Assessing Fluctuating Cognition in Dementia Diagnosis: Interrater Reliability of the Clinician Assessment of Fluctuation.
Fluctuating cognition (FC) is a core feature of dementia with Lewy bodies (DLB) but is challenging to assess. This study assessed the reliability and validity of the Clinician Assessment of Fluctuation (CAF), which assesses FC in patients with dementia. Interrater agreement of CAF outcomes (FC present and FC severe) was evaluated between physicians and nonphysicians in 141 patients with Alzheimer's disease (AD) or DLB. Frequency of CAF outcomes by clinical and neuropathological diagnosis was examined. We found that interrater reliability was fair on FC present and almost perfect on FC severe, and both outcomes were higher in patients with clinical DLB than with clinical AD and were qualitatively more often endorsed in cases with neuropathological evidence of Lewy bodies. We conclude that the CAF is a reliable measure of FC and can be valuable in differential dementia diagnosis.
Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA Department of Psychology, Queens College and The Graduate Center, City University of New York, New York, NY, USA.
Kathleen
K
Van Dyk
Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA Department of Clinical Psychology, Antioch University New England, Keene, NH, USA.
Stephanie
S
Towns
Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Oksana
O
Tatarina
Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Philip
P
Yeung
Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Jhedy
J
Dorrejo
Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Laura B
LB
Zahodne
Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA ys11@columbia.edu.
Yaakov
Y
Stern
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000145:classification / Q000175:diagnosis*; D003071:Cognition; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D020961:Lewy Body Disease / Q000145:classification / Q000175:diagnosis*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D015588:Observer Variation; D015203:Reproducibility of Results
Alzheimer’s Disease; dementia; dementia with Lewy Bodies; fluctuating cognition