Background
The criteria (A-D) must all be satisfied
Methods
Design
Measures
10/66 dementia diagnosis
Operationalisation of the DSM-IV criteria for the computerised DSM-IV algorithm
Criterion A1 (memory impairment)
Criterion A2 (at least one of aphasia, apraxia, agnosia or disturbance in executive functioning)
a) Criterion A2a. Aphasia
b) Criterion A2b. Apraxia
c) Criterion A2c. Agnosia
d) Criterion A2d. Disturbance in executive functioning
Criterion B1
Criterion B2
Criterion C
Criterion D
Analyses
Results
Prevalence (%) in those with clinically diagnosed dementia | Prevalence (%) (high education controls) | Prevalence (%) (low education controls) | |
---|---|---|---|
A1 Memory impairment (must be present)
| |||
A1_1 > 1.5 standard deviations below the mean for their age and education group (among those free from dementia) on all three tests of memory and/or | 37 | 2 | 2 |
A1_2 > 1.5 standard deviations below the mean for their age and education group on at least two tests of memory and at least two memory lapses reported by informant, of which one should occur 'frequently' and/or | 55 | 3 | 3 |
A1_3 > 1.5 standard deviations below the mean for their age and education group on at least one test of memory and at least three memory lapses reported by informant, of which at least two should occur 'frequently' and/or | 69 | 3 | 4 |
A1_4 >= four memory lapses are reported by informant, of which at least three occur 'frequently' and/or | 78 | 4 | 5 |
A1_5 Severe memory impairment rated by the GMS interviewer | 51 | 1 | 2 |
A1 OVERALL | 71 | 3 | 3 |
A2 – language impairment, apraxia, agnosia and executive impairment – at least one must be present
| |||
A2a. Language impairment
| |||
Score of <= 4 on CSI'D' language subscale and/or | 32 | 2 | 2 |
Score of <= 5 on CSI'D' language subscale and informant reports that participant 'sometimes' or 'frequently' uses wrong words or has difficulty saying words, and/or | 22 | 1 | 1 |
informant reports that participant 'frequently' uses wrong words or has difficulty saying words | 23 | 1 | 1 |
A2a OVERALL | 52 | 2 | 3 |
A2b. Apraxia
| |||
Unable to dress, or wrong sequence/forgets items (DRESS >= 2) and/or | 22 | 0 | 1 |
Cannot eat cleanly with proper utensils (FEED >= 1) and/or | 20 | 1 | 1 |
Apraxia score <= 3 and some impairment in dressing or feeding (DRESS or FEED >= 1) | 29 | 1 | 2 |
A2b OVERALL | 31 | 1 | 2 |
A2c. Agnosia
| |||
the informant reports that the participant misidentifies family or friends and/or | 27 | 1 | 1 |
five or fewer of the seven objects/body parts are named correctly | 33 | 2 | 4 |
A2C OVERALL | 43 | 3 | 5 |
A2_d Executive function
| |||
participant cannot learn palm-fist-hand after five trials and/or | 52 | 7 | 15 |
participant cannot sequence palm-fist-hand and/or | 69 | 9 | 25 |
informant reports that participant 'frequently' has difficulty in adjusting to routine and/or | 25 | 7 | 8 |
informant reports any degree of impairment in three or more of the four examples of executive function | 52 | 2 | 3 |
informant reports some degree of impairment in two or more of the four examples of executive function and the participant scored more than 1.5 standard deviations below the mean for their age and education group (among those free from dementia) on the animal naming test | 46 | 1 | 1 |
A2_d OVERALL | 93 | 16 | 31 |
Prevalence (%) in those with clinically diagnosed dementia | Prevalence (%) (high education controls) | Prevalence (%) (low education controls) | |
---|---|---|---|
B1 criterion requires that the cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning
| |||
Memory impairment reported by informant, or | 77 | 7 | 11 |
problems in two or more memory areas by informant report at least one of which must be 'frequent', or | 90 | 26 | 32 |
any significant self-reported memory impairment (Q341, Q351, Q352 or Q361 >= 1) | 69 | 65 | 66 |
Any of the above memory impairments, and
| 95 | 67 | 69 |
General impairment – one or more informant reported deficits (reduced activities, loss of hobby or skills, problems with household chores, change in ability to handle money, gets lost in the community or at home) | 88 | 11 | 16 |
