Improving Early Recognition of Treatment‐Responsive Causes of Rapidly Progressive Dementia: The <scp>STAM<sub>3</sub>P</scp> Score
Nihal Satyadev, Philip W. Tipton, Yuka A. Martens, Steven Dunham, Michael D. Geschwind, John C. Morris, Matthew R. Brier, Neill R. Graff‐Radford, Gregory S. Day
Abstract
Objective To improve the timely recognition of patients with treatment‐responsive causes of rapidly progressive dementia (RPD). Methods A total of 226 adult patients with suspected RPD were enrolled in a prospective observational study and followed for up to 2 years. Diseases associated with RPD were characterized as potentially treatment‐responsive or non‐responsive, referencing clinical literature. Disease progression was measured using Clinical Dementia Rating® Sum‐of‐Box scores. Clinical and paraclinical features associated with treatment responsiveness were assessed using multivariable logistic regression. Findings informed the development of a clinical criterion optimized to recognize patients with potentially treatment‐responsive causes of RPD early in the diagnostic evaluation. Results A total of 155 patients met defined RPD criteria, of whom 86 patients (55.5%) had potentially treatment‐responsive causes. The median (range) age‐at‐symptom onset in patients with RPD was 68.9 years (range 22.0–90.7 years), with a similar number of men and women. Seizures, tumor (disease‐associated), magnetic resonance imaging suggestive of autoimmune encephalitis, mania, movement abnormalities, and pleocytosis (≥10 cells/mm 3 ) in cerebrospinal fluid at presentation were independently associated with treatment‐responsive causes of RPD after controlling for age and sex. Those features at presentation, as well as age‐at‐symptom onset <50 years (ie, STAM 3 P), captured 82 of 86 (95.3%) cases of treatment‐responsive RPD. The presence of ≥3 STAM 3 P features had a positive predictive value of 100%. Interpretation Selected features at presentation reliably identified patients with potentially treatment‐responsive causes of RPD. Adaptation of the STAM 3 P screening score in clinical practice may minimize diagnostic delays and missed opportunities for treatment in patients with suspected RPD. ANN NEUROL 2024;95:237–248