Questionable Dementia: Clinical Course and Predictors of Outcome

Devanand, D.P.; Folz, Mara; Gorlyn, Marianne; Moeller, James R.; Stern, Yaakov

OBJECTIVE:To evaluate the clinical course and predictors of outcome in outpatients with cognitive impairment who do not meet criteria for dementia at initial evaluation. DESIGN: Naturalistic longitudinal study. METHODS: Cognitively impaired patients in a memory disorders clinic who fell between the “normal” and “dementia” categories were defined broadly as “questionable dementia” (QD).Of 127consecutiveQ D patients, 75were followed for a minimum of 1year (mean 2.5 years, SD 1.7).Baseline neuropsychological testing was conducted in 62 of these 75 QD patients. RESULTS:: At the final follow-up time-point, 41.3% met diagnostic criteria for dementia (27 of 31 patients with dementia had possible or probable Alzheimer’s Disease, AD), 44% were rated as not demented, and 14.7% remained as “uncertain” dementia. Increased age was associated with the final diagnosis of dementia, but duration of follow-up, Clinical Dementia Rating, and modified Mini Mental State (mMMS) scores were not predictive. Low scores on the mMMS delayed recall subtest, consistent long-term retrieval on the Selective Reminding Test, category naming for animals, and the WAIS-R digit symbol, picture arrangement, and block design subtests were predictive of the final diagnosis of dementia (all P 5.01). mMMS delayed recall showed 66.7% sensitivity and 71.4% specificity, the other five neuropsychological subtests together showed 66.7% sensitivity and 66.7% specificity, and the six tests together showed 81% sensitivity and 76.9% specificity. Similar predictive accuracy was obtained for the final diagnosis of AD. CONCLUSIONS:In Q D patients, poor performance on the mMMS delayed recall item may be a useful predictor of the diagnosis of dementia (and AD) on follow-up. Combining a screening instrument like the mMMS with specific neuropsy-



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Journal of the American Geriatrics Society

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February 11, 2022