B2 criterion requires that the cognitive deficits described in A1 and A2 represent a significant decline from a previous level of functioning
| |||
B2_1 a 'change in activities', and/or | 68 | 7 | 11 |
B2_2 a 'general decline in mental function' and/or | 80 | 6 | 9 |
B2_3 an overall deterioration and/or | 83 | 5 | 7 |
B2_4 gradual decline over two or more years, and
| 71 | 4 | 6 |
B2_5 the impairment is not considered to date from birth or early life | 100 | 100 | 100 |
Prevalence (%) in those with clinically diagnosed dementia N = 130 | Prevalence (%) (high education controls) N = 50 | Prevalence (%) (low education controls) N = 95 | |
---|---|---|---|
C criterion requires that the deficits do not occur exclusively during the course of a delirium
| |||
C_1 no onset in the last month, and
| 100 | 98 | 100 |
C_2 no sudden onset in 1–3 days, and
| 93 | 94 | 93 |
C_3 not changeable over 24 hours, alert at one time, drowsy and confused the next, or
| 75 | 85 | 87 |
C_4 no confusion worse towards night or evening | 52 | 70 | 61 |
Prevalence (%) in those with clinically diagnosed dementia | Prevalence (%) (high education controls) | Prevalence (%) (low education controls) | ||
---|---|---|---|---|
D criterion requires that the disturbance is not better accounted for by another axis I disorder (for example, major depressive disorder, schizophrenia)
| ||||
D-1 No AGECAT stage 2 diagnosis of 'schizophrenia' or
| Clinical | 99 | 100 | 100 |
D_2 No AGECAT stage 2 diagnosis of 'depression' and
| Clinical | 93 | 74 | 67 |
D_3 Dementia diagnosis confirmed by 10/66 algorithm | Clinical | 97 | 2 | 4 |
DSM-IV criterion | Dementia diagnosis | Prevalence (%) in those with dementia | Prevalence (%) (high education controls) | Prevalence (%) (low education controls) |
---|---|---|---|---|
Criterion A1: Memory impairment | Clinical | 71 | 3 | 3 |
10/66 | 71 | 2 | 2 | |
Criterion A2: Impairment in other cognitive function | Clinical | 95 | 17 | 33 |
10/66 | 96 | 17 | 37 | |
Criterion A (A1+A2) | Clinical | 70 | 2 | 3 |
10/66 | 70 | 1 | 1 | |
Criterion B1: Impaired social/occupational functioning | Clinical | 85 | 9 | 14 |
10/66 | 90 | 10 | 14 | |
Criterion B2: Decline from a previous level of functioning | Clinical | 82 | 10 | 14 |
10/66 | 85 | 12 | 15 | |
Criterion B B1+B2 | Clinical | 73 | 7 | 9 |
10/66 | 79 | 8 | 8 | |
Criterion C: Deficits do not occur only in delirium | Clinical | 100 | 100 | 100 |
10/66 | 100 | 100 | 100 | |
Criterion D: Disturbances not better accounted for by another axis 1 disorder | Clinical | 99 | 74 | 67 |
10/66 | n/a | 71 | 65 | |
OVERALL (A+B+C+D) | Clinical | 58 | 1 | 2 |
10/66 | 58 | 0 | 0 |
Group 1 (n = 2587) Non-cases | Group 2 (n = 134) 10/66 cases not confirmed by DSM-IV | Group 3 (n = 188) DSM-IV cases | Mean difference (group 2 vs group 1) | Mean difference (group 2 vs group 3) | ||
---|---|---|---|---|---|---|
CSI'D' COGSCORE (cognitive test score) | Mean (95% CI) | 30.6 (30.5–30.6) | 22.4 (21.3–23.7) | 17.1 (15.9–18.3) | -8.1 (-6.9 to -9.3) | 5.4 (3.7 to 7.1) |
Median (IQR) | 31.0 (29.6–32.1) | 23.9 (20.7–27.2) | 16.6 (12.3–23.4) | |||
CSI'D'RELSCORE(informant reports of cognitive and functional decline) | Mean (95% CI) | 1.1 (1.0–1.2) | 8.3 (7.3–9.3) | 15.4 (14.5–16.3) | 7.2 (6.2 to 8.2) | -7.1 (-5.8 to -8.5) |
Median (IQR) | 0.5 (0.0–1.5) | 7.5 (5.5–10.0) | 14.3 (10.0–20.0) | |||
NPI-Q Severity (severity of behavioural and psychological symptoms) | Mean (95% CI) | 2.0 (1.9–2.1) | 5.0 (4.1–5.9) | 7.1 (6.3–7.9) | 3.0 (2.2 to 3.9) | -2.1 (-0.9 to -3.2) |
Median (IQR) | 1 (0–3) | 3 (1–8) | 7 (2–11) | |||
NPI'Q' Distress (distress caused to the caregiver by BPSD) | Mean (95% CI) | 1.7 (1.6–1.9) | 5.0 (3.9–6.1) | 7.3 (6.3–8.4) | 3.3 (2.2 to 4.3) | -2.3 (-0.8 to -3.8) |
Median (IQR) | 0 (0–2) | 3 (0–7) | 5 (1–12) | |||
WHODAS II Disability | Mean (95% CI) | 9.6 (9.1–10.2) | 36.0 (30.8–41.2) | 48.7 (44.0–53.3) | 26.4 (21.2 to 31.6) | -12.7 (-5.7 to -19.7) |
Median (IQR) | 2.8 (0.0–13.9) | 26.4 (8.3–63.2) | 50.0 (19.4–77.8) | |||
Needs for care | No care needed | 96.6% | 58.7% | 29.8% | Chi sq = 1043, 1 df, p < 0.001 | |
Needs care some of the time | 1.9% | 11.6% | 15.2% | |||
Needs care much of the time | 1.4% | 29.8% | 55.1% |