Abstract Details

Title Assessing the Reliability of Reported Medical History in Older Adults

Topic General Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 6-001

Objective Determine the accuracy of medical history in community-dwelling older adults.

Background A reliable history is critical to establish accurate clinical diagnoses, prioritize investigations and select appropriate treatments; yet few studies have rigorously evaluated the reliability of medical histories or the factors that influence reliability.

Design/Methods The association between participant-specific factors and accurate reporting of stroke or diabetes was evaluated using multivariable logistic regression in 1,401 participants engaged in longitudinal studies at the Knight Alzheimer Disease Research Center (Saint Louis, Missouri), including 425 participants with dementia (30.3%). History was verified with a reliable collateral source in all participants. Stroke and diabetes were selected as index variables as gold standard measures—brain MRI for stroke and hemoglobinA1c (HbA1c) for diabetes—were routinely obtained in participants.

Results 25/862 (2.9%) participants endorsed a history of stroke, which was confirmed on MRI in 8/25 (positive predictive value, 17.4%). Stroke was detected on MRI in 38/837 (4.5%) of those without reported stroke (negative predictive value, 95.5%). Older age (OR per decade=1.7, 95%CI: 1.2-2.5) and use of an unrelated collateral source (OR=2.0, 95%CI: 1.03-3.7) were associated with greater odds of inaccurate reporting. 190/1322 (14.4%) participants reported a history of diabetes, which was confirmed with HbA1c in 105/190 (positive predictive value, 55.3%). HbA1c ≥6.5% was detected in 29/1132 (2.6%) of those who denied diabetes (negative predictive value, 97.4%). African Americans (OR=1.6, 95%CI: 1.02-2.6) and those with hypertension (OR=2.6, 95%CI: 1.5-4.2) or HbA1c compatible with impaired glucose tolerance (OR=4.2, 95%CI: 2.7-6.4) had greater odds of reporting a history of diabetes. Cognitive impairment was not associated with inaccurate reporting.

Conclusions The accuracy of reported history of diabetes and stroke was low in older community-dwelling participants, independent of cognitive status. A history of diabetes or stroke should be objectively confirmed when relevant to decision making in clinical or research settings.

Authors/Disclosures
Gregory S. Day, MD, MSc, FAAN (Mayo Clinic) PRESENTER	Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for DynaMed (EBSCO Health). Dr. Day has or had stock in ANI Pharmaceuticals. The institution of Dr. Day has received research support from National Institutes of Health / NIA. The institution of Dr. Day has received research support from National Institutes of Health / NINDS. The institution of Dr. Day has received research support from Amgen Pharmaceuticals. The institution of Dr. Day has received research support from AVID Radiopharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Presenter at Annual Meeting (CME) with ��ɫ��. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development (CME) with PeerView, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Continuing ��ɫ��, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Ionis Pharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a ��ɫ��al Case Development + Presentation (video) with PeerDirect (P\S\L Group). Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development / Presentation (non-CME) with MJH Life Sciences (NeurologyLive). Dr. Day has a non-compensated relationship as a Clinical Director with Anti-NMDA Receptor Encephalitis Foundation that is relevant to AAN interests or activities.
	No disclosure on file
John C. Morris, MD, FAAN (Washington University)	Dr. Morris has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CBR International Advisory Board. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cure Alzheimers Fund. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for LEADS Steering Commitee. The institution of Dr. Morris has received research support from NIH grants. Dr. Morris has received intellectual property interests from a discovery or technology relating to health care. Dr. Morris has received intellectual property interests from a discovery or technology relating to health care.

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