, laboratory tests, cognitive screening and physical and neurological examination) and the final diagnosis after additional testing of 752 memory clinic patients were collected. We specifically registered if, and what type of, additional testing was requested.


RESULTS
additional testing was performed in 518 patients (69%), 67% of whom underwent magnetic resonance imaging, 45% had neuropsychological assessment, 14% had cerebrospinal fluid analysis and 49% had (combinations of) other tests. This led to a modification of the initial diagnosis in 17% of the patients. The frequency of change was highest in patients with an initial non-Alzheimer's disease (AD) dementia diagnosis (54%, compared with 11 and 14% in patients with AD and 'no dementia'; P < 0.01). Finally, after additional testing 44% was diagnosed with AD, 9% with non-AD dementia and 47% with 'no dementia'.


CONCLUSIONS
additional testing should especially be considered in non-AD patients. In the large group of patients with an initial AD or 'no dementia' diagnosis, additional tests have little diagnostic impact and may perhaps be used with more restraint.
Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
Anouk P
AP
Meijs
Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
Jurgen A H R
JA
Claassen
Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
Marcel G M Olde
MG
Rikkert
Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands.
Bianca W M
BW
Schalk
Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands.
Olga
O
Meulenbroek
Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands.
Roy P C
RP
Kessels
Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
René J F
RJ
Melis
D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology; D015415:Biomarkers / Q000134:cerebrospinal fluid; D003071:Cognition; D003072:Cognition Disorders / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000523:psychology; D016208:Databases, Factual; D003704:Dementia / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010044:Outpatient Clinics, Hospital; D011237:Predictive Value of Tests
D015415:Biomarkers
MRI; dementia; diagnostic accuracy, older people; memory clinic; neuropsychological testing