Original article
Prevalence and concordance between the clinical and the post-mortem diagnosis of dementia in a psychogeriatric clinic
Prevalencia y concordancia entre diagnóstico clínico y anatomopatológico de demencia en una clínica psicogeriátrica
B. Grandal Leirosa,
, L.I. Pérez Méndezb, M.V. Zelaya Huertac, L. Moreno Eguinoad, F. García-Bragadoe, T. Tuñón Álvareze, J.J. Roldán Larretad
Corresponding author
a Servicio de Geriatría, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
b Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
c Navarrabiomed Fundación Miguel Servet, Complejo Hospitalario de Navarra Osasunbidea, Pamplona, Spain
d Clínica Psicogeriátrica Josefina Arregui , Alsasua, Navarra, Spain
e Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra Osasunbidea, Pamplona, Spain
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The most frequent progression for hyperreflexia and Babinski sign was persistence from baseline (65.4% and 45.4%, respectively) (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001). Regarding muscle tone, spasticity remained absent throughout disease progression in most patients (73.8%) (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001). Babinski sign appeared after the baseline consultation in 21 patients (16.5%), disappeared in 5 (3.8%), and remained absent in 45 (34.6%). Hyperreflexia appeared after baseline in 12 patients (9.2%), disappeared in 5 (3.8%), and remained absent in 28 (21.5%). 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Grandal Leiros, L.I. Pérez Méndez, M.V. Zelaya Huerta, L. Moreno Eguinoa, F. García-Bragado, T. Tuñón Álvarez, J.J. Roldán Larreta" "autores" => array:7 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Grandal Leiros" "email" => array:1 [ 0 => "beatrizgrandal@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L.I." "apellidos" => "Pérez Méndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.V." "apellidos" => "Zelaya Huerta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "L." 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"apellidos" => "Roldán Larreta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Geriatría, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Navarrabiomed Fundación Miguel Servet, Complejo Hospitalario de Navarra Osasunbidea, Pamplona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Clínica Psicogeriátrica Josefina Arregui , Alsasua, Navarra, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra Osasunbidea, Pamplona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia y concordancia entre diagnóstico clínico y anatomopatológico de demencia en una clínica psicogeriátrica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dementia has severe consequences for patients and families in particular, and for a country's healthcare system and economy in general.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Alzheimer disease (AD) has traditionally been considered the most frequent cause of dementia in Western countries. However, recent studies suggest that vascular dementia (VD), either isolated or in combination with AD, may be at least equally frequent.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis of dementia in daily practice is based on clinical findings and not on anatomical pathology (AP). Findings in AP are frequently more heterogeneous than might be expected. Almost 46% of the brains in a sample of subjects with a clinical diagnosis of AD displayed several pathological entities, although one clearly predominated.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This article shows the distribution of types of dementia among patients from our clinic who agreed to donate neurological tissue. We also assess the concordance between clinical and AP diagnoses, and analyse the similarities and differences between our data and those reported in other studies.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population and clinical evaluation</span><p id="par0025" class="elsevierStylePara elsevierViewall">We analysed the brains of 114 patients from our clinic with a diagnosis of dementia or mild cognitive impairment (MCI). They or their families agreed to our request for tissue donation. We duly informed them about the procedure, its aim, and the possible implications, and they signed the applicable informed consent form.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We included the following variables in the database: sex; family history of dementia; age at symptom onset, diagnosis, and death; the baseline, final, and AP diagnoses; and complementary test results (neuropsychological examination [NPE], Mini-Examen Cognoscitivo<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> [MEC], cranial computed tomography [CT], brain nuclear magnetic resonance imaging [MRI], single photon emission computed tomography, and electroencephalography).</p><p id="par0035" class="elsevierStylePara elsevierViewall">We included the diagnosis made after the first examination at our clinic or at another centre as the baseline diagnosis; final diagnosis was established after our assessment and follow-up. Dementia was diagnosed according to DSM-IV<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> criteria. To determine the type of dementia, we used the NINCDS-ADRA criteria for the diagnosis of possible and probable AD.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> NINDA criteria were also used for the diagnosis of VD and AD with VD. Other dementias were diagnosed according to the commonly-used criteria applicable at each time. Diagnosis of MCI was based on Petersen criteria.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We established that there was concordance between clinical and AP diagnoses not only when both coincided, but also when, in the case that AP findings pointed to various pathologies, one clearly predominated over the others and clinical diagnosis was correct according to clinical data and the complementary tests available. Diagnoses were considered not to be concordant when final and AP diagnoses did not coincide, or when cerebrovascular comorbidity was not studied or considered in the final clinical diagnosis but was detected in the AP diagnosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding MCI, we considered there to be concordance when AP findings were not decisive enough to meet the criteria for any type of dementia, so MCI was considered in the AP diagnosis of those cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Inclusion criteria were: diagnosis of dementia or MCI when the patient was alive, consent to tissue donation, no required judicial autopsy, and an available final AP report.