Year: 2006
Type: article
Abstract: Determining the cause of dementia on clinical grounds alone can be difficult, even for experienced clinicians. As a result, many dementia research centers have adopted a consensus approach to diagnosis, rather than relying on the judgment of a single clinician. While this has face validity, panels are at a disadvantage because they cannot examine patients directly and group dynamics may adversely affect decisions. Consensus procedures also vary widely across centers. To determine whether a systematic approach to consensus increases the accuracy of dementia diagnosis. We convened a panel of 6 dementia experts (4 neurologists and 2 psychiatrists) and a (non–expert) panel of 6 residents/fellows from neurology, psychiatry, and geriatric medicine. Each panel reviewed brief clinical summaries of medical records from 45 patients with pathologically–confirmed frontotemporal dementia (FTD, 17 cases) or Alzheimer's disease (AD, 31 cases). Panels used a modified Delphi method to incrementally arrive at a diagnosis. First, panelists independently and anonymously made an initial diagnosis of either FTD or AD and indicated their degree of confidence. They then were informed of the vote tally and encouraged to discuss the diagnostic features of the case. Following discussion, a second independent and anonymous vote was held. Finally, the panel was asked to reach a unanimous consensus diagnosis. All votes were compared to the neuropathological diagnosis. The consensus process increased diagnostic accuracy for both experts (79% before discussion, 81% after discussion, 84% at consensus) and non–experts (71% before discussion, 79% after discussion, 84% at consensus). It also increased diagnostic certainty. Case discussion took on average 4.5 minutes (range 0.5–15 minutes) and changed at least one of each panelist's diagnoses. This practical, yet rigorous, consensus method takes advantage of the diverse backgrounds of panelists while avoiding recognized pitfalls of undue influence by single individuals and group persuasion. It improves the accuracy of making a specific dementia diagnosis, particularly when using final, unanimous panel agreement. This approach provides an acceptably accurate “best possible” diagnosis for research studies when pathological data are not available.
Source: Alzheimer s & Dementia
Authors: Judith L. Heidebrink, Matthew J. Gabel, Roger Higdon, Norman L. Foster, Pilot Collaborative PET Imaging Trial
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2618947357