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         headline:Consensus neuropathological diagnosis of common dementia syndromes: testing and standardising the use of multiple diagnostic criteria
         description: The aim of this study was to assess the variation between neuropathologists in the diagnosis of common dementia syndromes when multiple published protocols are applied. Fourteen out of 18 Australian neuropathologists participated in diagnosing 20 cases (16 cases of dementia, 4 age-matched controls) using consensus diagnostic methods. Diagnostic criteria, clinical synopses and slides from multiple brain regions were sent to participants who were asked for case diagnoses. Diagnostic sensitivity, specificity, predictive value, accuracy and variability were determined using percentage agreement and kappa statistics. Using CERAD criteria, there was a high inter-rater agreement for cases with probable and definite Alzheimer's disease but low agreement for cases with possible Alzheimer's disease. Braak staging and the application of criteria for dementia with Lewy bodies also resulted in high inter-rater agreement. There was poor agreement for the diagnosis of frontotemporal dementia and for identifying small vessel disease. Participants rarely diagnosed more than one disease in any case. To improve efficiency when applying multiple diagnostic criteria, several simplifications were proposed and tested on 5 of the original 20 cases. Inter-rater reliability for the diagnosis of Alzheimer's disease and dementia with Lewy bodies significantly improved. Further development of simple and accurate methods to identify small vessel lesions and diagnose frontotemporal dementia is warranted.
         datePublished:2002-03-22T00:00:00Z
         dateModified:2002-03-22T00:00:00Z
         pageStart:72
         pageEnd:78
         sameAs:https://doi.org/10.1007/s00401-002-0529-5
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            Pathology
            Neurosciences
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      headline:Consensus neuropathological diagnosis of common dementia syndromes: testing and standardising the use of multiple diagnostic criteria
      description: The aim of this study was to assess the variation between neuropathologists in the diagnosis of common dementia syndromes when multiple published protocols are applied. Fourteen out of 18 Australian neuropathologists participated in diagnosing 20 cases (16 cases of dementia, 4 age-matched controls) using consensus diagnostic methods. Diagnostic criteria, clinical synopses and slides from multiple brain regions were sent to participants who were asked for case diagnoses. Diagnostic sensitivity, specificity, predictive value, accuracy and variability were determined using percentage agreement and kappa statistics. Using CERAD criteria, there was a high inter-rater agreement for cases with probable and definite Alzheimer's disease but low agreement for cases with possible Alzheimer's disease. Braak staging and the application of criteria for dementia with Lewy bodies also resulted in high inter-rater agreement. There was poor agreement for the diagnosis of frontotemporal dementia and for identifying small vessel disease. Participants rarely diagnosed more than one disease in any case. To improve efficiency when applying multiple diagnostic criteria, several simplifications were proposed and tested on 5 of the original 20 cases. Inter-rater reliability for the diagnosis of Alzheimer's disease and dementia with Lewy bodies significantly improved. Further development of simple and accurate methods to identify small vessel lesions and diagnose frontotemporal dementia is warranted.
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            address:
               name:Anatomical Pathology, Royal Melbourne Hospital, Grattan Street, Melbourne, 3050 Victoria, Australia
               type:PostalAddress
            type:Organization
      name:C. Harper
      affiliation:
            name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales
            address:
               name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales, Australia
               type:PostalAddress
            type:Organization
      name:R. Kalnins
      affiliation:
            name:Anatomical Pathology, Austin Hospital, Studley Road, Heidelberg, 3084 Victoria
            address:
               name:Anatomical Pathology, Austin Hospital, Studley Road, Heidelberg, 3084 Victoria, Australia
               type:PostalAddress
            type:Organization
      name:C. Masters
      affiliation:
            name:Department of Pathology, University of Melbourne, Melbourne, 3010 Victoria
            address:
               name:Department of Pathology, University of Melbourne, Melbourne, 3010 Victoria, Australia
               type:PostalAddress
            type:Organization
      name:C. McLean
      affiliation:
            name:Department of Pathology, University of Melbourne, Melbourne, 3010 Victoria
            address:
               name:Department of Pathology, University of Melbourne, Melbourne, 3010 Victoria, Australia
               type:PostalAddress
            type:Organization
      name:D. Milder
      affiliation:
            name:Department of Forensic Medicine, Central Sydney Area Health Service, Glebe, 2037 New South Wales
            address:
               name:Department of Forensic Medicine, Central Sydney Area Health Service, Glebe, 2037 New South Wales, Australia
               type:PostalAddress
            type:Organization
      name:R. Pamphlett
      affiliation:
            name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales
            address:
               name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales, Australia
               type:PostalAddress
            type:Organization
      name:G. Scott
      affiliation:
            name:Neuropathology Laboratory, Institute of Medical and Veterinary Science, Frome Road, Adelaide, 5000 South Australia
            address:
               name:Neuropathology Laboratory, Institute of Medical and Veterinary Science, Frome Road, Adelaide, 5000 South Australia, Australia
               type:PostalAddress
            type:Organization
      name:A. Tannenberg
      affiliation:
            name:Pathology Department, Mater Misericordiae Public Hospital, South Brisbane, 4101 Queensland
            address:
               name:Pathology Department, Mater Misericordiae Public Hospital, South Brisbane, 4101 Queensland, Australia
               type:PostalAddress
            type:Organization
      name:J. Kril
      affiliation:
            name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales
            address:
               name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales, Australia
               type:PostalAddress
            type:Organization
PostalAddress:
      name:Prince of Wales Medical Research Institute, High Street, Randwick, 2031 New South Wales, Australia
      name:Anatomical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, 2145 New South Wales, Australia
      name:Department of Forensic Medicine, Central Sydney Area Health Service, Glebe, 2037 New South Wales, Australia
      name:Prince of Wales Medical Research Institute, High Street, Randwick, 2031 New South Wales, Australia
      name:Neuropathology Laboratory, Institute of Medical and Veterinary Science, Frome Road, Adelaide, 5000 South Australia, Australia
      name:Department of Forensic Medicine, Central Sydney Area Health Service, Glebe, 2037 New South Wales, Australia
      name:Department of Neuropathology, Royal Perth Hospital, Wellington Street, Perth, 6001 Western Australia, Australia
      name:Anatomical Pathology, Royal North Shore Hospital, St. Leonards, 2065 New South Wales, Australia
      name:Anatomical Pathology, Royal Melbourne Hospital, Grattan Street, Melbourne, 3050 Victoria, Australia
      name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales, Australia
      name:Anatomical Pathology, Austin Hospital, Studley Road, Heidelberg, 3084 Victoria, Australia
      name:Department of Pathology, University of Melbourne, Melbourne, 3010 Victoria, Australia
      name:Department of Pathology, University of Melbourne, Melbourne, 3010 Victoria, Australia
      name:Department of Forensic Medicine, Central Sydney Area Health Service, Glebe, 2037 New South Wales, Australia
      name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales, Australia
      name:Neuropathology Laboratory, Institute of Medical and Veterinary Science, Frome Road, Adelaide, 5000 South Australia, Australia
      name:Pathology Department, Mater Misericordiae Public Hospital, South Brisbane, 4101 Queensland, Australia
      name:Department of Pathology, University of Sydney, Sydney, 2006 New South Wales, Australia
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