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Tissue collection and processing</span><p id="par0055" class="elsevierStylePara elsevierViewall">The neuropathological study protocol included basic techniques and specific procedures, according to the guidelines of the European network BrainNet.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We included 114 brains: 5 cases were excluded, 3 due to lacking AP results and 2 because patients received no diagnosis of dementia or cognitive impairment when they were alive.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis to determine the mean age at disease onset, at diagnosis, and at the time of death; prevalence of sex; family history of dementia and diagnostic tests performed.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Furthermore, we analysed data on absolute and relative frequencies of every type of dementia at the time of baseline, final, and AP diagnoses.</p><p id="par0075" class="elsevierStylePara elsevierViewall">We finally performed a point estimation and 95% confidence interval (95% CI) estimation of the concordance between clinical and AP diagnosis, as well as a multivariate analysis to determine which of the studied variables may have a role in increasing said concordance.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">One hundred and fourteen cases met the inclusion criteria. Mean age was 77<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 years at disease onset, 79<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 years at diagnosis, and 84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 years at the time of death, with an average survival of 7 years. Seventy-five percent of patients were diagnosed within the 3 first years following symptom onset. Most patients were women (60.5%). Family history of dementia was detected in 30% of patients.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Complete NPE was available for 89.5% of the patients. Mean MEC score at diagnosis was 20<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6 points. CT scans were available for 79% of patients, but MRI scans only in 19%. Single-photon emission CT and electroencephalography had been performed in 14% and 17% of patients, respectively. Seventy-five percent of patients had undergone a complete NPE and a neuroimaging study (CT or MRI) at the time of final diagnosis.</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> includes prevalence by type of dementia at the time of baseline, final, and AP diagnosis. To simplify the analysis of results, it was decided that the category of frontotemporal dementia would include cases both of behavioural variant and of progressive supranuclear palsy and corticobasal degeneration. We used the term “vascular plus” (VP) to include the cases of cerebrovascular disease with non-AD neurodegenerative involvement, and the term “multiproteins” to refer to those cases with deposition of 2 or more proteins.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Concordance between final clinical diagnosis and AP diagnosis amounted to 62.3% (95% CI, 53%-72%). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> details the data on diagnosis concordance for each type of dementia, while also attempting to identify the errors in clinical diagnosis, taking into account AP diagnosis.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Availability of more complementary tests, the patient's sex, a lesser degree of cognitive impairment at diagnosis (based on the MEC score), and earlier diagnosis were not found to improve diagnostic concordance.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">We found significant differences with regards to similar studies when we analysed AP prevalence of the different types of dementia.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> An interesting result was the higher prevalence of mixed dementia (MD) (34% vs 4%-21%) and the lower prevalence of AD in our study (22% vs 42%-65%).<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> These differences may be exacerbated by the high mean age of our sample, which was associated with increased cerebral comorbidity.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The main comorbidities we found were cerebrovascular diseases. In up to 53% of cases, the AP study confirmed the presence of vascular lesions, either in isolation or associated with the deposition of several proteins. Previous studies have found vascular lesions in 29%-41% of autopsy studies of patients with dementia.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In 11% of the cases, deposition of Lewy bodies was found, whether in association with vascular lesions or with other proteins (cases included in the VP or MP categories, respectively). Furthermore, we observed deposition of at least 2 proteins (MP) in up to 7% of cases and 2 proteins and vascular lesions (included in the VP category) in 3%. Presence of Lewy bodies has previously been observed in 10%-20% of brains of patients with dementia.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Advances in immunohistochemistry have enabled neurodegenerative diseases to be classified according to the deposition in the brain of a protein, which would be responsible for activating different pathogenic mechanisms and for differing symptoms. Nevertheless, both our study and previous studies have shown that the presence of an isolated type of lesion is an infrequent occurrence.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The concordance we obtained was far from the 97% reported by other studies<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>; this value did not increase with more complementary tests, as observed in the multivariate analysis. The comparison was made between final clinical diagnosis and AP diagnosis. We did not analyse the reasons for differing baseline and final diagnoses, but progression of MCI to dementia and the possibility of sudden cerebrovascular events are well-known phenomena. Furthermore, the appearance of new symptoms or the performance of new complementary tests frequently lead to changes in diagnosis.