Diagnostic accuracy of Alzheimer’s disease: A clinicopathological study
Diagnostic accuracy of Alzheimer’s disease: A clinicopathological study
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阿尔茨海默病的诊断准确性：临床病理学研究
作者：
K. Jellinger
Kosunen等人。[9]，在一项关于阿尔茨海默病(AD)诊断准确性的前瞻性研究中，包括53例尸检病例，报告了96%临床诊断的可能AD(NINCDS-ADRDA标准；n=28)的死后诊断(CERAD标准/10)，但在临床可能的AD中只有14%(n=7)，其中56%满足可能AD的病理标准[10]；该系列的另一例可能对应于以神经纤维为主的AD[2]。在确诊或可能的AD病例中，33%可见额外的脑血管病变。在血管性痴呆(VaD)组(n=10)中，仅2例(20%)为单纯的VaD，其余均有一定程度的AD病理改变。在混合性痴呆(AD+VAD)小样本(n=6)中，5例(83%)为AD，50%无脑血管病变。4个大脑或7.5%的大脑皮质路易体被诊断为阿尔茨海默病的路易体变种(LBV-AD/6)。使用标准化的临床和形态标准对AD的临床诊断准确性的这些数据可以从1989至1994年间对老年痴呆受试者的连续尸检系列结果中得到很大程度的证实。这一队列包括269名(男性90名，女性189名)年龄55-97岁(平均+SD 79.5+6.7岁)的临床诊断为可能或可能的AD(DSM-III-R，NINCDS-ADRDRA，ICD.9标准)的患者；122名(34名男性，88名女性)平均死亡年龄为79.4岁的患者是维也纳痴呆症前瞻性纵向研究的一部分[1，7]，其精神状态(MMS)在死亡前不超过4-6个月进行。其余病例从医院病历中进行回顾评估。神经病理学诊断是由两位熟练的神经病理学家按照目前的诊断标准[8，10，12]和神经炎性AD的分期独立盲目地进行的
Kosunen et al. [9], in a prospective study on the diagnostic accuracy of Alzheimer's disease (AD) which included 53 autopsy cases, reported post-mortem diagnoses of definite AD (CERAD criteria/10) in 96% of clinically diagnosed probable AD (NINCDS-ADRDA criteria; n = 28), but in only 14% of clinically possible AD (n = 7), with 56% satisfying the pathological criteria for probable AD [ 10]; another case from this series probably corresponded to the neurofibrillary predominant form of AD [2]. Additional cerebrovascular lesions were seen in 33% of the definite or probable cases of AD. In the group with vascular dementia (VaD) (n = 10), only two cases (20%) were morphologically pure VaD, while the others had some additional AD pathology. In the small sample of mixed dementias (AD+VaD) (n = 6), five (83%) were AD, and 50% lacked cerebrovascular lesions. Four brains or 7.5% of the total showing cortical Lewy bodies were diagnosed as a Lewy body variant of AD (LBV-AD/6). These data on the clinical diagnostic accuracy of AD using standardized clinical and morphological criteria can be largely confirmed by the results of a consecutive autopsy series of elderly demented subjects between 1989 and 1994. This cohort included 269 patients (90 males, 189 females) aged 55-97 years (mean + SD 79.5 + 6.7 years) with a clinical diagnosis of probable or possible AD (DSM-III-R, NINCDS-ADRDRA, ICD.9 criteria); 122 patients (34 males, 88 females) with a mean age at death of 79.4 years were part of the Vienna Prospective Longitudinal Study of Dementia [1, 7] with a psychostatus (Minimental status, MMS) performed not longer than 4-6 months prior to death. The remaining cases were evaluated retrospectively from hospital charts. Neuropathological diagnosis was performed blindly and independently by two skilled neuropathologists using current diagnostic criteria [8, 10, 12], and staging of neuritic AD