Post-Mortem diagnosis of dementia by informant interview

Ferretti, Renata Eloah de Lucena; Damin, Antonio Eduardo; Brucki, Sonia Maria Dozzi; Morillo, Lilian Schafirovits; Perroco, Tibor Rilho; Campora, Flávia; Moreira, Eliza Guccione; Balbino, Érika Silvério; Lima, Maria do Carmo de Ascenção; Battela, Camila; Ruiz, Lumena; Grinberg, Lea Tenenholz; Farfel, José Marcelo; Leite, Renata Elaine Paraiso; Suemoto, Claudia Kimie; Pasqualucci, Carlos Augusto; Rosemberg, Sérgio; Saldiva, Paulo Hilário Nascimento; Jacob-Filho, Wilson; Nitrini, Ricardo

doi:10.1590/S1980-57642010DN40200011

Abstract

The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant.

Objectives: To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic.

Methods: A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists' panel consensus, in each group, determined the final diagnosis of the case, blind to other center's diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed.

Results: Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition.

Conclusions: The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition.

Key words: brain bank; postmortem diagnosis; dementia; aging; informant-interview.

Resumo

Os diagnósticos de cognição normal ou de demência dos casos do Banco de Encéfalos do Grupo Brasileiro de Estudos de Envelhecimento Cerebral tem se baseado em entrevista realizada com informante.

Objetivos: Verificar a sensibilidade e especificidade do diagnóstico postmortem baseado em entrevista com informante quando comparado com o diagnóstico estabelecido em clínica de memória.

Métodos: Um estudo prospectivo foi conduzido no Banco de Encéfalos e no Centro de Referência em Distúrbios Cognitivos (CEREDIC), uma clínica especializada do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Indivíduos controle e cognitivamente comprometidos foram encaminhados pelo Hospital das Clínicas ao CEREDIC onde os indivíduos foram avaliados e os informantes entrevistados. O mesmo informante foi então entrevistado pela equipe do Banco de Encéfalos. Consenso em painel de especialistas, em cada centro, estabeleceu o diagnóstico final em cada caso, sem conhecimento do diagnóstico do outro centro. Os diagnósticos foram comparados, admitindo-se o diagnóstico estabelecido no CEREDIC como padrão-ouro. Sensibilidade e especificidade foram calculadas.

Resultados: 90 indivíduos foram incluídos, 45 com demência e 45 não-dementes (26 cognitivamente normais e 19 com comprometimento cognitivo sem demência). A entrevista realizada no Banco de Encéfalos teve sensibilidade de 86,6% e especificidade de 84,4% para o diagnóstico de demência e sensibilidade de 65,3% e especificidade de 93,7% para o diagnóstico de cognição normal.

Conclusões: A entrevista com informante realizada no Banco de Encéfalos do Grupo Brasileiro de Estudos de Envelhecimento Cerebral tem altas sensibilidade e especificidade para o diagnóstico de demência e alta especificidade para o diagnóstico de cognição normal.

Palavras-chave: banco de encéfalos; diagnóstico postmortem; demência; envelhecimento; entrevista com informante.