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our results are more in line with classic studies reporting that between 10% and 20% of patients clinically diagnosed with AD lack AP findings of the disease, and that up to 40% show AP findings of AD with no clinical diagnosis.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The use of CT scans mainly for neuroimaging may have contributed to an underestimation of the cerebrovascular component.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Other studies have revealed that having a structural neuroimaging study as part of the diagnostic process increased sensitivity and specificity for certain types of dementia.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Our low levels of concordance may also be explained by the fact that donations of neurological tissue were frequently requested from patients with atypical clinical manifestations; also, this was a case series from clinical practice, where the examinations and assessments were frequently incomplete. Furthermore, we should note that our setting is a psychogeriatric clinic; therefore, our patients are very elderly and severe behavioural disorders constitute the most frequent reason for admission or consultation.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Nearly one third of our patients were not accurately diagnosed when alive, despite our efforts and experience, the use of clinical practice guidelines, and the complementary tests performed.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Although none of the drugs available have a significant impact on the course of the disease, we are convinced that correct therapeutic management of dementia helps slow disease progression. In addition to an improvement in patients’ quality of life, this has significant economic consequences.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres995551" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec958914" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres995550" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec958913" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population and clinical evaluation" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Tissue collection and processing" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack336424" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-03-08" "fechaAceptado" => "2016-04-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec958914" "palabras" => array:6 [ 0 => "Dementia prevalence" 1 => "Dementia diagnosis accuracy" 2 => "Alzheimer's disease" 3 => "Cerebrovascular disease" 4 => "Post-mortem diagnosis" 5 => "Mixed brain pathologies" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec958913" "palabras" => array:6 [ 0 => "Prevalencia de demencia" 1 => "Fiabilidad diagnóstica en demencia" 2 => "Enfermedad de Alzheimer" 3 => "Enfermedad cerebrovascular" 4 => "Diagnóstico post-mortem" 5 => "Comorbilidad cerebral" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of our study is to describe the types of dementia found in a series of patients and to estimate the level of agreement between the clinical diagnosis and post-mortem diagnosis.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a descriptive analysis of the prevalence of the types of dementia found in our series and we established the level of concordance between the clinical and the post-mortem diagnoses. The diagnosis was made based on current diagnostic criteria.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">114 cases were included. The most common clinical diagnoses both at a clinical and autopsy level were Alzheimer disease and mixed dementia but the prevalence was quite different. While at a clinical level, prevalence was 39% for Alzheimer disease and 18% for mixed dementia, in the autopsy level, prevalence was 22% and 34%, respectively. The agreement between the clinical and the autopsy diagnoses was 62% (95% CI, 53%-72%).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Almost a third of our patients were not correctly diagnosed in vivo. The most common mistake was the underdiagnosis of cerebrovascular pathology.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir los tipos de demencia en una serie de pacientes valorados en una clínica psicogeriátrica y estimar el grado de acuerdo entre el diagnóstico clínico y el anatomopatológico.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Realizamos un análisis descriptivo de la prevalencia de los tipos de demencia entre los pacientes valorados en nuestro centro y establecemos el grado de concordancia entre el diagnóstico clínico y el anatomopatológico. Los diagnósticos se establecieron en función de los criterios diagnósticos vigentes en cada momento.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ciento catorce casos cumplieron los criterios de inclusión. Los diagnósticos más frecuentes tanto a nivel clínico como anatomopatológico fueron enfermedad de Alzheimer y demencia mixta, pero la prevalencia se invirtió pasando de un 39% y 18% a nivel clínico a un 22% y 34% a nivel anatomopatológico respectivamente. La concordancia entre el diagnóstico clínico y el anatomopatológico fue de un 62% (IC 95%: 53-72%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Casi un tercio de nuestros pacientes no tenía un diagnóstico certero en vida, fundamentalmente a expensas del infradiagnóstico a nivel clínico de la enfermedad cerebrovascular.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Grandal Leiros B, Pérez Méndez LI, Zelaya Huerta MV, Moreno Eguinoa L, García-Bragado F, Tuñón Álvarez T, et al. Prevalencia y concordancia entre diagnóstico clínico y anatomopatológico de demencia en una clínica psicogeriátrica. Neurología. 2018;33:13–17.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">MCI: mild cognitive impairment; VD: vascular dementia; MD: mixed dementia; AD: Alzheimer disease; FTD: frontotemporal dementia; LBD: Lewy body dementia; PDD: Parkinson's disease dementia; VP: vascular plus; MP: multiproteins.