FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 337:1667-1674 December 4, 1997 Number 23 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background There are several widely used sets of criteria for the diagnosis of dementia, but little is known about their degree of agreement and their effects on estimates of the prevalence of dementia.

Methods We examined 1879 men and women 65 years of age or older who were enrolled in the Canadian Study of Health and Aging and calculated the proportion given a diagnosis of dementia according to six commonly used classification systems: the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition (DSM-III), the third edition, revised, of the DSM (DSM-III-R), the fourth edition of the DSM (DSM-IV), the World Health Organization's International Classification of Diseases (ICD), 9th revision (ICD-9) and 10th revision (ICD-10), and the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). The degree of concordance among classification schemes and the importance of various factors in determining diagnostic agreement or disagreement were examined.

Results The proportion of subjects with dementia varied from 3.1 percent when we used the criteria of the ICD-10 to 29.1 percent when the DSM-III criteria were used. The six classification systems identified different groups of subjects as having dementia; only 20 subjects were given a diagnosis of dementia according to all six systems. The classifications based on the various systems differed little according to the patients' age, sex, educational level, or status with respect to institutionalization. The factors that most often caused disagreement in diagnosis between DSM-III and ICD-10 were long-term memory, executive function, social activities, and duration of symptoms.

Conclusions The commonly used criteria for diagnosis can differ by a factor of 10 in the number of subjects classified as having dementia. Such disagreement has serious implications for research and treatment, as well as for the right of many older persons to drive, make a will, and handle financial affairs.

Source Information

From the Memory Research Unit, Department of Neurology, University of Helsinki, Helsinki, Finland (T.E.); and the Departments of Epidemiology and Biostatistics (T.Ø., V.H.) and Clinical Neurological Sciences (R.S., V.H.), University of Western Ontario, and Psychological Services, University Campus, London Health Sciences Centre (R.S.) — both in London, Ont., Canada.

Address reprint requests to Dr. Østbye at the Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON N6A 5C1, Canada.

Full Text of this Article

This article has been cited by other articles:

• First, M. B. (2009). Harmonisation of ICD-11 and DSM-V: opportunities and challenges. Br. J. Psychiatry 195: 382-390 [Abstract] [Full Text]  
• Sampson, E. L., Blanchard, M. R., Jones, L., Tookman, A., King, M. (2009). Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br. J. Psychiatry 195: 61-66 [Abstract] [Full Text]  
• Pimlott, N. J.G., Persaud, M., Drummond, N., Cohen, C. A., Silvius, J. L., Seigel, K., Hollingworth, G. R., Dalziel, W. B. (2009). Family physicians and dementia in Canada: Part 2. Understanding the challenges of dementia care. cfp 55: 508-509.e7 [Abstract] [Full Text]  
• Hachinski, V. (2008). Shifts in Thinking About Dementia. JAMA 300: 2172-2173 [Full Text]  
• Corrada, M. M., Brookmeyer, R., Berlau, D., Paganini-Hill, A., Kawas, C. H. (2008). Prevalence of dementia after age 90: Results from The 90+ Study. Neurology 71: 337-343 [Abstract] [Full Text]  
• Chien, I-C., Lin, Y.-C., Chou, Y.-J., Lin, C.-H., Bih, S.-H., Lee, C.-H., Chou, P. (2008). Treated Prevalence and Incidence of Dementia Among National Health Insurance Enrollees in Taiwan, 1996-2003. J Geriatr Psychiatry Neurol 21: 142-148 [Abstract]  
• Wiederkehr, S., Simard, M., Fortin, C., van Reekum, R. (2008). Comparability of the Clinical Diagnostic Criteria for Vascular Dementia: A Critical Review. Part I. J. Neuropsychiatry Clin. Neurosi. 20: 150-161 [Abstract] [Full Text]  
• Wiederkehr, S., Simard, M., Fortin, C., van Reekum, R. (2008). Validity of the Clinical Diagnostic Criteria for Vascular Dementia: A Critical Review. Part II. J. Neuropsychiatry Clin. Neurosi. 20: 162-177 [Abstract] [Full Text]  
• STRYDOM, A., LIVINGSTON, G., KING, M., HASSIOTIS, A. (2007). Prevalence of dementia in intellectual disability using different diagnostic criteria. Br. J. Psychiatry 191: 150-157 [Abstract] [Full Text]  
• Burns, A., O'Brien, J. (2006). Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology. J Psychopharmacol 20: 732-755 [Abstract]  
• Leblanc, G. G., Meschia, J. F., Stuss, D. T., Hachinski, V. (2006). Genetics of Vascular Cognitive Impairment: The Opportunity and the Challenges. Stroke 37: 248-255 [Abstract] [Full Text]  
• Lopez, O. L., Kuller, L. H., Becker, J. T., Jagust, W. J., DeKosky, S. T., Fitzpatrick, A., Breitner, J., Lyketsos, C., Kawas, C., Carlson, M. (2005). Classification of vascular dementia in the Cardiovascular Health Study Cognition Study. Neurology 64: 1539-1547 [Abstract] [Full Text]  
• Greenberg, S. M., Eng, J. A., Ning, M., Smith, E. E., Rosand, J. (2004). Hemorrhage Burden Predicts Recurrent Intracerebral Hemorrhage After Lobar Hemorrhage. Stroke 35: 1415-1420 [Abstract] [Full Text]  
• Adair, J. C., Charlie, J., Dencoff, J. E., Kaye, J. A., Quinn, J. F., Camicioli, R. M., Stetler-Stevenson, W. G., Rosenberg, G. A. (2004). Measurement of Gelatinase B (MMP-9) in the Cerebrospinal Fluid of Patients With Vascular Dementia and Alzheimer Disease. Stroke 35: e159-e162 [Abstract] [Full Text]  
• Covinsky, K. E., Yaffe, K. (2004). Dementia, Prognosis, and the Needs of Patients and Caregivers. ANN INTERN MED 140: 573-574 [Full Text]  
• Graham, N L, Emery, T, Hodges, J R (2004). Distinctive cognitive profiles in Alzheimer's disease and subcortical vascular dementia. J. Neurol. Neurosurg. Psychiatry 75: 61-71 [Abstract] [Full Text]  
• Boustani, M., Peterson, B., Hanson, L., Harris, R., Lohr, K. N. (2003). Screening for Dementia in Primary Care: A Summary of the Evidence for the U.S. Preventive Services Task Force. ANN INTERN MED 138: 927-937 [Abstract] [Full Text]  
• Rahkonen, T, Eloniemi-Sulkava, U, Rissanen, S, Vatanen, A, Viramo, P, Sulkava, R (2003). Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older. J. Neurol. Neurosurg. Psychiatry 74: 720-724 [Abstract] [Full Text]  
• Wardlaw, J.M., Sandercock, P.A.G., Dennis, M.S., Starr, J., Kalimo, H. (2003). Is Breakdown of the Blood-Brain Barrier Responsible for Lacunar Stroke, Leukoaraiosis, and Dementia?. Stroke 34: 806-812 [Abstract] [Full Text]  
• Kukull, W. A., Higdon, R., Bowen, J. D., McCormick, W. C., Teri, L., Schellenberg, G. D., van Belle, G., Jolley, L., Larson, E. B. (2002). Dementia and Alzheimer Disease Incidence: A Prospective Cohort Study. Arch Neurol 59: 1737-1746 [Abstract] [Full Text]  
• Chan, D. K. Y. (2002). A New Hypothesis (Concept) of Diagnosing Alzheimer's Disease. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 57: M645-647 [Abstract] [Full Text]  
• Lindeboom, J, Schmand, B, Tulner, L, Walstra, G, Jonker, C (2002). Visual association test to detect early dementia of the Alzheimer type. J. Neurol. Neurosurg. Psychiatry 73: 126-133 [Abstract] [Full Text]  
