Andrea M Weinstein1, Swathi Gujral2, Meryl A Butters3, Christopher R Bowie4, Corinne E Fischer5, Alastair J Flint6, Nathan Herrmann7, James L Kennedy8, Linda Mah9, Shima Ovaysikia10, Bruce G Pollock8, Tarek K Rajji8, Benoit H Mulsant8. 1. Department of Psychiatry (AMW, SWG, MAB), University of Pittsburgh, Pittsburgh, PA. 2. Department of Psychiatry (AMW, SWG, MAB), University of Pittsburgh, Pittsburgh, PA; VA VISN 4 MIRECC, VA Pittsburgh Healthcare System (SG), Pittsburgh, PA. 3. Department of Psychiatry (AMW, SWG, MAB), University of Pittsburgh, Pittsburgh, PA. Electronic address: buttersma@upmc.edu. 4. Centre for Addiction and Mental Health (CRB, JLK, SO, BGP, TKR, BHM), Toronto, Ontario, Canada; Departments of Psychology and Psychiatry (CRB), Queens University, Kingston, Ontario, Canada. 5. 1 Keenan Research Centre for Biomedical Science (CEF), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 6. Department of Psychiatry (AJF, JLK, LM, BGP, TKR, BH, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health (AJF), University Health Network, Toronto, Ontario, Canada. 7. Division of Geriatric Psychiatry (NH), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 8. Department of Psychiatry (AJF, JLK, LM, BGP, TKR, BH, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CRB, JLK, SO, BGP, TKR, BHM), Toronto, Ontario, Canada. 9. Department of Psychiatry (AJF, JLK, LM, BGP, TKR, BH, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Baycrest (LM), Rotman Research Institute, Toronto, Ontario, Canada. 10. Centre for Addiction and Mental Health (CRB, JLK, SO, BGP, TKR, BHM), Toronto, Ontario, Canada.
Abstract
OBJECTIVE: This study compared diagnostic rates and clinical predictors of discrepancies between diagnoses conferred via: 1) a comprehensive neuropsychological evaluation and National Institute on Aging-Alzheimer's Association (NIA-AA) criteria versus 2) a cognitive screener and Diagnostic Statistical Manual of Mental Disorders (DSM-5) criteria. DESIGN: Cross-sectional examination of baseline data from the Prevention of Alzheimer's dementia (AD) using Cognitive remediation and transcranial direct current stimulation in Mild Cognitive Impairment (MCI) and Depression (PACt-MD; ClinicalTrials.gov Identifier: NCT02386670) trial. SETTING: Five geriatric psychiatry and memory clinics located at academic hospitals affiliated with the Department of Psychiatry, University of Toronto. PARTICIPANTS: Older adults (N = 431) with a history of major depressive disorder (MDD) in remission, MCI, or both. MEASUREMENTS: Main outcome was a comparison of NIA-AA diagnostic rates of MCI or dementia versus DSM-5 rates of mild or major neurocognitive disorder. Secondary analyses examined demographic, race, gender, premorbid intellectual ability, psychosocial, health-related, and genetic predictors of discrepancy between DSM-5 and NIA-AA diagnoses. RESULTS: There were 103 (23.8%) discrepant cases, with most (91; 88.3%) of these discrepant cases reflecting more impairment with the detailed neuropsychological testing and NIA-AA criteria. Discrepancies were more likely in individuals with a history of MDD or who had at least one ApoE4 allele. CONCLUSION: The NIA-AA criteria, in conjunction with comprehensive neuropsychological testing, identified a greater prevalence of cognitive impairment than DSM-5 criteria, in conjunction with the Montreal Cognitive Assessment. Detailed neuropsychological evaluations are recommended for older adults who have a history of MDD or a genetic vulnerability to dementia.
OBJECTIVE: This study compared diagnostic rates and clinical predictors of discrepancies between diagnoses conferred via: 1) a comprehensive neuropsychological evaluation and National Institute on Aging-Alzheimer's Association (NIA-AA) criteria versus 2) a cognitive screener and Diagnostic Statistical Manual of Mental Disorders (DSM-5) criteria. DESIGN: Cross-sectional examination of baseline data from the Prevention of Alzheimer's dementia (AD) using Cognitive remediation and transcranial direct current stimulation in Mild Cognitive Impairment (MCI) and Depression (PACt-MD; ClinicalTrials.gov Identifier: NCT02386670) trial. SETTING: Five geriatric psychiatry and memory clinics located at academic hospitals affiliated with the Department of Psychiatry, University of Toronto. PARTICIPANTS: Older adults (N = 431) with a history of major depressive disorder (MDD) in remission, MCI, or both. MEASUREMENTS: Main outcome was a comparison of NIA-AA diagnostic rates of MCI or dementia versus DSM-5 rates of mild or major neurocognitive disorder. Secondary analyses examined demographic, race, gender, premorbid intellectual ability, psychosocial, health-related, and genetic predictors of discrepancy between DSM-5 and NIA-AA diagnoses. RESULTS: There were 103 (23.8%) discrepant cases, with most (91; 88.3%) of these discrepant cases reflecting more impairment with the detailed neuropsychological testing and NIA-AA criteria. Discrepancies were more likely in individuals with a history of MDD or who had at least one ApoE4 allele. CONCLUSION: The NIA-AA criteria, in conjunction with comprehensive neuropsychological testing, identified a greater prevalence of cognitive impairment than DSM-5 criteria, in conjunction with the Montreal Cognitive Assessment. Detailed neuropsychological evaluations are recommended for older adults who have a history of MDD or a genetic vulnerability to dementia.
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