Sensitivity and specificity of ventromedial prefrontal cortex tests in behavioral variant frontotemporal dementia.
Sensitivity and specificity of ventromedial prefrontal cortex tests in behavioral variant frontotemporal dementia.
复制标题
DOI：
10.1016/j.jalz.2012.09.010
复制
发表时间：
2013-10-01
期刊：
影响因子：
--
通讯作者：
Hornberger, Michael
中科院分区：
文献类型：
--
作者：
Bertoux, Maxime;Funkiewiez, Aurelie;Hornberger, Michael
背景技术背景：行为变异性额颞叶痴呆（bvFTD）的特征是早期和实质性的腹内侧前额叶皮层（VMPFC）功能障碍。然而，到目前为止，关于哪种试验对评估这种情况下VMPFC功能障碍最敏感和特异性还没有达成共识。在这项研究中，我们比较了四种常见的VMPFC特异性检测的敏感性和特异性在两个神经退行性队列中首次临床表现时（Mini-SEA、正面评估组合的进行/不进行子测试、反向学习测试和爱荷华州赌博任务）（bvFTD，阿尔茨海默病）和年龄匹配的健康对照。结果：我们发现，迷你SEA，评估心理和情绪过程的理论，成为最敏感和具体的VMPFC测试。在>82%的首次就诊受试者中，单独使用Mini-SEA成功区分了bvFTD和阿尔茨海默病（AD）。同样，FAB Go/No-Go和反向学习测试也显示出非常好的辨别力，但程度较低。爱荷华州赌博任务，VMPFC功能的最常见的措施之一，是最不具体的这些tests.CONCLUSION：检测VMPFC功能障碍的灵敏度是高的所有测试，但特异性差异很大。Mini-SEA成为最有前途的VMPFC特异性诊断测试。临床医生应考虑到目前可用的VMPFC测试的可变特异性，这可以补充目前基于护理人员的问卷调查和临床评估，以提高对VMPFC功能障碍所致行为功能障碍的诊断。
BACKGROUND: Behavioral variant frontotemporal dementia (bvFTD) is characterized by early and substantial ventromedial prefrontal cortex (VMPFC) dysfunction. To date, however, there is no consensus regarding which tests are most sensitive and specific to assess VMPFC dysfunction in this condition.METHODS: In this study we compared the sensitivity and specificity of four common VMPFC specific tests (Mini-SEA, Go/No-Go Subtest of the Frontal Assessment Battery, Reversal-Learning Test, and Iowa Gambling Task) at first clinic presentation in two neurodegenerative cohorts (bvFTD, Alzheimer's disease) and age-matched, healthy controls.RESULTS: We found that the Mini-SEA, evaluating theory of mind and emotion processes, emerged as the most sensitive and specific of the VMPFC tests employed. The Mini-SEA alone successfully distinguished bvFTD and Alzheimer's disease (AD) in >82% of subjects at first presentation. Similarly, the FAB Go/No-Go and Reversal-Learning Tests also showed very good discrimination power, but to a lesser degree. The Iowa Gambling Task, one of the most common measures of VMPFC function, was the least specific of these tests.CONCLUSION: Sensitivity to detect VMPFC dysfunction was high across all test employed, butspecificity varied considerably. The Mini-SEA emerged as the most promising of the VMPFC-specific diagnostic tests. Clinicians should take into account the variable specificity of currently available VMPFC tests, which can complement current carer-based questionnaires and clinical evaluation to improve the diagnosis of behavioral dysfunctions due to VMPFC dysfunction.