Sak 03807 O Vedlegg Fagleg Rapportering 2006 - Helse Vest

294Prosessmidler 970009:Diagnostic criteria in dementiaProsjektansvarlig: Mala Naik (mnai@haraldsplass.no), Haraldsplass Diakonale SykehusProsjektet er tilknyttet Kompetansesenter for klinisk forskning.Prosjektet er tilknyttet Opptrappingsplanen for psykisk helse i Nasjonal helseplan.Diagnosing Dementia - ICD not so bad after allBackground: The discrepancy between results of diagnosing dementia with ICD-10 andDSM-IV has been shown by several studies. Our aim was to show that the two diagnosticsystems are more or less alike if ICD-10 is interpreted in the way we believe is in theintention of the ICD-10 authors.MethodsThe study was performed in the Geriatric out-patient department Haraldsplass Deaconess Hospital,Bergen, Norway. All the data was collected during routine examination of patients who were referredfor dementia assessment.207 consecutively referred patients and their caregivers were interviewed and the patients wereclinically examined. The patients included in the study were recruited from the assessments of 3doctors, two consultants in geriatric medicine and one experienced resident. In addition the necessaryblood tests, psychometric tests and a CT scan of the brain were performed on all patients. For routinepurposes we use an algorithm based on the research criteria of the ICD-10 (WHO, 1993) where thevarious symptom categories are listed. Based on the interviews, the clinical examination and resultsfrom psychometric tests, the physician ticks a box for the presence of the individual criteria. Adementia diagnosis automatically emerges when sufficient criteria are fulfilled. In conjunction withthis study a similar algorithm was constructed based on DSM-IV(American psychiatric Association ,1994 ). There were separate forms for each of the two diagnostic systems. By going through thealgorithms for each patient we were able to conclude whether the patient had a dementia or not. Thefollowing psychometric tests are routinely used: Mini Mental State Examination Folstein et al., 1975)Kendrick object learning test (Kendrick et al, 1979) and the Logical Memory subtest of the WechslerMemory Scale (Wecshler, 1945), Trail making A and B (Reitan, 1958), Clock Drawing Test (Sunderlandet al., 1989) and part tests of the CAMDEX-battery (Roth et al.,1988) .Experienced nurses performmost of the tests. The criteria for diagnosing dementia according to DSM-IV (American psychiatricAssociation , 1994 ) and ICD-10 (WHO,1993) respectively are depicted in Table 1.StatisticsDescriptive statistics were applied. Agreement between ICD-10 and DSM-IV was assessed by Cohen'skappa. Interpretation of kappa was made according to Daly & Bourke (Daly et al. 2000): kappa 0.2 =poor, 0.2 < k < 0.4 = fair, 0.4 < k < 0.6 = moderate, 0.6 < k < 0.8 = good, 0.8 < k = excellentagreement. P < 0.05 was considered statistically significant.A total of 207 patients were eligible for the study. One patient in whom no informant was availablewas excluded from the analysis. A total of 206 patients, 71 men and 135 women were included in thestatistical analysis. The mean age of the study group was 78.3 (SD 6.5), men 78.0 (SD 7.7) andwomen 78.5 (SD 5.9), p = 0.57). A diagnosis of dementia was made for 198 patients and there was100% agreement (kappa = 1.0) between ICD-10 and DSM-IV diagnosis. According to ICD-10, 105patients were mildly, 85 moderately and eight severely demented.Klinisk forskning - Geriatrics & Gerontology