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Does the diagnosis of dementia depend on which criteria are used?
December 03, 2002In a study carried out at the Centro de Estudos Egas Moniz da Faculdade de Medicina of Lisbon, the researcher Manuela Guerreiro analyses the two most internationally-used criteria in Medicine to gauge to what extent the criteria adopted determines the diagnosis of dementia in a patient.
The two criteria most used are that of the World Health Organization (WHO) and of the American Psychiatry Association (APA). This research with almost nine hundred patients revealed that the neuropsychological evaluation with the first criteria classifies 64% of the patients with dementia, but with the second the figure rises to 83%.
The concordance of diagnosis with both criteria - that is patients classified in the same way in both criteria - is only 62% of the patients. This difference in diagnosis has great implications, because on one hand individuals can be incorrectly diagnosed as having dementia, on the other hand this implies different therapy.
In 62 % of the cases there was the same diagnosis; with 16% agreement about the absence of dementia and in the remaining 46% of the cases there being agreement about dementia being found. This means that 20% of cases can be classified as "dementia" based on one criteria and "not dementia" on the other criteria.
"Despite the various attempts at making the general concept of dementia uniform, and the fact that there is now more consensus than in the past, there are still discrepancies between the most used criteria for diagnosis, the DSM-IV (APA, 1994) and the ICD-10 (OMS, 1992)" says the researcher.
The WHO criteria is the stricter and more specific than that of the APA, which is more sensitive, which means a higher figure of false positives, individuals that are not ill but classified as having dementia.
This question also has implications in the area of medical research, as the option for using one or the other criteria depends on the objectives of the studies and the consideration of the risk of including more false positives or more false negatives. However, it should always be known that these two criteria are instruments that, even when used on the same people, give results with important differences.
Dementia, according to WHO is evidence of a decline, simultaneously, of memory and thought (capacity for rational thinking), sufficiently significant to interfere with daily life, with a minimum evolution of six months and with the possibility of alteration in the following functions: language, calculation, judgment, practice, knowledge or personality. In the APA definition, dementia is the loss of intellectual capacity, sufficiently serious to interfere with social and professional functions, with memory defects and at least one other cognitive function.
Observatório da CiÙncia e do Ensino Superior
In 62 % of the cases there was the same diagnosis; with 16% agreement about the absence of dementia and in the remaining 46% of the cases there being agreement about dementia being found. This means that 20% of cases can be classified as "dementia" based on one criteria and "not dementia" on the other criteria.
"Despite the various attempts at making the general concept of dementia uniform, and the fact that there is now more consensus than in the past, there are still discrepancies between the most used criteria for diagnosis, the DSM-IV (APA, 1994) and the ICD-10 (OMS, 1992)" says the researcher.
The WHO criteria is the stricter and more specific than that of the APA, which is more sensitive, which means a higher figure of false positives, individuals that are not ill but classified as having dementia.
This question also has implications in the area of medical research, as the option for using one or the other criteria depends on the objectives of the studies and the consideration of the risk of including more false positives or more false negatives. However, it should always be known that these two criteria are instruments that, even when used on the same people, give results with important differences.
Dementia, according to WHO is evidence of a decline, simultaneously, of memory and thought (capacity for rational thinking), sufficiently significant to interfere with daily life, with a minimum evolution of six months and with the possibility of alteration in the following functions: language, calculation, judgment, practice, knowledge or personality. In the APA definition, dementia is the loss of intellectual capacity, sufficiently serious to interfere with social and professional functions, with memory defects and at least one other cognitive function.
Observatório da CiÙncia e do Ensino Superior
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