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An Interactional Profile to Assist the Differential Diagnosis of Neurodegenerative and Functional Memory Disorders

Reuber, Markus, SEM, MD, PhD, FRCP*; Blackburn, Daniel J., MBChB, BSc, PhD*; Elsey, Chris, PhD; Wakefield, Sarah, BSc, PhD*; Ardern, Kerry A., MSc*; Harkness, Kirsty, BmedSc, MBChB, PhD, FRCP; Venneri, Annalena, BSc, PhD*; Jones, Danielle, BA (York), MA (York), PhD (York)§; Shaw, Chloe, PhD, MRes, BSc; Drew, Paul, BA (Exeter), PhD (Lancaster)

Alzheimer Disease & Associated Disorders: July-September 2018 - Volume 32 - Issue 3 - p 197–206
doi: 10.1097/WAD.0000000000000231
Original Articles

Objective: Specialist services for dementia are seeing an increasing number of patients. We investigated whether interactional and linguistic features in the communication behavior of patients with memory problems could help distinguish between those with problems secondary to neurological disorders (ND) and those with functional memory disorder (FMD).

Methods: In part 1 of this study, a diagnostic scoring aid (DSA) was developed encouraging linguists to provide quantitative ratings for 14 interactional features. An optimal cut-off differentiating ND and FMD was established by applying the DSA to 30 initial patient-doctor memory clinic encounters. In part 2, the DSA was tested prospectively in 10 additional cases analyzed independently by 2 conversation analysts blinded to medical information.

Results: In part 1, the median score of the DSA was +5 in ND and −5 in FMD (P<0.001). The optimal numeric DSA cut-off (+1) identified patients with ND with a sensitivity of 86.7% and a specificity of 100%. In part 2, DSA scores of rater 1 correctly predicted 10/10 and those of rater 2 predicted 9/10 diagnoses.

Conclusions: This study indicates that interactional and linguistic features can help distinguish between patients developing dementia and those with FMD and could aid the stratification of patients with memory problems.

*Department of Neuroscience, University of Sheffield

Department of Neurology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield

School of Allied Health Sciences, De Montfort University, Leicester

§School of Dementia Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford

UCL Institute for Women’s Health, London

Department of Social Sciences, Loughborough University, Loughborough, UK

M.R. and D.J.B. contributed equally.

Supported by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB-PG-0211-24079). This is a summary of independent research carried out at the NIHR Sheffield Biomedical Research Centre (Translational Neuroscience). The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health.

The authors declare no conflicts of interest.

Reprints: Daniel J. Blackburn, MBChB, BSc, PhD, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK (e-mail:

Received June 16, 2017

Accepted October 26, 2017

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