Stability of clinical etiologic diagnosis in dementia and mild cognitive impairment: Results from a multicenter longitudinal database

Thomas D. Koepsell, Dawn P. Gill, Baojiang Chen

Research output: Contribution to journalArticle

15 Scopus citations


Many new therapies for dementia target a specific pathologic process and must be applied early. Selection of specific therapy is based on the clinical etiologic diagnosis. We sought to determine the stability of the clinical etiologic diagnosis over time and to identify factors associated with instability. We identified 4141 patients with dementia or mild cognitive impairment who made at least 2 visits approximately a year apart to a dementia research center, receiving a clinical etiologic diagnosis on each visit. We assessed concordance of etiologic diagnoses across visits, κ-statistics, and transition probabilities among diagnoses. The primary clinical etiologic diagnosis remained stable for 91% of patients but with a net shift toward dementia with Lewy bodies and Alzheimer's disease. Lower diagnostic stability was significantly associated with older age, nonwhite race, milder disease at presentation, more underlying conditions contributing to cognitive decline, lack of a consistent spouse/partner informant, and being evaluated by different clinicians on different visits. Multistate Markov modeling generally confirmed these associations. Clinical etiologic diagnoses were generally stable. However, several readily ascertained characteristics were associated with higher instability. These associations may be useful to clinicians for anticipating when an etiologic diagnosis may be more prone to future change.

Original languageEnglish (US)
Pages (from-to)750-758
Number of pages9
JournalAmerican Journal of Alzheimer's Disease and Other Dementias
Issue number8
Publication statusPublished - Dec 2013



  • dementia diagnosis
  • dementia etiology
  • diagnosis stability

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Psychology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health

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