A clinicopathological comparison of community-based and clinic-based cohorts of patients with dementia
A clinicopathological comparison of community-based and clinic-based cohorts of patients with dementia
复制标题
DOI：
10.1001/archneur.56.11.1368
复制
发表时间：
1999-11-01
影响因子：
--
通讯作者：
Mayeux, R
中科院分区：
文献类型：
--
作者：
Massoud, F;Devi, G;Mayeux, R
目的：比较阿尔茨海默病临床诊断的敏感性和特异性，病理原因的分布，以及两组不同痴呆患者的人口统计学和临床特征。设计：回顾性临床病理学研究。设置：一所大学医院和一个多民族社区的记忆障碍诊所。患者：来自记忆障碍诊所的63名患者和来自大型社区研究的26名患者在临床评估后进行尸检。主要结果测量：临床和病理学发现的差异分布，以及临床病理学相关性。门诊患者在诊断时更年轻，受教育程度更高，更可能是白色。在我们评估的63例临床患者中，29例（46%）病理诊断为明确的AD，15例（24%）诊断为混合型AD，19例（30%）诊断为其他类型的痴呆。社区患者的病理诊断分布如下：6例（23%）为确诊AD，6例（23%）为混合型AD，6例（23%）为脑血管病，8例（31%）为其他类型痴呆。两组病理诊断的分布差异仅在脑血管疾病中有显著性。对于门诊患者，AD临床诊断的敏感性为98%，特异性为84%;对于社区人群，敏感性为92%，特异性为79%。临床诊断的敏感性和特异性在门诊组和社区组之间差异无统计学意义，痴呆与脑血管疾病是更普遍的社区样本。这种差异可能归因于两组之间的临床和人口统计学差异。
Objectives: To compare the sensitivity and specificity of the clinical diagnosis of Alzheimer disease, the distribution of pathological causes, and the: demographic and clinical characteristics of 2 different groups of patients with dementia.Design: Retrospective clinicopathological study.Setting: A memory disorder clinic in a university hospital and a multiethnic community.Patients: Sixty-three patients from a memory disorder clinic and 26 patients from a large community-based study who underwent autopsy after clinical evaluation.Main Outcome Measures: Differential distribution of clinical and pathological findings, with clinicopathological correlations.Results: Clinic patients were younger at diagnosis, more educated, and more likely to be white. Of the 63 clinic patients we evaluated, 29 (46%) had a pathological diagnosis of definite AD, 15 (24%) had a diagnosis of mixed AD, and 19 (30%) had a diagnosis of another type of dementia. The pathological diagnoses in the community patients were distributed as follows: 6 (23%) had definite AD: 6 (23%) had mixed AD, 6 (23%) had cerebrovascular disease, and 8 (31%) had another type of dementia. The difference in distribution of pathological diagnoses between these 2 groups was only significant for cerebrovascular diseases. For patients seen at the clinic, the sensitivity of the clinical diagnosis of AD was 98% and the specificity was 84%; for the community group, the sensitivity was 92% and the specificity was 79%.Conclusions: The difference in sensitivity and specificity of clinical diagnosis was not statistically significant between the groups of clinic patients and community patients, Dementia associated vith cerebrovascular disease was more prevalent in the community sample. This difference may be attributable to clinical and demographic differences between the 2 groups.