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Baseline Dx \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Final Dx \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">AP Dx \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.4 (54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.6 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.9 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MCI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.8 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FTD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LBD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.8 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.5 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.9 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.4 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.2 (39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PDD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.5 (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1688226.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagnostic prevalence at baseline consultation (baseline Dx), at the time of death (final Dx), and at autopsy (AP Dx).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">MCI: mild cognitive impairment; VD: vascular dementia; MD: mixed dementia; AD: Alzheimer disease; FTD: frontotemporal dementia; LBD: Lewy body dementia; PDD: Parkinson's disease dementia; VP: vascular plus; MP: multiproteins.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">AP diagnosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="9" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Final clinical diagnosis</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MCI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LBD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PDD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FTD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VP \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AD %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80<br>(20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8<br>(2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8<br>(2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MCI %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<br>(3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VD %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67<br>(4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33<br>(2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MD %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44<br>(17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10<br>(4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33<br>(13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LBD %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40<br>(2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40<br>(2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PDD %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<br>(3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FTD %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<br>(6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83<br>(5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MP %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25<br>(2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25<br>(2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50<br>(4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VP %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25<br>(3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17<br>(2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42<br>(5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No disease %<br>(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<br>(1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1688225.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correspondence between anatomical pathology diagnosis and clinical diagnosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiological pathology of dementia: attributable-risks at death in the Medical Research Council Cognitive Function and Ageing Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 15 | 0 | 15 |
| 2024 September | 23 | 4 | 27 |
| 2024 August | 25 | 6 | 31 |
| 2024 July | 19 | 5 | 24 |
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| 2024 May | 21 | 7 | 28 |
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| 2024 March | 27 | 7 | 34 |
| 2024 February | 22 | 6 | 28 |
| 2024 January | 15 | 3 | 18 |
| 2023 December | 12 | 5 | 17 |
| 2023 November | 19 | 4 | 23 |
| 2023 October | 19 | 6 | 25 |
| 2023 September | 16 | 4 | 20 |
| 2023 August | 14 | 7 | 21 |
| 2023 July | 8 | 4 | 12 |
| 2023 June | 18 | 9 | 27 |
| 2023 May | 8 | 5 | 13 |
| 2023 April | 19 | 2 | 21 |
| 2023 March | 13 | 6 | 19 |
| 2023 February | 13 | 5 | 18 |
| 2023 January | 19 | 4 | 23 |
| 2022 December | 20 | 8 | 28 |
| 2022 November | 14 | 16 | 30 |
| 2022 October | 19 | 10 | 29 |
| 2022 September | 18 | 7 | 25 |
| 2022 August | 17 | 9 | 26 |
| 2022 July | 10 | 8 | 18 |
| 2022 June | 21 | 6 | 27 |
| 2022 May | 20 | 8 | 28 |
| 2022 April | 15 | 13 | 28 |
| 2022 March | 14 | 8 | 22 |
| 2022 February | 28 | 10 | 38 |
| 2022 January | 41 | 12 | 53 |
| 2021 December | 32 | 7 | 39 |
| 2021 November | 22 | 11 | 33 |
| 2021 October | 14 | 13 | 27 |
| 2021 September | 12 | 11 | 23 |
| 2021 August | 19 | 5 | 24 |
| 2021 July | 11 | 7 | 18 |
| 2021 June | 14 | 12 | 26 |
| 2021 May | 21 | 16 | 37 |
| 2021 April | 57 | 22 | 79 |
| 2021 March | 20 | 11 | 31 |
| 2021 February | 11 | 6 | 17 |
| 2021 January | 27 | 15 | 42 |
| 2020 December | 24 | 10 | 34 |
| 2020 November | 19 | 8 | 27 |
| 2020 October | 16 | 5 | 21 |
| 2020 September | 18 | 10 | 28 |
| 2020 August | 21 | 11 | 32 |
| 2020 July | 6 | 8 | 14 |
| 2020 June | 18 | 11 | 29 |
| 2020 May | 17 | 12 | 29 |
| 2020 April | 22 | 9 | 31 |
| 2020 March | 8 | 3 | 11 |
| 2020 February | 10 | 3 | 13 |
| 2020 January | 14 | 3 | 17 |
| 2019 December | 24 | 1 | 25 |
| 2019 November | 5 | 5 | 10 |
| 2019 October | 8 | 7 | 15 |
| 2019 September | 14 | 6 | 20 |
| 2019 August | 8 | 3 | 11 |
| 2019 July | 19 | 9 | 28 |
| 2019 June | 25 | 7 | 32 |
| 2019 May | 71 | 20 | 91 |
| 2019 April | 34 | 37 | 71 |
| 2019 March | 16 | 8 | 24 |
| 2019 February | 43 | 5 | 48 |
| 2019 January | 13 | 1 | 14 |
| 2018 December | 25 | 4 | 29 |
| 2018 November | 27 | 8 | 35 |
| 2018 October | 21 | 13 | 34 |
| 2018 September | 19 | 9 | 28 |
| 2018 August | 7 | 4 | 11 |
| 2018 July | 11 | 2 | 13 |
| 2018 June | 7 | 0 | 7 |
| 2018 May | 16 | 8 | 24 |
| 2018 April | 13 | 8 | 21 |
| 2018 March | 4 | 3 | 7 |
| 2018 February | 2 | 2 | 4 |
| 2018 January | 1 | 0 | 1 |
| 2017 December | 2 | 5 | 7 |
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