[Subjective memory impairments in early detection of dementia: Relation to acceptability of lumbar puncture in memory clinic patients].

BACKGROUND

In memory clinics, biomarker-based diagnostic tools for early detection and differential diagnosis of dementia are increasingly important, even if their acceptance by patients is relatively low.

OBJECTIVE

The aim of study was to examine whether sociodemographic and clinical features of memory clinic patients are associated with acceptance of lumbar puncture (LP). Of particular interest was the patients' self-perception of memory decline (subjective memory impairment, SMI) accompanied by related concerns that might affect decision to consent to LP.

METHODS

Consecutive patients were examined in a day-care hospital on two consecutive days in order to implement a diagnostic procedure based on the S3 guideline "Dementia" including offer of LP. We assessed demographic and clinical variables such as depression, anxiety, neurocognitive performance and dementia severity (Clinical Dementia Rating, CDR). Furthermore, patients were interviewed about perceived memory decline and were classified on this basis - independent of their neuropsychological results - into three groups: no SMI, SMI without concerns or SMI with concerns.

RESULTS

Of 44 patients (73.8 ± 8.3 years; 27 f/17 m; CDR < 1: n = 16, CDR = 1: n = 28), 29 had SMI with concerns. These patients tended to be younger and had a higher level of education than those who did not report SMI (n = 7) and those perceiving SMI without concerns (n = 8). Furthermore, patients without SMI more frequently had a dementia syndrome. Patients who agreed to lumbar puncture (n = 23) were - compared to patients refusing LP (n = 17; 4 patients had to be excluded because of medical contraindication for immediate LP) - more likely male, had significantly more frequent SMI with concerns and performed poorer on declarative memory tasks. Binary regression analysis yielded SMI with concerns, a more impaired memory performance and male sex as significant predictors for consenting to LP.

CONCLUSIONS

The study provides evidence that patient characteristics such as subjective and objective memory impairment as well as sex may affect the likelihood to consent to a generally less accepted biomarker-based dementia diagnostic procedure such as LP.