Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review

Bonanni, Laura; Bontempo, Giulia; Borrelli, I.; Bifolchetti, Stefania; Buongarzone, M. P.; Carlesi, N.; Carolei, Adriana; Ciccocioppo, Fausta; Colangelo, U; Colonna, G.; Desiderio, Manuela; Ferretti, Stefano; Fiorelli, L.; D’Alessio, O.; D’Amico, Alessandra; D’Amico, Maria Chiara; Lucia, Regina; Re, L. Del; Blasio, Francesco Di; Giacomo, Roberta Di; Iorio, Angelo Di; Santo, Espírito; Giuseppe, Morgia; Felice, Nicholas; Litterio, P.; Gabriele, Angela; Mancino, E.; Manzoli, Lamberto; Maruotti, Valerio; Mearelli, S.; Molino, Gabriella; Monaco, Daniela; Nuccetelli, F; Onofrj, Marco; Perfetti, Bernardo; Sacchet, C.; Sensi, Francesco De; Sensi, Stefano L.; Sucapane, Patrizia; Thomas, Astrid; Viola, P.; Viola, Stefano; Zito, M.; Zhuzhuni, Holta

doi:10.1007/s40520-013-0039-4

Cited by 5 publications

(6 citation statements)

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“…The second caveat comes from the notion that our patient population was selected in a tertiary clinic including both a dementia and a movement disorder center, therefore burdened by an ascertainment bias toward dementia associated with parkinsonian features (i.e., DLB) ( Bonanni et al., 2013; Onofrj et al., 2010, 2013 ). Consequently, replication of our findings by other research groups are needed to validate quantitative EEG as a tool to predict the development of DLB.…”

Section: Discussionmentioning

confidence: 99%

“…Given that the principal aim of the study was to assess the predictive value of EEG in the early diagnosis of DLB, we enriched our study sample by the inclusion of MCI subjects who had at least 1 core or suggestive DLB symptom ( McKeith et al., 2005 ). Therefore, based on DLB prevalence in our dementia center ( Bonanni et al, 2013 ) we selected 3 MCI subjects with 1 core or suggestive DLB symptom, according to DLB diagnostic criteria ( McKeith et al, 2005 ) for every MCI subject without any DLB symptom.…”

Section: Methodsmentioning

confidence: 99%

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Quantitative electroencephalogram utility in predicting conversion of mild cognitive impairment to dementia with Lewy bodies

Bonanni

Perfetti

Bifolchetti

et al. 2015

Neurobiology of Aging

108

130

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Mild cognitive impairment (MCI) as a precursor of dementia with Lewy bodies (DLB) is the focus of recent research, trying to explore the early mechanisms and possible biomarkers of DLB. Quantitative electroencephalogram (QEEG) methods are able to differentiate early DLB from Alzheimer's disease (AD). The aim of the present study was to assess whether QEEG abnormalities, characterized by dominant frequency <8 Hz and dominant frequency variability >1.5 Hz, typical of early DLB, are already present at the stage of MCI and to evaluate whether EEG abnormalities can predict the development of DLB. Forty-seven MCI subjects were followed for 3 years. EEG recordings were obtained at admission and at the end of the study. At the end of follow-up, 20 subjects had developed probable DLB (MCI-DLB), 14 had probable AD (MCI-AD), 8 did not convert to dementia, 5 developed a non-AD/DLB dementia. One hundred percent of MCI-DLB showed EEG abnormalities at admission. Ninety three percent of MCI-AD maintained a normal EEG throughout the study. QEEG may represent a powerful tool to predict the progression from MCI to DLB with a sensitivity and specificity close to 100%.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Quantitative electroencephalogram utility in predicting conversion of mild cognitive impairment to dementia with Lewy bodies

Bonanni

Perfetti

Bifolchetti

et al. 2015

Neurobiology of Aging

108

130

View full text Add to dashboard Cite

show abstract

“…The same meta-analysis found that DLB comprised 4.2% of community-based dementia populations. However, studies contributing to this meta-analysis observed prevalence rates ranging from 0 to 26% in individual cohorts [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical prevalence of Lewy body dementia