• Goodwin, J. S. (2002). Language and Medicine: Thinking and Talking About Alzheimer's Disease. Gerontologist 42: 293-296 [Full Text]  
• Mussi, C., Foroni, M., Valli, A., Ascari, S., Tolve, I., Salvioli, G. (2002). The "Time and Change" Test: An Appropriate Method to Detect Cognitive Decline in the Elderly. J Geriatr Psychiatry Neurol 15: 12-15 [Abstract]  
• STEVENS, T., LIVINGSTON, G., KITCHEN, G., MANELA, M., WALKER, Z., KATONA, C. (2002). Islington study of dementia subtypes in the community. Br. J. Psychiatry 180: 270-276 [Abstract] [Full Text]  
• Taylor, J., Stott, D. J. (2002). Chronic heart failure and cognitive impairment: co-existence of conditions or true association?. Eur J Heart Fail 4: 7-9 [Full Text]  
• Blauw, G.J., Bollen, E.L.E.M., van Buchem, M.A., Westendorp, R.G.J. (2001). Dementia at old age: a clinical end-point of atherosclerotic disease. Eur Heart J Suppl 3: N16-N19 [Abstract]  
• Waite, L M, Broe, G A, Grayson, D A, Creasey, H (2001). Preclinical syndromes predict dementia: the Sydney older persons study. J. Neurol. Neurosurg. Psychiatry 71: 296-302 [Abstract] [Full Text]  
• Taylor, D. H. Jr., Schenkman, M., Zhou, J., Sloan, F. A. (2001). The Relative Effect of Alzheimer's Disease and Related Dementias, Disability, and Comorbidities on Cost of Care for Elderly Persons. Journals of Gerontology Series B: Psychological Sciences and Social Science 56: S285-293 [Abstract] [Full Text]  
• RIEDEL-HELLER, S. G., BUSSE, A., AURICH, C., MATSCHINGER, H., ANGERMEYER, M. C. (2001). Incidence of dementia according to DSM-III-R and ICD-10: Results of the Leipzig Longitudinal Study of the Aged (LEILA75+), Part 2. Br. J. Psychiatry 179: 255-260 [Abstract] [Full Text]  
• Schifitto, G., Kieburtz, K., McDermott, M.P., McArthur, J., Marder, K., Sacktor, N., Palumbo, D., Selnes, O., Stern, Y., Epstein, L., Albert, S. (2001). Clinical trials in HIV-associated cognitive impairment: Cognitive and functional outcomes. Neurology 56: 415-418 [Abstract] [Full Text]  
• Magaziner, J., German, P., Zimmerman, S. I., Hebel, J. R., Burton, L., Gruber-Baldini, A. L., May, C., Kittner, S. (2000). The Prevalence of Dementia in a Statewide Sample of New Nursing Home Admissions Aged 65 and Older: Diagnosis by Expert Panel. Gerontologist 40: 663-672 [Abstract] [Full Text]  
• Pohjasvaara, T., Mantyla, R., Ylikoski, R., Kaste, M., Erkinjuntti, T. (2000). Comparison of Different Clinical Criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the Diagnosis of Vascular Dementia. Stroke 31: 2952-2957 [Abstract] [Full Text]  
• Royall, D. R., Roman, G. C., Sachdev, P. S., Looi, J. C. L. (2000). Differentiation of vascular dementia from AD on neuropsychological tests. Neurology 55: 604-606 [Full Text]  
• (2000). The incidence of dementia in Canada. Neurology 55: 66-73 [Abstract] [Full Text]  
• Barba, R., Martinez-Espinosa, S., Rodriguez-Garcia, E., Pondal, M., Vivancos, J., Del Ser, T. (2000). Poststroke Dementia : Clinical Features and Risk Factors. Stroke 31: 1494-1501 [Abstract] [Full Text]  
• Desmond, D. W., Moroney, J. T., Paik, M. C., Sano, M., Mohr, J. P., Aboumatar, S., Tseng, C.-L., Chan, S., Williams, J. B. W., Remien, R. H., Hauser, W. A., Stern, Y. (2000). Frequency and clinical determinants of dementia after ischemic stroke. Neurology 54: 1124-1131 [Abstract] [Full Text]  
• Bowler, J. V., Hachinski, V. (2000). Criteria for Vascular Dementia: Replacing Dogma With Data. Arch Neurol 57: 170-171 [Full Text]  
• Munoz, D. G., Feldman, H. (2000). Causes of Alzheimer's disease. CMAJ 162: 65-72 [Abstract] [Full Text]  
• Looi, J. C. L., Sachdev, P. S. (1999). Differentiation of vascular dementia from AD on neuropsychological tests. Neurology 53: 670-670 [Abstract] [Full Text]  
• Gambassi, G., Landi, F., Lapane, K. L, Sgadari, A., Mor, V., Bernabei, R. (1999). Predictors of mortality in patients with Alzheimer's disease living in nursing homes. J. Neurol. Neurosurg. Psychiatry 67: 59-65 [Abstract] [Full Text]  
• von Strauss, E., Viitanen, M., De Ronchi, D., Winblad, B., Fratiglioni, L. (1999). Aging and the Occurrence of Dementia: Findings From a Population-Based Cohort With a Large Sample of Nonagenarians. Arch Neurol 56: 587-592 [Abstract] [Full Text]  
• Andersen, K., Nielsen, H., Lolk, A., Andersen, J., Becker, I., Kragh-Sorensen, P. (1999). Incidence of very mild to severe dementia and Alzheimer's disease in Denmark: The Odense Study. Neurology 52: 85-85 [Abstract] [Full Text]  
• Gifford, D. R., Cummings, J. L. (1999). Evaluating dementia screening tests. Neurology 52: 224-224 [Full Text]