Diagnostic accuracy of DAT-SPECT and MIBG scintigraphy for dementia with Lewy bodies: an updated systematic review and Bayesian latent class model meta-analysis

2019 ◽  
Vol 47 (8) ◽  
pp. 1984-1997 ◽  
Author(s):  
Takashi Nihashi ◽  
Kengo Ito ◽  
Teruhiko Terasawa
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Dementia With Lewy Bodies ◽  
Latent Class ◽  
Meta Analysis ◽  
Latent Class Model ◽  
Lewy Bodies ◽  
Mibg Scintigraphy ◽  
Class Model ◽  
Dat Spect

scholarly journals Sputum Gram Stain for Bacterial Pathogen Diagnosis in Community-acquired Pneumonia: A Systematic Review and Bayesian Meta-analysis of Diagnostic Accuracy and Yield

2019 ◽  
Vol 71 (3) ◽  
pp. 499-513 ◽  
Author(s):  
Hiroaki Ogawa ◽  
Georgios D Kitsios ◽  
Mitsunaga Iwata ◽  
Teruhiko Terasawa
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Latent Class ◽  
Meta Analysis ◽  
Latent Class Model ◽  
Reporting Quality ◽  
Credible Interval ◽  
Community Acquired Pneumonia ◽  
Gram Stain ◽  
Clinical Role

Abstract Background The clinical role of sputum Gram stain (SGS) in community-acquired pneumonia (CAP) diagnosis remains controversial. A 1996 meta-analysis of the diagnostic accuracy of SGS reported heterogeneous results. To update the available evidence, we performed a systematic review and a Bayesian standard and latent-class model meta-analysis. Methods We searched Medline, Embase, and Cochrane Central by 23 August 2018 to identify studies reporting on the diagnostic accuracy, yield (percentage of patients with any pathogen[s] correctly identified by SGS), and clinical outcomes of SGS in adult patients with CAP. Two reviewers extracted the data. We quantitatively synthesized the diagnostic accuracy and yield, and descriptively analyzed other outcomes. Results Twenty-four studies with 4533 patients were included. The methodological and reporting quality of the included studies was limited. When good-quality sputum specimens were selected, SGS had a summary sensitivity of 0.69 (95% credible interval [CrI], .56–.80) and specificity of 0.91 (CrI, .83–.96) for detecting Streptococcus pneumoniae, and a sensitivity of 0.76 (CrI, .60–.87) and specificity of 0.97 (CrI, .91–.99) for Haemophilus influenzae. Adjusted analyses accounting for imperfect reference standards provided higher-specificity estimates than the unadjusted analyses. Bacterial pathogens were identified in 73% (CrI, 26%–96%) of good-quality specimens, and 36% (CrI, 22%–53%) of all specimens regardless of quality. Evidence on other bacteria was sparse. Conclusions SGS was highly specific to diagnose S. pneumoniae and H. influenzae infections in patients with CAP. With good-quality specimens, SGS can provide clinically actionable information for pathogen-directed antibiotic therapies.

Accuracy of clinical diagnosis of dementia with Lewy bodies: a systematic review and meta-analysis

2017 ◽  
Vol 89 (4) ◽  
pp. 358-366 ◽  
Author(s):  
Giovanni Rizzo ◽  
Simona Arcuti ◽  
Massimiliano Copetti ◽  
Maria Alessandria ◽  
Rodolfo Savica ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Criteria ◽  
Clinical Diagnosis ◽  
Dementia With Lewy Bodies ◽  
Meta Analysis ◽  
Lewy Bodies ◽  
Diagnosis Of Dementia ◽  
Sensitivity Specificity ◽  
Late Stages ◽  
Over Time

BackgroundThe diagnosis of dementia with Lewy bodies (DLB) is based on diagnostic clinical criteria, which were updated over the years.ObjectiveTo evaluate, through a systematic review, accuracy of the diagnostic criteria, testing a possible improvement over time.MethodsWe searched on MEDLINE and SCOPUS databases for studies reporting diagnostic parameters regarding the clinical diagnosis of DLB until October 2016. We performed meta-analysis, using a Bayesian approach, on those using pathological examination as gold standard, subclassified based on the different diagnostic criteria used.ResultsWe selected 22 studies on 1585 patients. Pooled sensitivity, specificity and accuracy were 60.2%, 93.8%, 79.7%, respectively, for criteria antecedents to McKeith 1996. For McKeith 1996-possible, pooled sensitivity, specificity and accuracy were 65.6%, 80.6%, 77.9% in early stages and 72.3%, 64.3%, 66% in late stages, respectively. For McKeith 1996-probable, pooled sensitivity, specificity and accuracy were 19.4%, 95.1%, 77.7% in early stages and 48.6%, 88%, 79.2% in late stages, respectively. McKeith criteria 2005 were evaluated only in late stages: pooled sensitivity, specificity and accuracy were 91.3%, 66.7% and 81.6%, respectively, for possible diagnosis (only one study) and 88.3%, 80.8%, 90.7% for probable diagnosis, decreasing to 85.6%, 77.1% and 81.7% if only considering clinical settings focused on dementia diagnosis and care.Conclusions and relevanceDiagnostic criteria have become more sensitive and less specific over time, without substantial change in the accuracy. Based on current data, about 20% of DLB diagnosis are incorrect. Future studies are needed to evaluate if the recently released revised consensus criteria will improve the diagnostic accuracy of DLB.

