This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (9)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Neurology  • Dementias  • Magnetic Resonance Imaging  • Alert me on articles by topic  Social Bookmarking   What's this?

David R. Gifford, MD, MPH; Robert G. Holloway, MD, MPH; Barbara G. Vickrey, MD, MPH

Arch Intern Med. 2000;160:2855-2862.

Background  Clinical practice guidelines for dementia do not recommend routine neuroimaging but vary in their recommended clinical prediction rules to identify patients who should undergo neuroimaging for potentially reversible causes of dementia.

Methods  Using a MEDLINE search supplemented by other strategies, we identified studies from January 1, 1983, through December 31, 1998, that evaluated the diagnostic performance of a clinical prediction rule. We calculated the sensitivity and specificity of each rule, then evaluated their diagnostic performance in a hypothetical cohort of 1000 patients with dementia, varying the prevalence of potentially reversible dementia from 1% to 15%.

Results  We identified 7 studies that evaluated at least 1 of 6 different clinical prediction rules. Only one rule consistently had high sensitivity (>85%) across all studies; none consistently had high specificity (>85%). Six of the 7 studies included less than 15 cases of potentially reversible dementia; thus the sensitivity and specificity for each rule had relatively wide confidence intervals. At a 5% prevalence of potentially reversible dementia, all rules had low positive predictive value (<15%) in our hypothetical cohort. Depending on the rule, our analysis predicts 6 to 44 of the 50 patients with potentially reversible dementia (5% prevalence in cohort of 1000 patients) would not undergo imaging.

Conclusions  There is considerable uncertainty in the evidence underlying clinical prediction rules to identify which patients with dementia should undergo neuroimaging. Application of these rules may miss patients with potentially reversible causes of dementia.

From the Departments of Medicine and Community Health, Brown University, School of Medicine, Providence, RI (Dr Gifford); the Departments of Neurology and Community and Preventive Medicine, University of Rochester, Rochester, NY (Dr Holloway); and the Department of Neurology and Alzheimer's Disease Research Center of California, University of California–Los Angeles (Dr Vickrey).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The value of cranial computed tomography in old age psychiatry: a review of the results of 178 consecutive scans
Fielding
Psychiatr. Bull. 2005;29:21-23.
ABSTRACT | FULL TEXT  

The Decreasing Prevalence of Reversible Dementias: An Updated Meta-analysis
Clarfield
Arch Intern Med 2003;163:2219-2229.
ABSTRACT | FULL TEXT  

Structural imaging in the clinical diagnosis of Alzheimer's disease: problems and tools
FRISONI
J. Neurol. Neurosurg. Psychiatry 2001;70:711-718.
FULL TEXT