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Different classification systems yield different dementia occurrence among nonagenarians and centenarians
Philippe Pioggiosi1, Paola Forti, Giovanni Ravaglia
1Institute of Psychiatry, University of Bologna, Bologna, Italy.
Dementia and Geriatric Cognitive Disorders
|October 16, 2003
Summary
Different dementia classification systems yield varying prevalence rates in the oldest old. The International Classification of Diseases, 10th revision (ICD-10) may be less adequate for public health due to excluding social function impairment.
Area of Science:
- Gerontology
- Neurology
- Psychiatry
Background:
- Dementia prevalence estimates vary significantly based on the classification system used.
- Data on dementia occurrence in the oldest old (nonagenarians and centenarians) are scarce.
- Accurate dementia assessment is crucial for understanding its impact on this aging population.
Purpose of the Study:
- To investigate and compare dementia prevalence in nonagenarians and centenarians using four distinct classification systems.
- To identify factors contributing to discrepancies in dementia diagnoses across different criteria.
- To evaluate the adequacy of current classification systems for public health implications in the oldest old.
Main Methods:
- A cohort of 34 nonagenarians and centenarians underwent comprehensive neuropsychological examination.
- Dementia occurrence was assessed using four criteria: DSM-III-R, DSM-IV, ICD-10, and CAMDEX.
- Cognitive functioning, social function, and daily living independence were evaluated.
Main Results:
- Dementia prevalence varied: DSM-III-R (47.1%), DSM-IV (41.2%), ICD-10 (29.4%), and CAMDEX (38.2%).
- Disagreements between DSM-III-R and DSM-IV were linked to calculation impairment and personality changes.
- ICD-10 criteria emphasize executive functions, while CAMDEX considers progressive deterioration, differentiating them from DSM-III-R.
Conclusions:
- The choice of dementia classification system significantly impacts prevalence estimates in the oldest old.
- The ICD-10 system's exclusion of social function impairment makes it less suitable for public health assessments in this demographic.
- Considering functional decline alongside cognitive impairment is essential for a comprehensive understanding of dementia's impact.