Diagnostic reversion in dementia care: A real‐world analysis of mild cognitive impairment diagnoses after dementia in a large electronic medical record system
6 affiliations
- 1Bakar Computational Health Sciences Institute University of California, San Francisco San Francisco California USA
- 2Department of Epidemiology Boston University School of Public Health Boston Massachusetts USA
- 3Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco California USA
- 4Academic Research Services University of California San Francisco California USA
- 5Department of Pediatrics and Medicine University of California, San Francisco San Francisco California USA
- 6Global Brain Health Institute University of California, San Francisco San Francisco California USA
Abstract
INTRODUCTION: If mild cognitive impairment (MCI) is diagnosed after dementia, it suggests either the dementia diagnosis was premature, or the MCI diagnosis is incorrect. We investigated the prevalence and predictors of such “diagnostic reversion”—MCI after dementia—in a large health system.
METHODS: Among 5965 patients aged 50+ with incident dementia in University of California San Francisco electronic health records, we identified “reverters” with a subsequent MCI diagnosis. We used group least absolute shrinkage and selection operator–regularized logistic regression and random forest models to identify predictors.
RESULTS: Reversion occurred in 13.7% of patients. Lower odds were observed among older adults (odds ratio [OR] = 0.95/year; 95% confidence interval [CI]: 0.92–0.98), while higher odds were found among Spanish speakers (OR = 2.26; 95% CI: 1.28–4.00), those with greater cardiovascular risk (OR = 1.16; 95% CI: 1.01–1.33), and higher Charlson Comorbidity Index burden (OR = 1.09; 95% CI: 1.05–1.14).
DISCUSSION: Diagnostic reversion is common and socially patterned, suggesting contributions from misdiagnosis, clinical uncertainty, or variability in clinical presentation and care setting.
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BibTeX
@article{miramontes2026diagnostic,
title = {{Diagnostic reversion in dementia care: A real‐world analysis of mild cognitive impairment diagnoses after dementia in a large electronic medical record system}},
author = {Silvia Miramontes and Umair Khan and Scott Zimmerman and Erin L. Ferguson and Hunter Mills and Boris Oskotsky and Evan Phelps and Tomiko T. Oskotsky and John A. Capra and M. Maria Glymour and Marina Sirota and Elena Tsoy},
journal = {Alzheimer's \& Dementia : Diagnosis, Assessment \& Disease Monitoring},
year = {2026},
month = oct,
doi = {10.1002/dad2.70523},
url = {https://doi.org/10.1002/dad2.70523},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Diagnostic reversion in dementia care: A real‐world analysis of mild cognitive impairment diagnoses after dementia in a large electronic medical record system
AU - Silvia Miramontes
AU - Umair Khan
AU - Scott Zimmerman
AU - Erin L. Ferguson
AU - Hunter Mills
AU - Boris Oskotsky
AU - Evan Phelps
AU - Tomiko T. Oskotsky
AU - John A. Capra
AU - M. Maria Glymour
AU - Marina Sirota
AU - Elena Tsoy
PY - 2026
DA - 2026/10/01
JO - Alzheimer's & Dementia : Diagnosis, Assessment & Disease Monitoring
DO - 10.1002/dad2.70523
UR - https://doi.org/10.1002/dad2.70523
AB - INTRODUCTION: If mild cognitive impairment (MCI) is diagnosed after dementia, it suggests either the dementia diagnosis was premature, or the MCI diagnosis is incorrect. We investigated the prevalence and predictors of such “diagnostic reversion”—MCI after dementia—in a large health system. METHODS: Among 5965 patients aged 50+ with incident dementia in University of California San Francisco electronic health records, we identified “reverters” with a subsequent MCI diagnosis. We used group least absolute shrinkage and selection operator–regularized logistic regression and random forest models to identify predictors. RESULTS: Reversion occurred in 13.7% of patients. Lower odds were observed among older adults (odds ratio [OR] = 0.95/year; 95% confidence interval [CI]: 0.92–0.98), while higher odds were found among Spanish speakers (OR = 2.26; 95% CI: 1.28–4.00), those with greater cardiovascular risk (OR = 1.16; 95% CI: 1.01–1.33), and higher Charlson Comorbidity Index burden (OR = 1.09; 95% CI: 1.05–1.14). DISCUSSION: Diagnostic reversion is common and socially patterned, suggesting contributions from misdiagnosis, clinical uncertainty, or variability in clinical presentation and care setting.
SN - 2352-8729
ER -