Research evaluation and diagnosis of probable Alzheimer's disease over the last two decades: I
Research evaluation and diagnosis of probable Alzheimer's disease over the last two decades: I
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DOI：
10.1212/wnl.55.12.1854
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发表时间：
2000-12-26
期刊：
影响因子：
9.9
通讯作者：
DeKosky, ST
中科院分区：
文献类型：
--
作者：
Lopez, OL;Becker, JT;DeKosky, ST
目的：描述过去二十年来临床诊断阿尔茨海默病的经验，特别强调符合国家神经和交流障碍研究所和卒中-阿尔茨海默病及相关疾病协会标准的可能的阿尔茨海默病患者，他们的临床表现模式和神经病理结果。背景：可能的阿尔茨海默病具有异质的临床表现，并且可能在复杂因素的背景下发生。很少有报告，而且没有一个有这么大的样本，关于表现模式，合并症的性质，以及诊断的敏感性和特异性。结果：匹兹堡阿尔茨海默病研究中心在1983年4月至2000年2月期间检查了1139例可能患有阿尔茨海默病的患者。在1139例疑似AD患者中，29例（2.5%）进展缓慢，27例（2%）进展迅速，70例（6%）表现不典型，85例（7%）合并脑血管疾病。348例（30.5%）疑似AD患者发现合并性脑室周围白质病变。诊断AD的总体敏感性为97%，特异性为80%。然而，AD诊断的准确性随时间而变化：1983 - 1989年敏感性为94%，特异性为52%，1990 - 2000年敏感性为98%，特异性为88%。结论：虽然可能AD的诊断已被用来表明存在一个同质的临床实体，但这些患者在表现、发病或临床病程上可能各不相同。这一发现对于了解该疾病的病理生理基础以及更好地识别对痴呆症治疗有反应的患者具有特别重要的意义。虽然在过去的二十年中，AD诊断的敏感性保持在90%以上，但特异性增加，反映了其他痴呆疾病诊断的逐步改善。
Objective: To describe the experience of a research clinic diagnosing AD during the last two decades, with special emphasis on patients who meet the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable AD, their patterns of clinical presentation, and neuropathologic outcomes. Background: Probable AD has a heterogeneous clinical presentation, and can occur in the context of complicating factors. There are few reports, and none with this large of a sample, about the pattern of presentation, the nature of comorbidities, and the sensitivity and specificity of diagnosis. Results: The AD Research Center of Pittsburgh examined 1139 patients with probable AD between April 1983 and February 2000. Of these 1139 probable AD patients, 29 (2.5%) had slow progression, 27 (2%) had rapid progression, 70 (6%) had an atypical presentation, and 85 (7%) had coexistent cerebrovascular disease. Confluent periventricular white matter lesions were found in 348 (30.5%) patients with probable AD. The overall sensitivity for the diagnosis of AD was 97% and the specificity 80%. However, the accuracy for the diagnosis of AD varied over the years: from 1983 to 1989, the sensitivity was 94% and specificity 52%, and from 1990 to 2000, the sensitivity was 98% and specificity 88%. Conclusion: Although the diagnosis of probable AD has been used to indicate the presence of a homogeneous clinical entity, these patients can vary in presentation, onset, or clinical course. This finding is of particular importance for the understanding of the pathophysiologic basis of the disease, and for the better identification of responders to dementia treatments. Although the sensitivity for the diagnosis of AD remained above 90% over the last two decades, the specificity increased, reflecting progressive improvement in the diagnosis of other dementing disorders.