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Consistency of clinical diagnosis in a community-based longitudinal study of dementia and Alzheimer's disease

From the Gertrude H. Sergievsky Center (Drs. Schofield, Tang, Marder, Bell, Dooneief, Stern, and Mayeux); the Center for Geriatrics and Gerontology (Drs. Lantigua, Wilder, and Gurland); the Division of Epidemiology (Dr. Mayeux), Columbia University School of Public Health; the Center for Alzheimer's Disease Research in the City of New York (Drs. Lantigua, Wilder, Gurland, Stern, and Mayeux); and the Departments of Neurology (Drs. Schofield, Tang, Marder, Bell, Dooneief, Stern, and Mayeux) and Psychiatry (Drs. Wilder, Gurland, Stern, and Mayeux) and the Division of General Medicine (Dr. Lantigua), College of Physicians and Surgeons, Columbia University, New York, NY.
Supported by federal grants AG07232, AG10963, AG08702, and RR00645, and the Charles S. Robertson Memorial Gift for Alzheimer's Disease Research from the Banbury Fund.
Received October 18, 1994. Accepted in final form April 13, 1995.
Address correspondence and reprint requests to Dr. R. Mayeux, G.H. Sergievsky Center, 630 West 168th Street, Columbia University, New York, NY 10032.

We evaluated the consistency of the diagnosis of dementia in a multicultural, longitudinal community-based study of cognitive impairment and dementia. We diagnosed dementia using a fixed neuropsychological paradigm; the diagnosis also required historical evidence of functional impairment. In a sample of 656 subjects with at least one annual follow-up examination, dementia was confirmed at 1 year in 89% of the 304 subjects initially demented, and in 90% of the 136 subjects with the initial diagnosis of probable Alzheimer's disease (AD). The 34 initially demented subjects who failed to meet criteria for dementia at follow-up included 13 with an initial diagnosis of probable AD. All 34 still had evidence of cognitive impairment; this group was more likely to have a history of pulmonary disease, multiple medication use, or chronic alcohol use than other demented patients. Consistency of dementia diagnosis did not vary according to educational attainment or ethnic background. The use of a neuropsychological paradigm such as ours in large longitudinal studies of dementia may minimize interobserver diagnostic variability or diagnostic drift over time while contributing the benefits of a comprehensive cognitive evaluation to the diagnostic process.

NEUROLOGY 1995;45: 2159-2164

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