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References

¹ Ravid R, Grinberg LT. How to run a brain bank: revisited. Cell Tissue Bank 2008;9:149-150.
² Hulette CM. Brain banking in the United States. J Neuropathol Exp Neurol 2003;62:715-722.
³ Ravid R, Swaab DF, Van Zwieten EJ, et al. Controls are what makes a brain bank go round. In: Cruz-Sanchez F, Cuzner M, Ravid R, Editors. Neuropathological diagnostic criteria for brain banking, biomedical and health research. Vol. 10. Amsterdam: IOS Press; 1995:4-13.
⁴ Zaccai J, Ince P, Brayne C. Population-based neuropathological studies of dementia: design, methods and areas of investigation: a systematic review. BMC Neurol 2006;6:2.
⁵ Grinberg LT, Ferretti RE, Farfel JM, et al. Brain bank of the Brazilian aging brain study group: a milestone reached and more than 1,600 collected brains. Cell Tissue Bank 2007;8: 151-162.
⁶ Jorm AF. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 1994;24:145-153.
⁷ Pfeffer RI, Kurosaki TT, Harrach CH, et al. Measurement of functional activities in older adults in the community. J Gerontology 1982;37:323-329.
⁸ Kukull WA, Larson EB. Distinguishing Alzheimer's disease from other dementias: questionnaire responses of close relatives and autopsy results. J Am Geriatr Soc 1989;37:521-527.
⁹ Davis PB, White H, Price JL, McKeek D, Robins LN. Retrospective postmortem dementia assessment: validation of a new clinical interview to assist neuropathologic study. Arch Neurol 1991;48:613-617.
¹⁰ Rockwood K, Howard K, Thomas VS, et al. Retrospective diagnosis of dementia using an informant interview based on the Brief Cognitive Rating Scale. Int Psychogeriatr 1998;10:53-60.
¹¹ Ellis RJ, Jan K, Kawas C, Koller WC, et al. Diagnostic validity of the dementia questionnaire for Alzheimer disease. Arch Neurol 1998;55:360-365.
¹² Ferretti REL, Grinberg LT, Leite RP, Farfel JM, Pasqualucci CA, Nitrini R, Jacob-Filho W. Banco de encéfalos humanos: uma ferramenta importante para o estudo do envelhecimento cerebral. Mundo da Saúde São Paulo 2009;33:89-98.
¹³ Nitrini R, Caramelli P, Bottino CMC, et al. Diagnóstico de Doença de Alzheimer no Brasil. Critérios diagnósticos e exames complementares: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005; 63:713-719.
¹⁴ Almeida P, Wickerhauser H. O critério ABA/ABIPEME: em busca de uma atualização. Editora da Associação Brasileira dos Institutos de Pesquisa de Mercado, São Paulo, Editora ABA/ABIPEME; 1991.
¹⁵ Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
¹⁶ Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
¹⁷ Spitzer RL, Williams JB, Gibbon M, First MB. The structured clinical interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry 1992;49:624-629.
¹⁸ Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185:914-919.
¹⁹ Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.
²⁰ Tanner CM, Gilley DW, Goetz CG. A brief screening questionnaire for parkinsonism (Abstr). Ann Neurol 1990;28:267-268.
²¹ Roth M, Tym E, Mountiov CQ et al. CAMDEX: a standardized instrument for the diagnosis of mental disorder in the elderly with special reference to elderly detection of dementia. Br J Psychiatry 1986;149:698-709.
²² Galvin JE, Roe CM, Powlishta KK, et al. The AD8: A brief informant interview to detect dementia. Neurology 2005;65: 559-564.
²³ Damin AE, Nitrini R, Silva MNM, et al. Cognitive change questionnaire as a method for dementia detection (Abstr). Dement Neuropsychol 2009;3(suppl 1):9.
²⁴ Folstein MF, Folstein SE, McHugh PR. Mini Mental State: a practical method for grading the cognitive state of patients for the clinicians. J Psychiatr Res 1975;12:189-198.
²⁵ Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
²⁶ Huppert FA, Brayne C, Gill C, Paykel ES, Beardsall L. CAMCOG: a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample. Br J Clin Psychol 1995;34:529-541.
²⁷ Nitrini R, Caramelli P, Herrera Júnior E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.
²⁸ Spreen O, Strauss E, Sherman EMS. A compendium of neuropsychological tests: administration, norms, and commentary. 3 ed. New York: Oxford University Press; 2006.
²⁹ Bustamante SE, Bottino CM, Lopes MA, et al. Combined instruments on the evaluation of dementia in the elderly: preliminary results. Arq Neuropsiquiatr 2003;61:601-606.
³⁰ Isella V, Villa L, Russo A et al. Discriminative and predictive power of an informant report in mild cognitive impairment. J Neurol Neurosurg Psychiatry 2006;77:166-171.
³¹ Mackinnon A, Khalilian A, Jorm AF, Korten AE, Christensen H, Mulligan R. Improving screening accuracy for dementia in a community sample by augmenting cognitive testing with informant report. J Clin Epidemiol 2003;56:358-366.
³² Ladeira RB, Diniz BS, Nunes PV, Forlenza OV. Combining cognitive screening tests for the evaluation of mild cognitive impairment in the elderly. Clinics (São Paulo) 2009;64:967-973.
³³ Waite L, Grayson D, Jorm AF, et al. Informant-based staging of dementia using the clinical dementia rating. Alzheimer Disease Assoc Disorders 1999;13:34-37.

Publication Dates

Publication in this collection
Apr-Jun 2010

History

Received
13 Jan 2009
Accepted
20 Mar 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹ Ravid R, Grinberg LT. How to run a brain bank: revisited. Cell Tissue Bank 2008;9:149-150.

[2] ² Hulette CM. Brain banking in the United States. J Neuropathol Exp Neurol 2003;62:715-722.

[3] ³ Ravid R, Swaab DF, Van Zwieten EJ, et al. Controls are what makes a brain bank go round. In: Cruz-Sanchez F, Cuzner M, Ravid R, Editors. Neuropathological diagnostic criteria for brain banking, biomedical and health research. Vol. 10. Amsterdam: IOS Press; 1995:4-13.

[4] ⁴ Zaccai J, Ince P, Brayne C. Population-based neuropathological studies of dementia: design, methods and areas of investigation: a systematic review. BMC Neurol 2006;6:2.

[5] ⁵ Grinberg LT, Ferretti RE, Farfel JM, et al. Brain bank of the Brazilian aging brain study group: a milestone reached and more than 1,600 collected brains. Cell Tissue Bank 2007;8: 151-162.

