Agreement in the Clinical Diagnosis of Dementia: Evaluation of a Case Series with Mild Cognitive Impairment

Abstract

Interobserver agreement in the clinical diagnosis of dementia among four neurologists was evaluated. The physicians, masked to the original diagnoses, independently reviewed the clinical records of 50 outpatients consulting either the 1st University Neurology Department of Milan or the Neuropsychology Unit of the Medical Center of Veruno (Novara) for suspected cognitive impairment, during a 6-month period. The records contained patients'' medical and neurological history, results of neuropsychological testing, laboratory tests, cerebral computed tomography and other investigations. For each patient, the raters had to provide both a diagnosis concerning the presence or absence of dementia and to assign an analytical diagnosis to all the dementia cases. The ĸstatistic was used as a measure of interrater reliability. The level of agreement on the primary diagnosis of dementia was moderate Κ= 0.49); with respect to the nosological diagnoses, the ĸvalues ranged from 0.16 for depression to 0.80 for multi-infarct dementia.

Neuropsychological detection of cognitive impairment: Inter-rater agreement and factors affecting clinical decision-making

“…In our study, the neuropsychologists showed a moderate level of agreement when asked to judge whether a participant exhibited CI or not. The level of agreement observed (kappa 5 0.49) is virtually identical to that reported in the existing literature for psychologists making similar judgments concerning the presence of cognitive impairment (i.e., 0.48, White et al, 2002) and for dementia diagnoses made by neurologists using clinical records (i.e., 0.49, Solari et al, 1994). When agreement on diagnosis of specific disorders has been examined, agreement tends to be lower (e.g., White et al, 2002).…”

“…A number of studies have examined inter-rater agreement in the context of specific disorders affecting cognition (e.g., Alzheimer's disease, Kukull et al, 1990;Lopez et al, 1990;Hogervorst et al, 2000; the clinical identification of dementia using DSM-III-R criteria, Baldereschi et al, 1994;Solari et al, 1994;Graham et al, 1996;O'Connor et al, 1996), but few have examined the agreement between raters in the detection of CI more generally. Only one study, that included older adults, specifically examined the interrater agreement among neuropsychologists (5 clinical neuropsychologists from 4 medical centers) when identifying CI (White et al, 2002).…”

A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients

“…There is variability in how doctors practise medicine and in this respect neurologists are no different. [20][21][22] Therefore, it is as yet unknown how generalisable the results of the study will be and this can only be resolved by conducting a bigger trial. From the technological point of view all the staff who used the telemedicine equipment easily mastered the process.…”

Dementia as a Predictor of Adverse Outcomes Following Stroke

“…25 In the Stroke Data Bank, 26 dementia diagnosis based solely on clinical judgment resulted in a frequency of dementia of 16.0%, with a coefficient of 0.34 suggesting that interrater reliability was only moderate. Solari et al 27 performed a record review based on 50 patients presenting with possible cognitive impairment of varied etiology and reported a coefficient of 0.49 for agreement on dementia diagnosis among four neurologists using DSM-III-R 28 criteria. Similarly, Fratiglioni et al 29 reported only moderate interrater reliability for the use of DSM-III-R criteria, and they suggested that interrater reliability could be improved by providing operationalized guidelines for the definition of impairment in cognitive function.…”