BACKGROUND Determining the underlying etiology of dementia can be challenging. Computer- based Clinical Decision Support Systems (CDSS) have the potential to provide an objective comparison of data and assist clinicians. OBJECTIVES To assess the diagnostic impact of a CDSS, the PredictND tool, for differential diagnosis of dementia in memory clinics. METHODS In this prospective multicenter study, we recruited 779 patients with either subjective cognitive decline (n=252), mild cognitive impairment (n=219) or any type of dementia (n=274) and followed them for minimum 12 months. Based on all available patient baseline data (demographics, neuropsychological tests, cerebrospinal fluid biomarkers, and MRI visual and computed ratings), the PredictND tool provides a comprehensive overview and analysis of the data with a likelihood index for five diagnostic groups; Alzheimer´s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia and subjective cognitive decline. At baseline, a clinician defined an etiological diagnosis and confidence in the diagnosis, first without and subsequently with the PredictND tool. The follow-up diagnosis was used as the reference diagnosis. RESULTS In total, 747 patients completed the follow-up visits (53% female, 69±10 years). The etiological diagnosis changed in 13% of all cases when using the PredictND tool, but the diagnostic accuracy did not change significantly. Confidence in the diagnosis, measured by a visual analogue scale (VAS, 0-100%) increased (ΔVAS=3.0%, p<0.0001), especially in correctly changed diagnoses (ΔVAS=7.2%, p=0.0011). CONCLUSION Adding the PredictND tool to the diagnostic evaluation affected the diagnosis and increased clinicians' confidence in the diagnosis indicating that CDSSs could aid clinicians in the differential diagnosis of dementia.

中文翻译：

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临床决策支持工具对记忆临床中痴呆症诊断的影响：PredictND验证研究。

背景技术确定痴呆症的潜在病因可能具有挑战性。基于计算机的临床决策支持系统（CDSS）有潜力提供客观的数据比较并协助临床医生。目的评估PredictND工具CDSS对记忆诊所中痴呆症的鉴别诊断的诊断作用。方法在这项前瞻性多中心研究中，我们招募了779名主观认知能力下降（n = 252），轻度认知障碍（n = 219）或任何类型的痴呆（n = 274）的患者，并随访了至少12个月。基于所有可用的患者基线数据（人口统计学，神经心理学测试，脑脊液生物标志物以及MRI视觉和计算评分），PredictND工具可对数据进行全面的概述和分析，并为五个诊断组提供可能性指数；阿尔茨海默氏病，血管性痴呆，路易体痴呆，额颞痴呆和主观认知能力下降。在基线时，临床医生首先要使用PredictND工具定义病因诊断和对诊断的信心。随访诊断作为参考诊断。结果总共有747例患者完成了随访，其中女性53％，69±10岁。使用PredictND工具时，所有病例中的病因学诊断发生了13％的变化，但诊断准确性没有明显变化。通过视觉模拟量表（VAS，0-100％）测量的诊断信心有所提高（ΔVAS= 3.0％，p <0.0001），特别是在正确更改的诊断中（ΔVAS= 7.2％，p = 0.0011）。结论在诊断评估中添加PredictND工具影响了诊断，并增加了临床医生对诊断的信心，表明CDSS可以帮助临床医生进行痴呆的鉴别诊断。