Diagnostic reversion in dementia care: A real‐world analysis of mild cognitive impairment diagnoses after dementia in a large electronic medical record system
Silvia Miramontes, Umair Khan, Scott Zimmerman, Erin L. Ferguson, Hunter Mills, Boris Oskotsky, Evan Phelps, Tomiko T. Oskotsky, John A. Capra, M. Maria Glymour, Marina Sirota, Elena TsoyAbstract
INTRODUCTION
If mild cognitive impairment (MCI) is diagnosed after dementia, it suggests either the dementia diagnosis was premature, or the MCI diagnosis is incorrect. We investigated the prevalence and predictors of such “diagnostic reversion”—MCI after dementia—in a large health system.
METHODS
Among 5965 patients aged 50+ with incident dementia in University of California San Francisco electronic health records, we identified “reverters” with a subsequent MCI diagnosis. We used group least absolute shrinkage and selection operator–regularized logistic regression and random forest models to identify predictors.
RESULTS
Reversion occurred in 13.7% of patients. Lower odds were observed among older adults (odds ratio [OR] = 0.95/year; 95% confidence interval [CI]: 0.92–0.98), while higher odds were found among Spanish speakers (OR = 2.26; 95% CI: 1.28–4.00), those with greater cardiovascular risk (OR = 1.16; 95% CI: 1.01–1.33), and higher Charlson Comorbidity Index burden (OR = 1.09; 95% CI: 1.05–1.14).
DISCUSSION
Diagnostic reversion is common and socially patterned, suggesting contributions from misdiagnosis, clinical uncertainty, or variability in clinical presentation and care setting.