Clinicopathological Concordance in Dementia Diagnostics
Clinicopathological Concordance in Dementia Diagnostics
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DOI：
10.1097/jgp.0b013e3181a6516e
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发表时间：
2009-08-01
影响因子：
7.2
通讯作者：
Englund, Elisabet
中科院分区：
文献类型：
--
作者：
Brunnstrom, Hans;Englund, Elisabet
目的：准确区分痴呆亚型对患者护理和药物治疗非常重要。临床和神经病理性痴呆诊断的持续系统比较可能为进一步改进诊断程序提供基础。本研究的目的是探讨痴呆症的临床诊断和神经病理学检查结果之间的一致性，在专门的痴呆症护理。研究方法：入选要求1）在医院记忆诊所诊断的临床痴呆症，2）1996-2006年期间在瑞典隆德大学医院病理科进行神经病理学检查。共有176名连续患者符合标准，因此被纳入。临床痴呆诊断从病历中获得，并与神经病理学结果进行比较。结果：86例（49%）患者的临床诊断与病理诊断完全一致（kappa 0.37）。在另外24例（14%）病例中，临床诊断与判定为导致痴呆症的部分但非全部病理成分相对应。在临床阿尔茨海默病患者中，84%（46/55）的患者在神经病理学检查中有明显的阿尔茨海默病成分，伴或不伴其他明显的病理变化。血管性痴呆（VaD）的相应数字为59%（24/41），额颞叶痴呆为74%（20/27），阿尔茨海默病和VaD联合为25%（4/16），路易体痴呆为67%（6/9）。结论：本研究表明，临床痴呆诊断并不总是符合神经病理学改变。它强调了神经病理学检查在研究和日常临床实践中的重要性。(Am J Geriatr Psychiatry 2009; 17：664-670）
Objective: Accurate distinction between dementia subtypes is important for patient care and pharmacological treatment. Continuing systematic comparisons of clinical and neuropathological dementia diagnoses may provide a basis for further improvement of the diagnostic procedure. The purpose of this study was to investigate concordance between clinical dementia diagnosis and neuropathological findings in the specialized dementia care. Methods: Inclusion required 1) a clinical dementia disorder diagnosed at a hospital-based memory clinic and 2) a neuropathological examination within the Department of Pathology at the University Hospital in Lund, Sweden, during the years 1996-2006. A total of 176 consecutive patients fulfilled the criteria and were thus included. Clinical dementia diagnoses were obtained from the medical records and compared with the neuropathological findings. Results: The clinical and pathological dementia diagnoses were in full accordance in 86 (49%) of the patients (kappa 0.37). In an additional 24 (14%) cases, the clinical diagnosis corresponded with some but not all pathological components judged to contribute to the dementia disorder. Of the patients with clinical Alzheimer disease, 84% (46/55) had a significant Alzheimer component with or without other significant pathology at neuropathological examination. The corresponding figure for vascular dementia (VaD) was 59% (24/41), for frontotemporal dementia 74% (20/27), for combined Alzheimer and VaD 25% (4/16), and for dementia with Lewy bodies 67% (6/9). Conclusions: This study shows that clinical dementia diagnoses do not always correspond with neuropathological changes. It stresses the importance of neuropathological examination in research and in daily clinical practice. (Am J Geriatr Psychiatry 2009; 17: 664-670)