Abstract
BackgroundThis study compared individuals whose clinical diagnosis of Alzheimer’s disease (AD) matched or did not match neuropathologic results at autopsy on clinical and functional outcomes (cognitive impairment, functional status and neuropsychiatric symptoms). The study also assessed the extent of potentially inappropriate medication use (using potentially unnecessary medications or potentially inappropriate prescribing) among misdiagnosed patients.MethodsLongitudinal data from the National Alzheimer’s Coordinating Center Uniform Data Set (NACC-UDS, 2005–2010) and corresponding NACC neuropathological data were utilized to compare 88 misdiagnosed and 438 accurately diagnosed patients.ResultsFollowing adjustment of sociodemographic characteristics, the misdiagnosed were found to have less severe cognitive and functional impairment. However, after statistical adjustment for sociodemographics, dementia severity level, time since onset of cognitive decline and probable AD diagnosis at baseline, the groups significantly differed on only one outcome: the misdiagnosed were less likely to be depressed/dysphoric. Among the misdiagnosed, 18.18% were treated with potentially inappropriate medication. An additional analysis noted this rate could be as high as 67.10%.ConclusionsFindings highlight the importance of making an accurate AD diagnosis to help reduce unnecessary treatment and increase appropriate therapy. Additional research is needed to demonstrate the link between potentially inappropriate treatment and adverse health outcomes in misdiagnosed AD patients.
Highlights
This study compared individuals whose clinical diagnosis of Alzheimer’s disease (AD) matched or did not match neuropathologic results at autopsy on clinical and functional outcomes
The National Alzheimer’s Coordinating Center (NACC) Uniform Data Set is a publicly accessible, longitudinal database that includes standardized cognitive, behavioral, and functional data for each Alzheimer’s Disease Centers (ADCs) participant based on their annual visits
As one of the aims of the current study was to examine whether potentially inappropriate medication use occurred among those who were misdiagnosed as having probable AD [4], those in the possible AD group as well as the false and true negatives in the original Beach et al analysis were excluded
Summary
This study compared individuals whose clinical diagnosis of Alzheimer’s disease (AD) matched or did not match neuropathologic results at autopsy on clinical and functional outcomes (cognitive impairment, functional status and neuropsychiatric symptoms). The observed misdiagnosis rate may be partly driven by the fact that numerous conditions can mimic symptoms of AD [2]. Some of these conditions constitute other types of progressive dementias (e.g., frontotemporal dementia, vascular dementia and dementia with Lewy bodies) while others may be treatable and possibly reversible conditions (e.g., drug intoxication, depression, nutritional deficiencies, infectious diseases) [10,11]. Other studies have found higher levels of concordance between clinical and post-mortem diagnosis of AD but diminished diagnostic accuracy with other types of dementia [14,15]
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