Mohammed T. Abou-Saleh

NOSOLOGY OF DEMENTIA 1898. Blennow K, Skoog I. Genetic testing for Alzheimer’s disease: howclose is reality? Curr Opin Psychiat, 1999; 12: 487–93.9. Skoog I. Blood pressure and dementia. In Hansson L, BirkenhägerWH (eds), Handbook of hypertension. Vol 18, Assessment ofHypertensive Organ Damage. Amsterdam: Elsevier Science, 1997.10. Román GC, Tatemichi TK, Erkinjuntti T et al. Vascular dementia:diagnostic criteria for research studies. Report of the NINDS–AIREN international workshop. Neurology 1993; 43: 250–60.11. Hachinski VC, Illif LD, Zihka E et al. Cerebral flow in dementia.Arch Neurol 1975; 32, 632–7.12. Bowler JV, Hachinski V. Vascular cognitive impairment: a newapproach to vascular dementia. In Baillie`re’s Clinical Neurology.London: Baillière Tindall, 1995; 357–76.13. Tatemichi TK, Desmond DW, Mayeux R et al. Dementia afterstroke: baseline frequency, risks, and clinical features in a hospitalisedcohort. Neurology 1992; 42: 1185–93.14. 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Clinical andneuropathological criteria for frontotemporal dementia. J NeurolNeurosurg Psychiat 1994; 57: 416–18.27. Neary D, Snowden JS, Gustafson L et al. Frontotemporal lobardegeneration: a consensus on clinical diagnostic criteria. Neurology,1998; 51: 1546–54.28. McKeith IG, Perry RH, Fairbairn AF et al. Operational criteria forsenile dementia of Lewy body type (SDLT). Psychol Med 1992; 22:911–22.29. McKhann G, Drachman D, Folstein M et al. Clinical diagnosis ofAlzheimer’s disease: report of the NINCDS–ADRDA work groupunder the auspices of Department of Health and Human ServicesTask Force on Alzheimer’s disease. Neurology, 1984; 34: 939–44.Cross-national Inter-rater Reliability ofDementia DiagnosisDaniel W. O’ConnorMonash University, Melbourne, AustraliaDSM-IV 1 , ICD-10 2 and other glossaries have proved successful inpromoting a common approach to psychiatric diagnosis. In fieldtrials of DSM-III-R, for example, psychiatrists achieved concordancerates for diagnosing dementia of 0.91, where 1.0represents complete agreement 3 .It cannot be assumed, however, that similar performances willbe achieved in ‘‘real world’’ practice. Most studies of diagnosticreliability involve assessments by experienced clinicians ofcooperative, physically healthy old people who are either‘‘normal’’ controls or ‘‘pure cases’’ of dementia. In reality,cognitive function lies on a spectrum and assessment is oftencomplicated by limited education, deafness, poor vision, physicalillness, anxiety or depression.In a study of five research teams in Australia, Germany, TheNetherlands, the UK and the USA, each centre contributed 20written vignettes of elderly persons encountered in clinics orcommunity surveys 4 . No exclusions were made because ofmedical, neurological or psychiatric complications. The vignetteswere brief and highly structured. The contents included subjects’demographic details, medical and psychiatric history, abbreviatedcognitive test results and an informant’s report of cognitive,personal and social performance.When 13 researchers applied DSM-III-R criteria to the 100vignettes, within-team levels of diagnostic agreement were high,ranging from kappa 0.72 in the centre with the least joint trainingto 0.86 in the centre with most. Between-team agreement waslower but still acceptable, with kappas ranging from 0.74 to 0.83.Some elements of DSM-III-R were easier to apply consistentlythan others. Mean percentage agreement was highest for socialand occupational dysfunction (94%) and lowest for impairmentof higher cortical function (87%). Concordance was alsosignificantly higher for cognitively intact (98%) and severelyimpaired (96%) persons than for those with minimal (80%) andmild (82%) degrees of dementia.