title: Diagnosing dementia in multiple system atrophy by applying Movement Disorder Society diagnostic criteria for Parkinson's disease dementia.
abstract: BACKGROUND
  Dementia is an exclusion criterion in current consensus diagnostic criteria, while growing evidence suggests the occurrence of cognitive dysfunction and even dementia in multiple system atrophy (MSA) patients. The main goal of this study was to determine if Movement Disorder Society (MDS) Parkinson's disease dementia (PDD) LEVEL-1 criteria are useful in screening for dementia in MSA patients compared to full cognitive testing (LEVEL-2 criteria).
  
  
  METHODS
  In this retrospective study, MDS diagnostic criteria for PDD were applied in 111 MSA patients from three centres. LEVEL-1 evaluation (short screening test) was compared to LEVEL-2 examination (extensive neuropsychological gold standard assessment). Sensitivity, specificity, positive and negative predictive values were calculated for LEVEL-1 compared to LEVEL-2. Two Mini Mental State Examination (MMSE) cut-off scores were evaluated (<26 according to MDS procedures for the diagnosis of PDD and <27 which has proven more sensitive in a recent study proposing a short procedure for PDD screening).
  
  
  RESULTS
  According to these criteria, 11.7% of MSA patients were demented on LEVEL-2 examination. LEVEL-1 examination showed strong specificity (96.9%) and negative predictive value (94.1%), while sensitivity (53.8%) and positive predictive (70%) value were moderate compared to LEVEL-2 evaluation. Sensitivity increased to 84.6% when using a MMSE threshold <27 for LEVEL-1. Executive dysfunction was the main prevalent finding (52% of all patients), while impairment of memory (15%), language (14%) and visuospatial functions was less frequent (13%).
  
  
  CONCLUSIONS
  Our findings suggest that the MDS PDD short screening test may be useful for the diagnosis of MSA dementia.
authors: Service de Neurologie, CHU de Bordeaux, Bordeaux, France; Univ. de Bordeaux, Laboratoire de Psychologie, Santé et Qualité de Vie, EA4139, Bordeaux, France.
authors: Nicolas
authors: N
authors: Auzou
authors: Service de Neurologie et Pathologies du Mouvement, CHRU de Lille, France; Inserm U1171, Troubles cognitifs dégénératifs et vasculaires, Université de Lille, Lille, France.
authors: Kathy
authors: K
authors: Dujardin
authors: Parkinson and Movement Disorders Unit, Fondazione Ospedale San Camillo, Venice, Italy.
authors: Roberta
authors: R
authors: Biundo
authors: Service de Neurologie, CHU de Bordeaux, Bordeaux, France; Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France; Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
authors: Alexandra
authors: A
authors: Foubert-Samier
authors: Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France.
authors: Caroline
authors: C
authors: Barth
authors: Service de Neurologie, CHU de Bordeaux, Bordeaux, France.
authors: Fanny
authors: F
authors: Duval
authors: Service de Neurologie, CHU de Bordeaux, Bordeaux, France; Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France; Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
authors: François
authors: F
authors: Tison
authors: Service de Neurologie et Pathologies du Mouvement, CHRU de Lille, France; Inserm U1171, Troubles cognitifs dégénératifs et vasculaires, Université de Lille, Lille, France.
authors: Luc
authors: L
authors: Defebvre
authors: Parkinson and Movement Disorders Unit, Fondazione Ospedale San Camillo, Venice, Italy.
authors: Angelo
authors: A
authors: Antonini
authors: Service de Neurologie, CHU de Bordeaux, Bordeaux, France; Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France; Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France. Electronic address: wassilios.meissner@chu-bordeaux.fr.
authors: Wassilios G
authors: WG
authors: Meissner
mesh_terms: D000368:Aged; D003704:Dementia / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000523:psychology*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000523:psychology; D012189:Retrospective Studies
keywords: Cognitive testing; Dementia; Executive function; Instrumental activities; Multiple system atrophy