The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 0/66 dementia algorithm and a clinician diagnosis: a population validation study
Fecha
2008-06-24Autor
Prince, Martin J.
Llibre de Rodríguez, Juan
Noriega, L.
López, A.
Acosta, Daisy
Albanese, Emiliano
Arizaga, Raúl
Copeland, John RM
Dewey, Michael
Ferri, Cleusa P.
Guerra, Mariella
Huang, Yueqin
Jacob, KS
Krishnamoorthy, ES
McKeigue, Paul
Sousa, Renata
Stewart, Robert J
Salas, Aquiles
Sosa, Ana Luisa
Uwakwa, Richard
Metadatos
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Background: The criterion for dementia implicit in DSM-IV is widely used in research but not fully
operationalised. The 10/66 Dementia Research Group sought to do this using assessments from
their one phase dementia diagnostic research interview, and to validate the resulting algorithm in
a population-based study in Cuba.
Methods: The criterion was operationalised as a computerised algorithm, applying clinical
principles, based upon the 10/66 cognitive tests, clinical interview and informant reports; the Community Screening Instrument for Dementia, the CERAD 10 word list learning and animal
naming tests, the Geriatric Mental State, and the History and Aetiology Schedule – Dementia
Diagnosis and Subtype. This was validated in Cuba against a local clinician DSM-IV diagnosis and the
10/66 dementia diagnosis (originally calibrated probabilistically against clinician DSM-IV diagnoses
in the 10/66 pilot study).
Results: The DSM-IV sub-criteria were plausibly distributed among clinically diagnosed dementia
cases and controls. The clinician diagnoses agreed better with 10/66 dementia diagnosis than with
the more conservative computerized DSM-IV algorithm. The DSM-IV algorithm was particularly
likely to miss less severe dementia cases. Those with a 10/66 dementia diagnosis who did not meet
the DSM-IV criterion were less cognitively and functionally impaired compared with the DSMIV
confirmed cases, but still grossly impaired compared with those free of dementia.
Conclusion: The DSM-IV criterion, strictly applied, defines a narrow category of unambiguous
dementia characterized by marked impairment. It may be specific but incompletely sensitive to
clinically relevant cases. The 10/66 dementia diagnosis defines a broader category that may be more
sensitive, identifying genuine cases beyond those defined by our DSM-IV algorithm, with relevance
to the estimation of the population burden of this disorder.
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