et al. 2018

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BackgroundThe prevalence of dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) in routine clinical practice is unclear. Prevalence rates observed in clinical and population-based cohorts and neuropathological studies vary greatly. Small sample sizes and methodological factors in these studies limit generalisability to clinical practice.MethodsWe investigated prevalence in a case series across nine secondary care services over an 18-month period, to determine how commonly DLB and PDD cases are diagnosed and reviewed within two regions of the UK.ResultsPatients with DLB comprised 4.6% (95% CI 4.0–5.2%) of all dementia cases. DLB was represented in a significantly higher proportion of dementia cases in services in the North East (5.6%) than those in East Anglia (3.3%; χ2 = 13.6, p < 0.01). DLB prevalence in individual services ranged from 2.4 to 5.9%. PDD comprised 9.7% (95% CI 8.3–11.1%) of Parkinson’s disease cases. No significant variation in PDD prevalence was observed between regions or between services.ConclusionsWe found that the frequency of clinical diagnosis of DLB varied between geographical regions in the UK, and that the prevalence of both DLB and PDD was much lower than would be expected in this case series, suggesting considerable under-diagnosis of both disorders. The significant variation in DLB diagnostic rates between these two regions may reflect true differences in disease prevalence, but more likely differences in diagnostic practice. The systematic introduction of more standardised diagnostic practice could improve the rates of diagnosis of both conditions.

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“…Data on prospective cohorts of patients followed in our region independently of a history of PTSD showed that incidences of different dementia types were inside the variability ranges reported in prior epidemiological surveys and by other centers [ 49 ]. It is actually interesting to note that FTD incidence was 3.5% among patients with dementia, matching the percentage found in our retrospective cohort (5% on a population of 849 demented patients).…”

Section: Discussionmentioning

confidence: 99%

“…The retrospective part of the study is, undoubtedly,flawed by the typical biases of any retrospective study, including recall bias which might explain the lower incidence of PTSD among the dementia population (4%) as compared to incidence of dementia found in PTSD population evaluated in the prospective study (17%). Another possible limitation is that the prevalence of specific diagnoses is higher in a tertiary center as our University center, which is endowed with several advanced diagnostic tools ranging from SPECT, PET, MRI, fMRI 1.5–3 T, to laboratories of proteomics for assessment of CSF proteins, to genetic assessments of neurodegenerative disease to neuroimmunological essays, to complex neuropsychological evaluations [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Post Traumatic Stress Disorder Heralding the Onset of Semantic Frontotemporal Dementia

Bonanni

Franciotti

Martinotti

et al. 2018

JAD

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Background:Post traumatic stress disorder (PTSD) is associated with cognitive decline. The dementia type following PTSD is unclear.Objective:To assess whether PTSD is associated with a specific dementia.Methods:Prospective study: 46 PTSD patients (DSM-IV-TR) were followed for 6–10 years with clinical, neuropsychological, imaging evaluations for possible development of dementia.Retrospective study:849 dementia patients followed during 1999–2014 (509 Alzheimer’s disease, AD; 207 dementia with Lewy bodies, DLB; 90 vascular dementia, VaD; 43 frontotemporal dementia, FTD) and 287 patients with any neurological condition (including patients with/without dementia) were evaluated for the presence of PTSD in their history.Results:Prospective study: 8 patients developed dementia; 1 AD, 1 DLB, 6 semantic FTD (13.0% of the PTSD population). Retrospective study: 38 patients (4.5%) had a history of PTSD; 3.5% of AD, 4.3% of DLB, 14.0% of FTD, 5.6% of VaD. The percentage was higher in FTD than in AD or DLB (χ2 = 10, p = 0.001, and χ2 = 6, p = 0.02). At difference with AD, DLB, or VaD, FTD incidence among dementia patients with PTSD history (38 patients) was higher than in the dementia population overall (16% versus 5%, χ2 = 8, p = 0.005). The impact of possible demographical/clinical confounders (age, gender, MMSE) was excluded by Poisson regression. PTSD prevalence in the comparative group without dementia matched the prevalence in the Italian general population (1.1%). PTSD prevalence in the demented comparative group matched the prevalence in our dementia retrospective cohort, 3.7%).Discussion:PTSD was associated with the development of semantic FTD.

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Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review

Abstract: The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.

Cited by 5 publications

References 64 publications

Quantitative electroencephalogram utility in predicting conversion of mild cognitive impairment to dementia with Lewy bodies

Quantitative electroencephalogram utility in predicting conversion of mild cognitive impairment to dementia with Lewy bodies

Clinical prevalence of Lewy body dementia

Post Traumatic Stress Disorder Heralding the Onset of Semantic Frontotemporal Dementia

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