Establishing the profile of cognitive complaints associated with neurodegenerative dementia

Abstract

Differentiating neurodegenerative and non-neurodegenerative disorders is important for several reasons, e.g., approval of disease-specific modifying treatments. Identifying patients in the early stages of a neurodegenerative disorder is a notoriously difficult task in primary care and in general outpatient clinics. This study aimed to identify the characteristics of people with cognitive complaints presenting to a Neurology appointment who later develop a neurodegenerative condition. We conducted a retrospective, single-center study of patients referred by primary care to the neurology outpatient clinic for cognitive complaints. Sociodemographic and clinical data were collected. The diagnoses of a "neurodegenerative disorder" or "non-degenerative disorder" were established per the judgement of the attending physician. Among 283 patients, 169 (59.7%) had a non-degenerative condition, 108 (38.2%) a neurodegenerative disease and 6 (2.1%) lost follow-up. The main characteristics associated with neurodegenerative disorder were: older age (OR 1.05), major cognitive complaints (i.e history of cognitive impairment likely to cause harm or requiring assistance from spouse / caretaker) (OR 2.27), a total score of Mini-Mental State Examination below the appropriate cut-off (OR 7.88), difficulties in memory recall bedside testing (OR 66.00), evidence of focal or asymmetrical atrophy in CT or MRI reports (OR 2.40). The multivariate analysis shows 93.4% accuracy, 87.4% sensitivity and 88% specificity in differentiating degenerative from non-degenerative cognitive disorders. This study identified traits that differentiate neurodegenerative from non-neurodegenerative cognitive complaints. Prospective application of this model should ideally be further explored in primary care, hopefully leading to more efficient triage of people presenting with cognitive complaints to primary care.