Supplementary Material for: Inter-Rater Agreement in the Clinical Diagnosis of Cognitive Status: Data from the Neurological Disorders in Central Spain 2 Pilot Study

<i>Background:</i> To assess the diagnostic agreement of cognitive status (dementia, mild cognitive impairment (MCI), normal cognition) among neurologists in the field of neurological disorders in Central Spain 2 study. <i>Methods:</i> Full medical histories of 30 individuals were provided to 27 neurologists: 9 seniors, 10 juniors and 8 residents. For each case, we were asked to assign a diagnosis of dementia, MCI or normal cognition using the National Institute on Aging-Alzheimer's Association workgroup (NIA-AA) core clinical criteria for all-cause dementia, Winblad et al. criteria for MCI, and analyze intensity and etiology if dementia was diagnosed. Inter-rater agreement was assessed both with percent concordance and non-weighted ? statistics. <i>Results:</i> Overall inter-rater agreement on cognitive status was ? = 0.76 (95% CI 0.65-0.86), being slightly higher among junior neurologists (? = 0.85, 95% CI 0.73-0.95) than among seniors (? = 0.71, 95% CI 0.59-0.83) and residents (? = 0.69, 95% CI 0.54-0.81) but without statistical significance among groups. Dementia severity showed an overall ? of 0.34, 0.44 and 0.64 for mild, moderate and severe dementia respectively. <i>Conclusions:</i>Substantial agreement was demonstrated for the diagnosis of cognitive status (dementia, MCI and normal cognition) among neurologists of different levels of experience in a population-based epidemiological study using NIA-AA and Winblad et al. criteria. The agreement rate was lower in the diagnosis of dementia severity.

背景：本研究旨在评估西班牙中部地区第2项神经系统疾病领域研究中，不同神经科医师对认知状态（痴呆、轻度认知障碍（MCI）、认知正常）的诊断一致性。
方法：向27名神经科医师（其中高年资医师9名、低年资医师10名、住院医师8名）提供了30名受试者的完整病历资料。针对每一例病例，要求医师依据美国国立衰老研究所-阿尔茨海默病协会（National Institute on Aging-Alzheimer's Association, NIA-AA）工作组制定的全因痴呆核心临床标准、Winblad等人提出的轻度认知障碍诊断标准，作出痴呆、MCI或认知正常的诊断；若确诊为痴呆，则需分析其严重程度与病因。采用百分比一致性法与非加权κ统计量评估评定者间一致性。
结果：认知状态整体评定者间一致性κ值为0.76（95%置信区间（Confidence Interval, CI）0.65~0.86）；低年资神经科医师的评定者间一致性κ值为0.85（95%置信区间0.73~0.95），略高于高年资医师（κ=0.71，95%置信区间0.59~0.83）与住院医师（κ=0.69，95%置信区间0.54~0.81），但组间差异无统计学意义。痴呆严重程度的评定一致性κ值分别为：轻度痴呆0.34、中度痴呆0.44、重度痴呆0.64。
结论：在采用美国国立衰老研究所-阿尔茨海默病协会（NIA-AA）标准与Winblad等人制定的诊断标准开展的人群流行病学研究中，不同经验水平的神经科医师对认知状态（痴呆、MCI与认知正常）的诊断具有较高一致性。而痴呆严重程度的诊断一致性相对较低。