Validity of early-onset dementia diagnoses in VA electronic medical record administrative data

Janice C. Marceaux, Jason R. Soble, Justin J.F. O’Rourke, Alicia A. Swan, Margaret Wells, Megan Amuan, Hari Krishna Raju Sagiraju, Blessen C. Eapen, Mary Jo Pugh

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: To determine the validity of diagnoses indicative of early-onset dementia (EOD) obtained from an algorithm using administrative data, we examined Veterans Health Administration (VHA) electronic medical records (EMRs). Method: A previously used method of identifying cases of dementia using administrative data was applied to a random sample of 176 cases of Post-9/11 deployed veterans under 65 years of age. Retrospective, cross-sectional examination of EMRs was conducted, using a combination of administrative data, chart abstraction, and review/consensus by board-certified neuropsychologists. Results: Approximately 73% of EOD diagnoses identified using existing algorithms were identified as false positives in the overall sample. This increased to approximately 76% among those with mental health conditions and approximately 85% among those with mild traumatic brain injury (TBI; i.e. concussion). Factors related to improved diagnostic accuracy included more severe TBI, diagnosing clinician type, presence of neuroimaging data, absence of a comorbid mental health condition diagnosis, and older age at time of diagnosis. Conclusions: A previously used algorithm for detecting dementia using VHA administrative data was not supported for use in the younger adult samples and resulted in an unacceptably high number of false positives. Based on these findings, there is concern for possible misclassification in population studies using similar algorithms to identify rates of EOD among veterans. Further, we provide suggestions to develop an enhanced algorithm for more accurate dementia surveillance among younger populations.

Original languageEnglish (US)
Pages (from-to)1175-1189
Number of pages15
JournalClinical Neuropsychologist
Issue number6
StatePublished - Jul 22 2020
Externally publishedYes


  • Dementia
  • TBI
  • epidemiology
  • health administrative data
  • veterans

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Developmental and Educational Psychology
  • Clinical Psychology
  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health


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