Post-Mortem diagnosis of dementia by informant interview

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.ObjectivesTo ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic.MethodsA 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.ResultsNinety 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.ConclusionsThe 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.

Validity of the Katz Index to assess activities of daily living by informants in neuropathological studies

“…We did not have a previous functional assessment to comparisons. The method of collecting postmortem data to assist a neuropathological study was previously validated by comparing the correspondence of information obtained by the caregiver to that obtained by the gold standard (20) . The results showed high specificity and sensitivity of the method for the diagnosis of dementia, normal cognition and function.…”

“…In the BB-BABSG, these variables are gathered during a clinical interview (20) with a knowledgeable informant and refer to the time prior to the subject's death. All of the informants reported having close contact (daily living) with the subject.…”

Very low levels of education and cognitive reserve

“…29 In addition, high levels of correspondence for the diagnosis of both dementia and normal cognition were obtained between the interviewing protocol used in this study and a gold standard interview performed with the patient and informant, as described previously. 18 Furthermore, an immediate postmortem interview may be helpful because the interval of time between the clinical and neuropathologic examination is minimal. This study investigated a convenience population submitted to mandatory autopsy examination due to unknown cause of death.…”

“…Sensitivity was 86.6% and specificity was 84.4% for the diagnosis of dementia. 18 Socioeconomic status was determined through a Brazilian scale that classifies subjects in 5 strata. Stratum A is the highest income and stratum E the lowest.…”

Do age and sex impact on the absolute cell numbers of human brain regions?

“…Only cognitively normal individuals (CDR = 0 and IQCODE B 3.40) were included in this study. The postmortem diagnostic protocols have been proven highly sensitive and specific by previous work (Ferretti et al 2010). Sex, age and clinical data of the subjects are listed in Table 1.…”