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. 2016;41(1-2):99-108.
doi: 10.1159/000438454. Epub 2016 Jan 8.

When a Little Knowledge Can Be Dangerous: False-Positive Diagnosis of Behavioral Variant Frontotemporal Dementia among Community Clinicians

Shunichiro Shinagawa  1 , Joseree Ann Catindig, Nikolas R Block, Bruce L Miller, Katherine P Rankin
Affiliations

When a Little Knowledge Can Be Dangerous: False-Positive Diagnosis of Behavioral Variant Frontotemporal Dementia among Community Clinicians

Shunichiro Shinagawa et al. Dement Geriatr Cogn Disord. 2016.

Abstract

Background: Accurate diagnosis of behavioral variant frontotemporal dementia (bvFTD) is important as patients' behavioral symptoms have profound implications for their families and communities. Since the diagnosis of bvFTD derives from behavioral features, accurate identification of patients can be difficult for non-specialists. Concrete rates of diagnostic accuracy among non-specialists are unavailable.

Methods: To examine the accuracy of community clinicians' diagnoses of bvFTD and to identify patient characteristics leading to misdiagnosis, we reviewed the charts and referral letters of 3,578 patients who were seen at our specialized center. Referral diagnosis and reasons, manifesting symptoms, demographic data, Mini-Mental State Examination score, Clinical Dementia Rating score and Neuropsychiatric Inventory score were extracted.

Results: 60% of patients assigned a single diagnosis of bvFTD by community clinicians did not have bvFTD according to specialists. Compared to specialist-confirmed bvFTD patients, false bvFTD patients were more likely to be depressed and to be non-Caucasian, showed less euphoria, apathy, disinhibition and abnormal eating behaviors, had milder disease severity and better overall cognition. bvFTD was mentioned by referring clinicians in 86% of specialist-confirmed bvFTD cases, but missed cases were called Alzheimer's, Parkinson's or Huntington's disease, or progressive aphasia.

Conclusion: These results revealed a widespread lack of familiarity with core diagnostic symptoms among non-specialists and suggest that community clinicians require specialized diagnostic support before providing a definitive diagnosis of bvFTD.

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Figures

Fig. 1
Fig. 1
Main symptoms described by referring physicians in their referral documentation, among 147 subjects mistakenly diagnosed with bvFTD.
Fig. 2
Fig. 2
Comparison of neuropsychiatric features between patients correctly and incorrectly diagnosed with bvFTD. * p < 0.05; ** p < 0.01.
Fig. 3
Fig. 3
Changes of positive predictive value and false-positive rate by year. The positive predictive value includes patients whose referral mentioned bvFTD alone or with other diagnoses. The falsepositive rate includes subjects referred as bvFTD only.
See this image and copyright information in PMC

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