Diagnostic criteria influence dementia prevalence
Diagnostic criteria influence dementia prevalence
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DOI：
10.1097/jgp.0b013e31813c6b6c
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发表时间：
2007-12-01
影响因子：
7.2
通讯作者：
Skoog, Ingmar
中科院分区：
文献类型：
--
作者：
Wancata, Johannes;Borjesson-Hanson, Anne;Skoog, Ingmar
目的：本研究的目的是比较使用不同的诊断系统的痴呆症的患病率，并调查不同的诊断组件（记忆障碍，人格改变，其他智力功能的定义）的患病率的影响。研究方法：通过使用综合精神病理评定量表以及与痴呆诊断相关的特定评估，对居住在瑞典哥德堡的1,019名老年人的一般人群样本进行了调查。根据国际疾病分类第9版和第10版（ICD-9、ICD-10）以及精神疾病诊断和统计手册第3版和第4版（DSM-III-X DSM-IV）进行诊断。此外，老年痴呆症的“历史”标准被应用于旧的研究中。结果如下：DSM-IV痴呆发生率最高（9.6%），其次是根据“历史”标准的痴呆（7.4%）、DSM-III-R（63%）、ICD-10（3.1%）和ICD-9（1.2%）。诊断系统之间一致性的kappa值在0.166和0.810之间。DSM-III-R中对长时记忆和短时记忆损害的要求以及ICD-10中对人格改变的要求解释了大部分差异。当这些要求保持不变时，DSM-III-R，DSM-IV，ICD-10和“历史”标准主要将相同的人确定为痴呆症（Kappa：0.810-1.000）。结论：痴呆的患病率变化很大，这取决于所使用的诊断分类系统。对于DSM-III-R，DSM-IV，ICD-10和“历史”标准，人格变化的定义和记忆障碍的组合导致不同的患病率，而其他智力功能的定义几乎没有影响。
Objective: The objective of this study was to compare the prevalence of dementia using different diagnostic systems, and to investigate the influence of the different diagnostic components (memory impairment, personality changes, definition of other intellectual functions) on the prevalence. Methods: A general population sample of 1,019 elderly living in Gothenburg, Sweden was investigated by using the Comprehensive Psychopathological Rating Scale as well as specific assessments relevant for dementia diagnoses. Diagnoses were given according to the 9th and 10th version of the International Classification of Diseases (ICD-9, ICD-10) as well as the 3rd revised and 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-X DSM-IV). Further, "historical" criteria for dementia were applied as bad been used in older studies. Results: DSM-IV dementia occurred most frequently (9.6%), followed by dementia according to "historical" criteria (7.4%), DSM-III-R (63%), ICD-10 (3.1%), and ICD-9 (1.2%). The kappa values for the agreement between the diagnostic systems were between 0.166 and 0.810. The requirement of both long-term and short-term memory impairment in DSM-III-R and personality changes in ICD-10 explained most of the differences. When these requirements were held constant, DSM-III-R, DSM-IV, ICD-10 and "historical" criteria identified predominantly the same persons as demented (kappa: 0.810-1.000). Conclusion: Prevalence of dementia varied widely depending on diagnostic classification system used. For DSM-III-R, DSM-IV, ICD-10, and "historical" criteria, the definitions of personality changes and combinations of memory impairment lead to differing prevalence rates, whereas the definitions of other intellectual functions have little impact.