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Sensitivity and specificity of three clinical criteria for dementia with Lewy bodies in an autopsy-verified sample.
Int J Geriatr Psychiatry. 1999 Jul; 14(7):526-33.IJ

Abstract

OBJECTIVE

To evaluate the sensitivity and specificity of the clinical features of three published diagnostic criteria for diffuse Lewy body disease (DLBD) using autopsy-confirmed Alzheimer's (AD), DLBD and AD+DLBD (mixed) dementia cases.

DESIGN

Retrospective chart review of an autopsy series of 56 patients selected from the State of Florida Brain Bank on the basis of a pathological diagnosis of either pure AD, DLBD (pure and common forms) or AD+DLBD (mixed) dementia. Clinical features were assessed by three raters blind to the pathological diagnosis.

RESULTS

The existing criteria for a clinical diagnosis of DLBD were highly specific (90-100%) but not very sensitive (49-63%) in the differential diagnosis of DLBD versus AD; sensitivity did improve (61-74%) when mixed AD+DLBD cases were eliminated. Clinical features that occur more frequently in DLBD than in AD were unspecified hallucinations, unspecified EPS, fluctuating course and rapid progression. Post-hoc analysis also indicated that hallucinations and EPS were more common early in the disease course of DLBD than in AD. Empirically derived criteria, formulated using the most prevalent clinical features, demonstrated sensitivity values of 57-96% for pure forms and 43-91% for mixed forms.

CONCLUSIONS

This study demonstrated that additional improvements in the established criteria for DLBD are needed. Our empirically derived criteria enhanced the distinction of DLBD from AD while allowing the clinician the choice of maximizing sensitivity with acceptable specificity, and vice versa.

Authors+Show Affiliations

Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL 33141, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10440972

Citation

Luis, C A., et al. "Sensitivity and Specificity of Three Clinical Criteria for Dementia With Lewy Bodies in an Autopsy-verified Sample." International Journal of Geriatric Psychiatry, vol. 14, no. 7, 1999, pp. 526-33.
Luis CA, Barker WW, Gajaraj K, et al. Sensitivity and specificity of three clinical criteria for dementia with Lewy bodies in an autopsy-verified sample. Int J Geriatr Psychiatry. 1999;14(7):526-33.
Luis, C. A., Barker, W. W., Gajaraj, K., Harwood, D., Petersen, R., Kashuba, A., Waters, C., Jimison, P., Pearl, G., Petito, C., Dickson, D., & Duara, R. (1999). Sensitivity and specificity of three clinical criteria for dementia with Lewy bodies in an autopsy-verified sample. International Journal of Geriatric Psychiatry, 14(7), 526-33.
Luis CA, et al. Sensitivity and Specificity of Three Clinical Criteria for Dementia With Lewy Bodies in an Autopsy-verified Sample. Int J Geriatr Psychiatry. 1999;14(7):526-33. PubMed PMID: 10440972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sensitivity and specificity of three clinical criteria for dementia with Lewy bodies in an autopsy-verified sample. AU - Luis,C A, AU - Barker,W W, AU - Gajaraj,K, AU - Harwood,D, AU - Petersen,R, AU - Kashuba,A, AU - Waters,C, AU - Jimison,P, AU - Pearl,G, AU - Petito,C, AU - Dickson,D, AU - Duara,R, PY - 1999/8/10/pubmed PY - 1999/8/10/medline PY - 1999/8/10/entrez SP - 526 EP - 33 JF - International journal of geriatric psychiatry JO - Int J Geriatr Psychiatry VL - 14 IS - 7 N2 - OBJECTIVE: To evaluate the sensitivity and specificity of the clinical features of three published diagnostic criteria for diffuse Lewy body disease (DLBD) using autopsy-confirmed Alzheimer's (AD), DLBD and AD+DLBD (mixed) dementia cases. DESIGN: Retrospective chart review of an autopsy series of 56 patients selected from the State of Florida Brain Bank on the basis of a pathological diagnosis of either pure AD, DLBD (pure and common forms) or AD+DLBD (mixed) dementia. Clinical features were assessed by three raters blind to the pathological diagnosis. RESULTS: The existing criteria for a clinical diagnosis of DLBD were highly specific (90-100%) but not very sensitive (49-63%) in the differential diagnosis of DLBD versus AD; sensitivity did improve (61-74%) when mixed AD+DLBD cases were eliminated. Clinical features that occur more frequently in DLBD than in AD were unspecified hallucinations, unspecified EPS, fluctuating course and rapid progression. Post-hoc analysis also indicated that hallucinations and EPS were more common early in the disease course of DLBD than in AD. Empirically derived criteria, formulated using the most prevalent clinical features, demonstrated sensitivity values of 57-96% for pure forms and 43-91% for mixed forms. CONCLUSIONS: This study demonstrated that additional improvements in the established criteria for DLBD are needed. Our empirically derived criteria enhanced the distinction of DLBD from AD while allowing the clinician the choice of maximizing sensitivity with acceptable specificity, and vice versa. SN - 0885-6230 UR - https://www.unboundmedicine.com/medline/citation/10440972/Sensitivity_and_specificity_of_three_clinical_criteria_for_dementia_with_Lewy_bodies_in_an_autopsy_verified_sample_ L2 - https://medlineplus.gov/parkinsonsdisease.html DB - PRIME DP - Unbound Medicine ER -