Low sensitivity in clinical diagnoses of dementia with Lewy bodies.
Low sensitivity in clinical diagnoses of dementia with Lewy bodies.
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DOI：
10.1007/s00415-009-5324-y
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发表时间：
2010-03
影响因子：
6
通讯作者：
Markesbery WR
中科院分区：
文献类型：
--
作者：
Nelson PT;Jicha GA;Kryscio RJ;Abner EL;Schmitt FA;Cooper G;Xu LO;Smith CD;Markesbery WR
未来神经退行性疾病(ND)治疗的成功在一定程度上取决于准确的生前诊断。先前在大型、多中心衍生数据集上进行的研究相对较少，以测试最终临床ND诊断的准确性与明确的神经病理学结果的关系。数据来自肯塔基大学阿尔茨海默病中心尸检系列和国家阿尔茨海默氏症协调中心(NACC)登记。NACC数据来自31个不同的学术医疗中心，每个中心都拥有与NDS相关的强大临床专业知识和基础设施。最后的临床诊断与随后的神经病理诊断进行了系统的比较。在符合最终纳入标准的受试者中(NACC注册数据的N=2,861)，临床诊断和随后的ND诊断之间的关联强度仅为中等。在路易体痴呆(DLB)的病例中尤其如此：临床诊断的敏感性相当低(对于单纯的DLB为32.1%，对于阿尔茨海默病(AD+DLB)为12.1%)，尽管特异性超过95%。AD临床诊断更准确(敏感性为85.0%，特异性为51.1%)。在过去的十年中，由于严重认知障碍患者的诊断“过度”增加，临床诊断的准确率有所下降。此外，使用视觉幻觉、锥体外系体征和/或波动的认知作为诊断DLB的临床标准的一部分，在严重痴呆症发病率较高的组(N=237)中几乎没有用处。我们的数据表明，需要进一步的工作来完善我们识别特定衰老相关脑疾病机制的能力，特别是在DLB中。
The success of future neurodegenerative disease (ND) therapies depends partly on accurate antemortem diagnoses. Relatively few prior studies have been performed on large, multicenter-derived datasets to test the accuracy of final clinical ND diagnoses in relation to definitive neuropathological findings. Data were analyzed from the University of Kentucky Alzheimer's Disease Center autopsy series and from the National Alzheimer's Coordinating Center (NACC) registry. NACC data are derived from 31 different academic medical centers, each with strong clinical expertise and infrastructure pertaining to NDs. The final clinical diagnoses were compared systematically with subsequent neuropathology diagnoses. Among subjects meeting final inclusion criteria (N = 2,861 for NACC Registry data), the strength of the associations between clinical diagnoses and subsequent ND diagnoses was only moderate. This was particularly true in the case of dementia with Lewy bodies (DLB): the sensitivity of clinical diagnoses was quite low (32.1% for pure DLB and 12.1% for Alzheimer's disease (AD + DLB) although specificity was over 95%. AD clinical diagnoses were more accurate (85.0% sensitivity and 51.1% specificity). The accuracy of clinical DLB diagnoses became somewhat lower over the past decade, due apparently to increased “over-calling” the diagnosis in patients with severe cognitive impairment. Furthermore, using visual hallucinations, extrapyramidal signs, and/or fluctuating cognition as part of the clinical criteria for DLB diagnosis was of minimal utility in a group (N = 237) with high prevalence of severe dementia. Our data suggest that further work is needed to refine our ability to identify specific aging-related brain disease mechanisms, especially in DLB.
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影响因子：
9.9
作者：
Lopez, OL;Hamilton, RL;DeKosky, ST
通讯作者：
DeKosky, ST
影响因子：
9.9
作者：
Olichney, JM;Galasko, D;Thal, LJ
通讯作者：
Thal, LJ
DOI：
10.1097/nen.0b013e31815c5efb
发表时间：
2007-12-01
影响因子：
3.2
作者：
Nelson, Peter T.;Jicha, Gregory A.;Markesbery, William R.
通讯作者：
Markesbery, William R.
DOI：
10.1046/j.1365-2389.2003.51308.x
发表时间：
2003-07-01
影响因子：
6.3
作者：
Holtzer, R;Tang, MX;Stern, Y
通讯作者：
Stern, Y
影响因子：
4.4
作者：
Fernando, MS;Ince, PG
通讯作者：
Ince, PG