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Comparative Study
. 2021;83(2):741-751.
doi: 10.3233/JAD-210278.

Comparing a Single Clinician Versus a Multidisciplinary Consensus Conference Approach for Dementia Diagnostics

Gorm Thorlacius-Ussing  1 , Marie Bruun  1 , Le Gjerum  1 , Kristian S Frederiksen  1 , Hanneke F M Rhodius-Meester  2 , Wiesje M van der Flier  2 , Gunhild Waldemar  1 , Steen G Hasselbalch  1
Affiliations
Comparative Study

Comparing a Single Clinician Versus a Multidisciplinary Consensus Conference Approach for Dementia Diagnostics

Gorm Thorlacius-Ussing et al. J Alzheimers Dis. 2021.

Abstract

Background: Evidence-based recommendations on the optimal evaluation approach for dementia diagnostics are limited. This impedes a harmonized workup across clinics and nations.

Objective: To evaluate the diagnostic performance of a multidisciplinary consensus conference compared to a single clinician approach.

Methods: In this prospective study, we enrolled 457 patients with suspected cognitive decline, from two European memory clinics. A diagnostic evaluation was performed at baseline independently in two ways: 1) by a single clinician and 2) at a multidisciplinary consensus conference. A syndrome diagnosis and an etiological diagnosis was made. The confidence in the diagnosis was recorded using a visual analogue scale. An expert panel re-evaluation diagnosis served as reference for the baseline syndrome diagnosis and a 12-24-month follow-up diagnosis for the etiological diagnosis.

Results: 439 patients completed the study. We observed 12.5%discrepancy (k = 0.81) comparing the baseline syndrome diagnoses of the single clinician to the consensus conference, and 22.3%discrepancy (k = 0.68) for the baseline etiological diagnosis. The accuracy of the baseline etiological diagnosis was significantly higher at the consensus conference and was driven mainly by increased accuracy in the MCI group. Confidence in the etiological diagnosis at baseline was significantly higher at the consensus conference (p < 0.005), especially for the frontotemporal dementia diagnosis.

Conclusion: The multidisciplinary consensus conference performed better on diagnostic accuracy of disease etiology and increased clinicians' confidence. This highlights the importance of a multidisciplinary diagnostic evaluation approach for dementia diagnostics, especially when evaluating patients in the MCI stage.

Keywords: Alzheimer disease; Lewy body disease; clinical decision-making; dementia; differential diagnosis; frontotemporal dementia; vascular dementia.

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Conflict of interest statement

Authors’ Competings available online (https://www.j-alz.com/manuscript-disclosures/21-0278r1).

Figures

Fig. 1
Fig. 1
Diagnostic accuracy of baseline syndrome diagnosis. Only cases with discrepancy at baseline regarding syndrome diagnosis were re-evaluated by an expert panel to determine a reference diagnosis. Stacked bar chart displaying total number correct and incorrect diagnoses.
Fig. 2
Fig. 2
Diagnostic accuracy of baseline etiological diagnosis. Stacked bar chart displaying total number correct and incorrect diagnoses. *p < 0.05.
See this image and copyright information in PMC

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