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Ferretti REDL, Damin AE, Brucki SMD, Morillo LS, Perroco TR, Campora F, Moreira EG, Balbino ÉS, Lima MDCDA, Battela C, Ruiz L, Grinberg LT, Farfel JM, Leite REP, Suemoto CK, Pasqualucci CA, Rosemberg S, Saldiva PHN, Jacob-Filho W, Nitrini R. Post-Mortem diagnosis of dementia by informant interview. Dement Neuropsychol 2010; 4:138-144. [PMID: 29213677 PMCID: PMC5619173 DOI: 10.1590/s1980-57642010dn40200011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 03/20/2010] [Indexed: 11/22/2022] Open
Abstract
The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant. OBJECTIVES To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic. METHODS A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists' panel consensus, in each group, determined the final diagnosis of the case, blind to other center's diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed. RESULTS Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition. CONCLUSIONS The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition.
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Affiliation(s)
- Renata Eloah de Lucena Ferretti
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- University of ABC
| | - Antonio Eduardo Damin
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Lilian Schafirovits Morillo
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
| | - Tibor Rilho Perroco
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Psychiatry,University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Flávia Campora
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Eliza Guccione Moreira
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Érika Silvério Balbino
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | | | - Camila Battela
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Lumena Ruiz
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Lea Tenenholz Grinberg
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
- Department of Neurology, University of California, San
Francisco
| | - José Marcelo Farfel
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Renata Elaine Paraiso Leite
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Carlos Augusto Pasqualucci
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
- São Paulo Autopsy Service
| | - Sérgio Rosemberg
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
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Cacchione PZ, Powlishta KK, Grant EA, Buckles VD, Morris JC. Accuracy of collateral source reports in very mild to mild dementia of the Alzheimer type. J Am Geriatr Soc 2003; 51:819-23. [PMID: 12757569 DOI: 10.1046/j.1365-2389.2003.51263.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the reporting accuracy of collateral sources (knowledgeable informants) regarding very mild and mild dementia of the Alzheimer type (DAT) and to identify characteristics associated with collateral source accuracy. DESIGN Secondary data analysis of initial visits of individuals enrolled in a longitudinal study of healthy aging and Alzheimer disease. SETTING Urban Alzheimer disease research center. PARTICIPANTS Pairs of 515 individuals with very mild (n = 203) or mild (n = 312) DAT and their collateral sources. MEASUREMENTS Collateral sources were asked separately during a semistructured interview by experienced clinicians to report current ability of the individual with DAT in memory, orientation, and judgment and problem solving. The clinical performance of the individuals with DAT in these domains was compared with these predictions. RESULTS Collateral sources were consistently and significantly accurate in reporting the cognitive capabilities of individuals with very mild and mild DAT. Although all types of collateral sources performed significantly better than chance, individual variables that correlated with collateral source accuracy included spousal relationship; living with the individual with DAT; frequent exposure to the individual; and age, education level, sex and dementia severity of the individual with DAT. CONCLUSION Collateral sources are accurate in reporting the cognitive capabilities of individuals with DAT, even in the very mild stage of dementia.
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Affiliation(s)
- Pamela Z Cacchione
- University of Iowa, Gerontological Nursing Intervention Center, College of Nursing, Iowa City, Iowa, USA
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Devi G, Marder K, Schofield PW, Tang MX, Stern Y, Mayeux R. Validity of family history for the diagnosis of dementia among siblings of patients with late-onset Alzheimer's disease. Genet Epidemiol 2000; 15:215-23. [PMID: 9593109 DOI: 10.1002/(sici)1098-2272(1998)15:3<215::aid-gepi1>3.0.co;2-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We examined 180 siblings of 127 probands with probable or possible Alzheimer's dementia (AD) in a family study of AD. The overall sensitivity of a simple family history questionnaire was 64% and the specificity was 84%. Sensitivity improved 90-100% with minimal decline in specificity when we considered clinic-based vs. population survey patients. Higher education among informants and the availability of a spouse or a sibling as informant significantly increased sensitivity. Awareness of such factors may improve the yield of the family history in AD using a simple questionnaire.
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Affiliation(s)
- G Devi
- Gertrude H. Sergievsky Center, Division of Epidemiology, Columbia University School of Public Health, New York, New York 10032, USA.
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Karlinsky H, Madrick E, Ridgley J, Berg JM, Becker R, Bergeron C, Hodgkinson S, Percy ME, McLachlan D. A family with multiple instances of definite, probable and possible early-onset Alzheimer's disease. Br J Psychiatry 1991; 159:524-30. [PMID: 1751863 DOI: 10.1192/bjp.159.4.524] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A family with a multigenerational history of proven or suspected early-onset Alzheimer's disease (AD) consistent with autosomal-dominant inheritance is described. To date, the pedigree comprises five generations in which there are 13 known affected individuals. The mean age of onset of cognitive deficits in those for whom data are available (n = 11) is 47.6 (s.d. 3.0) years and the mean age of death (n = 10) is 58.8 (s.d. 4.0) years. The variability in the extent and quality of available data illustrates the diagnostic difficulties encountered in ascertaining such an extended pedigree, and the need for caution in interpreting the evidence.
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Affiliation(s)
- H Karlinsky
- Geriatric Psychiatry Services, Queen Elizabeth Hospital, Toronto
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