The added value of a multidisciplinary approach in diagnosing dementia: a review.

BACKGROUND

The impact of dementia constitutes a major public health challenge to our society. A multidisciplinary approach to dementia is generally recommended.

OBJECTIVE

The objective of this review is to give an overview of the reported empirical studies on the added value of a multidisciplinary approach to diagnosing dementia, i.e. whether differences can be found between diagnostic multidisciplinary approaches, and/or monodisciplinary ones with respect to the diagnostic outcomes, the impact of diagnostics and their effects on quality of life and costs.

METHOD

Critical review of studies which involve a multidisciplinary assessment of dementia. Literature was systematically searched in a number of international databases (Medline, PsychInfo, Pubmed and EconLit). A first selection was based on screening titles by one author. Interrater reliability was determined by scoring all abstracts by two authors. The reliability of selecting full articles was based on scoring a random sample by two authors. Kappa values were calculated. The Kappa statistic (k) was also used as an indicator of the diagnostic agreement between single disciplines and multidisciplinary teams.

RESULTS

Five studies were identified as relevant for the purpose of this review. The most important outcome was the level of diagnostic agreement between single disciplines and multidisciplinary teams (MTs). Overall, there was substantial agreement (kappa: 0.37-0.76) on the diagnosis dementia (syndrome), but not on the subtypes (aetiology) (AD: 0.26-0.60; VD: 0.35-0.52; depression: 0.30-0.46). Diagnoses also differed between the disciplines.

CONCLUSIONS

Merely studies on diagnostic accuracy were found, all using different reference standards. Kappa values were chosen as outcome measure and every diagnosis was considered of equal value. Therefore, the added value could not definitively be demonstrated. However, the potential added value of a multidisciplinary approach to diagnosing dementia probably lies in the ability to differentiate among the subtypes of dementia and to detect comorbid psychiatric conditions such as depression. Disciplines within an MT complement each other in establishing a specific diagnosis, which is considered to be the added value of such a multidisciplinary team.