Autopsy in dementing illness: who participates?

The frequency of occurrence of various types of dementing disorders has been ascertained primarily from autopsied series. Since autopsy is voluntary, it is unknown if these series are representative of the entire demented population. To assess this issue, all deaths occurring over a 5-year period in our Memory Disorders Clinic were reviewed, and clinical variables and diagnoses were compared between patients who were autopsied and those who were not. Sixty-nine patients died; 43% (n = 30) underwent autopsy, and 57% (n = 39) did not. Race (no black patients were autopsied), age of disease onset, age of presentation to the clinic, age of death, and interval between last clinic contact and death (significantly less for nonautopsied patients) were found to differ between the two groups. However, clinical diagnosis of dementia was similar in the two groups. The clinical diagnosis was confirmed in 84% of autopsied patients. These results suggest that there are no major differences between clinical diagnoses for autopsied and non-autopsied patients and that the frequency of occurrence of various dementias obtained through autopsied series are representative of the demented population.