Clinical to Histopathological Correlation of the Diagnosis of Dementia

Abstract

Between January 1988 and December 1989, 1,600 autopsies were performed at Huddinge University Hospital, representing approximately 40% of the 4,000 deceased patients. In 40% (647) of the autopsy cases, patients showed clinical signs of CNS dysfunction.

Of these cases, 58% (380) were subject to neuropathological evaluation, including both macro- and microscopic examination. Only macroscopic examination by general pathologists was performed on the remaining cases. Clinical signs of dementia were seen in 10% (169 cases) of the autopsied patients. Neuropathological evaluations were performed on 70% (118) of these patients. Of these, 60% (70) showed degenerative changes and 36% (43) vascular alterations. Macroscopic examinations alone were performed in 30% of the cases. Of these, signs of severe cortical atrophy were seen in 21%, vascular lesions in 12%, and no macroscopic changes in 67%. The completeness of clinical and postmortem examinations of the 169 demented patients was variable. Approximately 40% of the patients lacked any diagnostic decision. In approximately 50% of the cases with diagnostic decision, the clinical diagnosis correlated with the histopathological diagnosis. This low correlation between the clinical diagnosis and the exact nature of the disease was primarily based on the variable completeness of the clinical examinations. In order to improve this situation, it is important to perform both a complete clinical investigation and a neuropathological verification of the nature of the disease.