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An evaluation of the predictive validity and inter‐rater reliability of clinical diagnostic criteria for senile dementia of Lewy body type

Lookup NU author(s): Professor Ian McKeith, Dr Andrew Fairbairn, Dr Brian Moore, Emeritus Professor Nicol Ferrier, Emeritus Professor Robert Perry


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Several recent autopsy studies suggest that senile dementia of Lewy body type (SDLT) may be the second most common neuropathologic cause of dementia in the elderly, accounting for 7 to 30% of all cases. Operational criteria for the antemortem clinical diagnosis of SDLT have already been proposed by our group. The performance of these is now examined by randomizing the case notes from a new series of SDLT, Alzheimer, and multiinfarct dementia patients for psychiatric assessment by four raters of varying clinical experience and blind to pathologic diagnosis. Using the SDLT criteria, the two most experienced raters agreed in 94% of cases (kappa = 0.87), with the least experienced rater agreeing in 78% (kappa = 0.50). Diagnostic specificity for SDLT was uniformly high (90.0 to 97.0%), with a mean sensitivity of detection of 74%, and was greater by the experienced (90.0%) than the least experienced (55%) clinician. The antemortem identification of SDLT patients can therefore be achieved with a high degree of diagnostic specificity using such operationalized criteria, although there remains a minority of patients who present with either ''typical'' Alzheimer-type symptoms or with paranoid or delusional symptoms in the absence of substantial cognitive impairment. Sensitivity to neuroleptics may be a useful diagnostic pointer in these patients.

Publication metadata

Author(s): McKeith IG, Fairbairn AF, Bothwell RA, Moore PB, Ferrier IN, Thompson P, Perry RH

Publication type: Article

Publication status: Published

Journal: Neurology

Year: 1994

Volume: 44

Issue: 5

Pages: 872-877

Print publication date: 01/05/1994

ISSN (print): 0028-3878

ISSN (electronic): 1526-632X

Publisher: Lippincott Williams & Wilkins


DOI: 10.1212/WNL.44.5.872


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