Jacopo C DiFrancesco1, Alessandra Pina2, Giorgia Giussani3, Laura Cortesi3, Elisa Bianchi3, Luca Cavalieri d'Oro4, Emanuele Amodio4, Alessandro Nobili3, Lucio Tremolizzo2, Valeria Isella2, Ildebrando Appollonio2, Carlo Ferrarese2, Ettore Beghi3. 1. Department of Neurology, San Gerardo Hospital, Laboratory of Neurobiology, Milan Center for Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy. jacopo.difrancesco@unimib.it. 2. Department of Neurology, San Gerardo Hospital, Laboratory of Neurobiology, Milan Center for Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy. 3. Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy. 4. Epidemiology Unit, Health Protection Agency (Agenzia per la Tutela della Salute - ATS), Monza, Italy.
Abstract
OBJECTIVES: To generate and validate algorithms for the identification of individuals with dementia in the community setting, by the interrogation of administrative records, an inexpensive and already available source of data. METHODS: We collected and anonymized information on demented individuals 65 years of age or older from ten general practitioners (GPs) in the district of Brianza (Northern Italy) and compared this with the administrative data of the local health protection agency (Agenzia per la Tutela della Salute). Indicators of the disease in the administrative database (diagnosis of dementia in the hospital discharge records; use of cholinesterase inhibitors/memantine; neuropsychological tests; brain CT/MRI; outpatient neurological visits) were used separately and in different combinations to generate algorithms for the detection of patients with dementia. RESULTS: When used individually, indicators of dementia showed good specificity, but low sensitivity. By their combination, we generated different algorithms: I-therapy with ChEI/memantine or diagnosis of dementia at discharge or neuropsychological tests (specificity 97.9%, sensitivity 52.5%); II-therapy with ChEI/memantine or diagnosis of dementia at discharge or neuropsychological tests or brain CT/MRI or neurological visit (sensitivity 90.8%, specificity 70.6%); III-therapy with ChEI/memantine or diagnosis of dementia at discharge or neuropsychological tests or brain CT/MRIMRI and neurological visit (specificity 89.3%, sensitivity 73.3%). CONCLUSIONS: These results show that algorithms obtained from administrative data are not sufficiently accurate in classifying patients with dementia, whichever combination of variables is used for the identification of the disease. Studies in large patient cohorts are needed to develop further strategies for identifying patients with dementia in the community setting.
OBJECTIVES: To generate and validate algorithms for the identification of individuals with dementia in the community setting, by the interrogation of administrative records, an inexpensive and already available source of data. METHODS: We collected and anonymized information on demented individuals 65 years of age or older from ten general practitioners (GPs) in the district of Brianza (Northern Italy) and compared this with the administrative data of the local health protection agency (Agenzia per la Tutela della Salute). Indicators of the disease in the administrative database (diagnosis of dementia in the hospital discharge records; use of cholinesterase inhibitors/memantine; neuropsychological tests; brain CT/MRI; outpatient neurological visits) were used separately and in different combinations to generate algorithms for the detection of patients with dementia. RESULTS: When used individually, indicators of dementia showed good specificity, but low sensitivity. By their combination, we generated different algorithms: I-therapy with ChEI/memantine or diagnosis of dementia at discharge or neuropsychological tests (specificity 97.9%, sensitivity 52.5%); II-therapy with ChEI/memantine or diagnosis of dementia at discharge or neuropsychological tests or brain CT/MRI or neurological visit (sensitivity 90.8%, specificity 70.6%); III-therapy with ChEI/memantine or diagnosis of dementia at discharge or neuropsychological tests or brain CT/MRIMRI and neurological visit (specificity 89.3%, sensitivity 73.3%). CONCLUSIONS: These results show that algorithms obtained from administrative data are not sufficiently accurate in classifying patients with dementia, whichever combination of variables is used for the identification of the disease. Studies in large patient cohorts are needed to develop further strategies for identifying patients with dementia in the community setting.
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