ABSTRACT
Discrepancies were examined in diagnostic outcome between a monodisciplinary approach and a multidisciplinary, criteria-based approach in patients referred to a university memory clinic. Of 278 patients not fulfilling dementia criteria, 19 had been previously diagnosed as demented (specificity: 0.93). In 60 of 152 demented patients, dementia had not been diagnosed before (sensitivity: 0.61). Underreporting was frequent for mildly demented patients and for patients with coexisting depressive symptoms. In patients referred by psychiatrists, sensitivity rates for dementia and Alzheimer's disease were low; in patients referred by neurologists, depression often went unreported. Results underscore the need for more frequent use of integrated multidisciplinary services for cognitively disturbed patients.
Subject(s)
Alzheimer Disease/diagnosis , Dementia/diagnosis , Aged , Dementia/classification , Depressive Disorder/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Prevalence , Psychiatric Status Rating ScalesABSTRACT
It is hardly known to what extent consensus criteria for dementia are adhered to in clinical practice. An inquiry was held among the participants of the Dutch consensus meeting on dementia to investigate this point. 85 clinicians diagnosed the case descriptions of 10 patients with cognitive dysfunctions. The inquiry was split into two parts, i.e. before and after the meeting. There was no difference between the two parts in the level of consensus. There was not difference between the disciplines in syndrome diagnoses. However, with regard to etiology, significant differences existed between the specialties. Furthermore, the agreement increased with the severity of the cognitive disturbances. In cases where depressive symptoms coexisted, the diagnosis was more often in error. The nature of the diagnoses appeared to be dependent on the discipline of the diagnostician. This study underlines the necessity of a multidisciplinary diagnostic approach based on well accepted criteria.
Subject(s)
Dementia/diagnosis , Medicine , Specialization , Aged , Consensus Development Conferences as Topic , Dementia/classification , Female , Geriatrics , Humans , Male , Neurology , Physicians, Family , Psychiatry , PsychologyABSTRACT
Ninety clinicians from six disciplines diagnosed ten case descriptions of patients, judged by a multidisciplinary expert committee to suffer from dementia. Five cases were diagnosed before and five after a consensus meeting on the diagnosis of dementia. A significant change in the level of agreement between the disciplines could not be established. The analysis did show a significant difference between the disciplines in the use of etiologic diagnoses. The results indicated that, in order to avoid possible bias caused by medical specialization, a multidisciplinary approach for this type of patient is recommended.
Subject(s)
Dementia/diagnosis , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
The diagnostic performance of the expert system EVINCE was compared with that of 85 clinicians in diagnosing 10 patients suspected of suffering from dementia. A multidisciplinary expert committee provided a standard diagnosis as reference for comparison. The results showed that the syndrome and etiologic diagnoses made by EVINCE were in very close agreement with those of the expert committee and that the diagnostic performance of EVINCE was better than that of the average clinician. The present findings indicate that expert systems, especially those within the realm of complex multidimensional medical problems, could be a valuable aid in medical practice.
Subject(s)
Alzheimer Disease/diagnosis , Dementia, Multi-Infarct/diagnosis , Depressive Disorder/diagnosis , Diagnosis, Computer-Assisted/instrumentation , Expert Systems , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Dementia, Multi-Infarct/psychology , Depressive Disorder/psychology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neuropsychological Tests/instrumentationABSTRACT
EVINCE-I is a desktop expert system for the differential diagnosis of dementia, implemented on a personal computer. It is intended to assess the effectiveness of this new technology in modeling a psychiatrist who uses international guidelines for diagnosing dementia. EVINCE-I was tested in diagnosing 19 patients with varying stages of dementia and 10 patients showing other disorders except dementia. EVINCE-I and the human expert were in perfect agreement on the diagnosis of dementia and correlated highly on the diagnosis of dementia of the Alzheimer type and multiple infarct dementia. EVINCE-I thus offers important possibilities as a tool in investigating the data and procedures used by the human expert.
Subject(s)
Dementia/diagnosis , Diagnosis, Computer-Assisted/methods , Expert Systems , Aged , Decision Trees , Dementia/classification , Diagnosis, Differential , Evaluation Studies as Topic , Humans , Middle Aged , Psychiatry/methods , Reproducibility of ResultsABSTRACT
EVINCE-I is an expert system for neuropsychiatric diagnostics implemented on a personal computer. It is developed to assess the possibilities of an expert system which models the procedures used for medical decision taking and data analysis by a neuro-psychiatrist when making a differential diagnosis in the domain of dementia syndromes. The knowledge of the system centers around detection of Alzheimer's disease, multi-infarct dementia and depression-induced dementia. EVINCE-I and the human expert were compared in their ability to diagnose 29 patients, i.e. 19 patients with early stages of dementia and 10 patients showing varying disorders except dementia. It is shown that EVINCE-I is able to detect dementia and its main causes, and produce diagnoses that agree with those of the human expert.
