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MRC Neurochemical Pathology Unit, Brighton Clinic, Newcastle Mental Health (NHS) Trust, Newcastle General Hospital, Newcastle upon Tyne UK (Drs. McKeith and Perry)
University Department of Old Age Psychiatry, Brighton Clinic, Newcastle Mental Health (NHS) Trust, Newcastle General Hospital, Newcastle upon Tyne UK (Drs. McKeith and Fair-bairn)
University Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne UK (Drs. McKeith, Bothwell, Moore, and Ferrier)
Department of Psychogeriatrics, Ellison Unit, Bensham General Hospital, Gateshead, Tyne & Wear, UK (Dr. Thompson)
Department of Neuropathology, Newcastle General Hospital, Newcastle upon Tyne, UK (Dr. Perry).
Article abstract –Several recent autopsy studies suggest that senile dementia of Lewy body type (SDLT) may be the second most common neuropathologic cause of dementia in the elderly, accounting for 7 to 30% of all cases. Operational criteria for the antemortem clinical diagnosis of SDLT have already been proposed by our group. The performance of these is now examined by randomizing the case notes from a new series of SDLT, Alzheimer, and multi-infarct dementia patients for psychiatric assessment by four raters of varying clinical experience and blind to pathologic diagnosis. Using the SDLT criteria, the two most experienced raters agreed in 94% of cases (kappa = 0.87), with the least experienced rater agreeing in 78% (kappa = 0.50). Diagnostic specificity for SDLT was uniformly high (90.0 to 97.0%), with a mean sensitivity of detection of 74%, and was greater by the experienced (90.0%) than the least experienced (55%) clinician. The antemortem identification of SDLT patients can therefore be achieved with a high degree of diagnostic specificity using such operationalized criteria, although there remains a minority of patients who present with either "typical" Alzheimer-type symptoms or with paranoid or delusional symptoms in the absence of substantial cognitive impairment. Sensitivity to neuroleptics may be a useful diagnostic pointer in these patients.
Address correspondence and reprint requests to Dr. I.G. McKeith, MRC Neurochemical Pathology Unit. Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK.
Received August 2, 1993. Accepted for publication in final form November 3, 1993.
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