[6] ⁶ Jorm AF. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 1994;24:145-153.

[7] ⁷ Pfeffer RI, Kurosaki TT, Harrach CH, et al. Measurement of functional activities in older adults in the community. J Gerontology 1982;37:323-329.

[8] ⁸ Kukull WA, Larson EB. Distinguishing Alzheimer's disease from other dementias: questionnaire responses of close relatives and autopsy results. J Am Geriatr Soc 1989;37:521-527.

[9] ⁹ Davis PB, White H, Price JL, McKeek D, Robins LN. Retrospective postmortem dementia assessment: validation of a new clinical interview to assist neuropathologic study. Arch Neurol 1991;48:613-617.

[10] ¹⁰ Rockwood K, Howard K, Thomas VS, et al. Retrospective diagnosis of dementia using an informant interview based on the Brief Cognitive Rating Scale. Int Psychogeriatr 1998;10:53-60.

[11] ¹¹ Ellis RJ, Jan K, Kawas C, Koller WC, et al. Diagnostic validity of the dementia questionnaire for Alzheimer disease. Arch Neurol 1998;55:360-365.

[12] ¹² Ferretti REL, Grinberg LT, Leite RP, Farfel JM, Pasqualucci CA, Nitrini R, Jacob-Filho W. Banco de encéfalos humanos: uma ferramenta importante para o estudo do envelhecimento cerebral. Mundo da Saúde São Paulo 2009;33:89-98.

[13] ¹³ Nitrini R, Caramelli P, Bottino CMC, et al. Diagnóstico de Doença de Alzheimer no Brasil. Critérios diagnósticos e exames complementares: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005; 63:713-719.

[14] ¹⁴ Almeida P, Wickerhauser H. O critério ABA/ABIPEME: em busca de uma atualização. Editora da Associação Brasileira dos Institutos de Pesquisa de Mercado, São Paulo, Editora ABA/ABIPEME; 1991.

[15] ¹⁵ Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.

[16] ¹⁶ Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

[17] ¹⁷ Spitzer RL, Williams JB, Gibbon M, First MB. The structured clinical interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry 1992;49:624-629.

[18] ¹⁸ Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185:914-919.

[19] ¹⁹ Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.

[20] ²⁰ Tanner CM, Gilley DW, Goetz CG. A brief screening questionnaire for parkinsonism (Abstr). Ann Neurol 1990;28:267-268.

[21] ²¹ Roth M, Tym E, Mountiov CQ et al. CAMDEX: a standardized instrument for the diagnosis of mental disorder in the elderly with special reference to elderly detection of dementia. Br J Psychiatry 1986;149:698-709.

[22] ²² Galvin JE, Roe CM, Powlishta KK, et al. The AD8: A brief informant interview to detect dementia. Neurology 2005;65: 559-564.

[23] ²³ Damin AE, Nitrini R, Silva MNM, et al. Cognitive change questionnaire as a method for dementia detection (Abstr). Dement Neuropsychol 2009;3(suppl 1):9.

[24] ²⁴ Folstein MF, Folstein SE, McHugh PR. Mini Mental State: a practical method for grading the cognitive state of patients for the clinicians. J Psychiatr Res 1975;12:189-198.

[25] ²⁵ Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[26] ²⁶ Huppert FA, Brayne C, Gill C, Paykel ES, Beardsall L. CAMCOG: a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample. Br J Clin Psychol 1995;34:529-541.

[27] ²⁷ Nitrini R, Caramelli P, Herrera Júnior E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.

[28] ²⁸ Spreen O, Strauss E, Sherman EMS. A compendium of neuropsychological tests: administration, norms, and commentary. 3 ed. New York: Oxford University Press; 2006.

[29] ²⁹ Bustamante SE, Bottino CM, Lopes MA, et al. Combined instruments on the evaluation of dementia in the elderly: preliminary results. Arq Neuropsiquiatr 2003;61:601-606.

[30] ³⁰ Isella V, Villa L, Russo A et al. Discriminative and predictive power of an informant report in mild cognitive impairment. J Neurol Neurosurg Psychiatry 2006;77:166-171.

[31] ³¹ Mackinnon A, Khalilian A, Jorm AF, Korten AE, Christensen H, Mulligan R. Improving screening accuracy for dementia in a community sample by augmenting cognitive testing with informant report. J Clin Epidemiol 2003;56:358-366.

[32] ³² Ladeira RB, Diniz BS, Nunes PV, Forlenza OV. Combining cognitive screening tests for the evaluation of mild cognitive impairment in the elderly. Clinics (São Paulo) 2009;64:967-973.

[33] ³³ Waite L, Grayson D, Jorm AF, et al. Informant-based staging of dementia using the clinical dementia rating. Alzheimer Disease Assoc Disorders 1999;13:34-37.