An evaluation of the predictive validity and inter‐rater reliability of clinical diagnostic criteria for senile dementia of Lewy body type
An evaluation of the predictive validity and inter‐rater reliability of clinical diagnostic criteria for senile dementia of Lewy body type
复制标题
路易体型老年痴呆临床诊断标准的预测有效性和评估者间信度评估
作者：
I. McKeith;A. Fairbairn;R. Bothwell;P. Moore;I. Ferrier;P. Thompson;R. Perry
文章摘要-最近的几项尸检研究表明，路易体型老年性痴呆（SDLT）可能是老年人痴呆的第二大常见神经病理学原因，占所有病例的7 - 30%。本研究小组已提出了生前临床诊断SDLT的操作标准。这些的性能，现在检查随机化的情况下，从一个新的系列SDLT，阿尔茨海默病，多梗死性痴呆患者的精神评估由四个不同的临床经验和盲目的病理诊断的评级。使用SDLT标准，两名经验最丰富的评估者在94%的病例中达成一致（kappa = 0.87），经验最少的评估者在78%的病例中达成一致（kappa = 0.50）。SDLT的诊断特异性一致较高（90.0%至97.0%），平均检测灵敏度为74%，经验丰富的临床医生（90.0%）高于经验最少的临床医生（55%）。因此，使用这种操作化标准可以实现SDLT患者的死前鉴定，具有高度的诊断特异性，尽管仍有少数患者在没有实质性认知障碍的情况下表现出“典型”阿尔茨海默型症状或偏执或妄想症状。抗精神病药敏感性可能是这些患者的一个有用的诊断指标。
Article abstract –Several recent autopsy studies suggest that senile dementia of Lewy body type (SDLT) may be the second most common neuropathologic cause of dementia in the elderly, accounting for 7 to 30% of all cases. Operational criteria for the antemortem clinical diagnosis of SDLT have already been proposed by our group. The performance of these is now examined by randomizing the case notes from a new series of SDLT, Alzheimer, and multi-infarct dementia patients for psychiatric assessment by four raters of varying clinical experience and blind to pathologic diagnosis. Using the SDLT criteria, the two most experienced raters agreed in 94% of cases (kappa = 0.87), with the least experienced rater agreeing in 78% (kappa = 0.50). Diagnostic specificity for SDLT was uniformly high (90.0 to 97.0%), with a mean sensitivity of detection of 74%, and was greater by the experienced (90.0%) than the least experienced (55%) clinician. The antemortem identification of SDLT patients can therefore be achieved with a high degree of diagnostic specificity using such operationalized criteria, although there remains a minority of patients who present with either “typical” Alzheimer-type symptoms or with paranoid or delusional symptoms in the absence of substantial cognitive impairment. Sensitivity to neuroleptics may be a useful diagnostic pointer in these patients.