Heart rate variability in patients with dementia or neurocognitive disorders: A systematic review and meta-analysis

2020 ◽  
pp. 000486742097685
Author(s):  
Ying-Chih Cheng ◽  
Yu-Chen Huang ◽  
Wei-Lieh Huang
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Dementia With Lewy Bodies ◽  
Meta Analysis ◽  
Lewy Bodies ◽  
Healthy Controls ◽  
Dementia Patients ◽  
Total Variability ◽  
Parasympathetic Function

Objective: Heart rate variability, a quantitative measure of mainly parasympathetic activity, has been applied in evaluating many types of psychiatric and neurological disorders, including dementia (or neurocognitive disorders). However, although dementia patients often showed significantly lower heart rate variability (various indices) than healthy controls, and different types of dementia had distinct heart rate variability features, the results were not identical across studies. We designed a systematic review and meta-analysis for incorporating data from different studies. Methods: We gathered studies comparing heart rate variability in patients with dementia and in healthy controls. Heart rate variability was analysed in several ways: parasympathetic function in hierarchical order (main analysis), total variability, comparison of heart rate variability between different subtypes of dementia, specific indices of heart rate variability and heart rate variability reactivity. Results: In the initial search, we found 3425 relevant articles, from which 24 studies with a total of 1107 dementia patients and 1017 control participants finally entered the main meta-analysis. The dementia patients had a significantly lower resting heart rate variability for parasympathetic function (Hedges’ g = −0.3596, p = 0.0002) and total variability (Hedges’ g = −0.3059, p = 0.0002) than the controls. For diagnostic subgroup analysis relative to the controls, heart rate variability was significantly lower in patients with mild cognitive impairment (Hedges’ g = −0.3060) and in patients with dementia with Lewy bodies (Hedges’ g = −1.4154, p < 0.0001). Relative to patients with Alzheimer’s disease, heart rate variability in patients with dementia with Lewy bodies was significantly lower (Hedges’ g = −1.5465, p = 0.0381). Meta-regression revealed that gender proportion was significantly associated with effect size. Conclusion: Our results show that dementia patients (especially those with dementia with Lewy bodies and mild cognitive impairment) have lower parasympathetic activity than healthy people. The influence of gender on the results should be carefully interpreted.

scholarly journals Auditory and visual hallucination prevalence in Parkinson's disease and dementia with Lewy bodies: a systematic review and meta-analysis

2018 ◽  
Vol 49 (14) ◽  
pp. 2342-2353 ◽  
Author(s):  
Charlotte Louise Eversfield ◽  
Llwyd David Orton
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dementia With Lewy Bodies ◽  
Meta Analysis ◽  
Lewy Bodies ◽  
Eligibility Criteria ◽  
Pooled Prevalence ◽  
Prevalence Estimates ◽  
Meta Analyses

AbstractBackgroundNon-motor features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB), such as auditory hallucinations (AH), contribute to disease burden but are not well understood.MethodsSystematic review and random-effects meta-analyses of studies reporting AH associated with PD or DLB. Prevalence of visual hallucinations (VH) in identified studies meeting eligibility criteria were included in meta-analyses, facilitating comparison with AH. Synthesis of qualitative descriptions of AH was performed. PubMed, Web of Science and Scopus databases were searched for primary journal articles, written in English, published from 1970 to 2017. Studies reporting AH prevalence in PD or DLB were screened using PRISMA methods.ResultsSearches identified 4542 unique studies for consideration, of which, 26 met inclusion criteria. AH pooled prevalence in PD was estimated to be 8.9% [95% confidence interval (CI) 5.3–14.5], while in DLB was estimated to be 30.8% (±23.4 to 39.3). Verbal hallucinations, perceived as originating outside the head, were the most common form of AH. Non-verbal AH were also common while musical AH were rare. VH were more prevalent, with an estimated pooled prevalence in PD of 28.2% (±19.1 to 39.5), while in DLB they were estimated to be 61.8% (±49.1 to 73.0). Meta-regression determined that the use of validated methodologies to identify hallucinations produced higher prevalence estimates.ConclusionsAH and VH present in a substantial proportion of PD and DLB cases, with VH reported more frequently in both conditions. Both AH and VH are more prevalent in DLB than PD. There is a need for standardised use of validated methods to detect and monitor hallucinations.

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