Severity of cognitive impairment and the clinical diagnosis of AD with Lewy bodies
Severity of cognitive impairment and the clinical diagnosis of AD with Lewy bodies
复制标题
DOI：
10.1212/wnl.54.9.1780
复制
发表时间：
2000-05-09
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;Hamilton, RL;DeKosky, ST
目的：1)比较阿尔茨海默病(AD)与路易体痴呆(AD+Lb)的临床差异；2)确定不同程度痴呆临床诊断标准的准确性。方法：对185例经病理确诊的AD患者和60例合并ADS-L B的AD患者的临床特点进行分析。临床症状与AD+LB的关系通过多因素分析确定，控制因素为年龄、症状持续时间、脑血管疾病的存在和痴呆的严重程度。结果：轻度痴呆综合征：AD+LB型患者无特殊临床症状。诊断本病的敏感性为62%，特异性为54%。中度痴呆综合征：锥体外系体征(EPS)，尤其是齿轮僵直和重度抑郁与AD+LB相关。DLB法的敏感性为82%，特异性为31%。重度痴呆综合征：齿轮肌僵硬和日间多眠与AD+LB相关。DLB法的敏感性为93%，特异性为16%。结论：在轻度痴呆患者中，EPS的存在无助于AD+LB和AD的鉴别。然而，随着疾病的发展，它们会成为决定性的特征，特别是齿轮僵硬。AD+LB诊断的准确性因痴呆综合征的严重程度而异。AD+LB型轻度痴呆患者的敏感性和特异度较低，提示早期AD+LB型患者不具备DLB型的临床特征。相比之下，在中/重度痴呆阶段诊断DLB的敏感性高而特异性低，表明AD患者也可以具有DLB的特征症状。这些结果表明：AD+LB的生前诊断在所有痴呆阶段都是困难的，需要对这些实体进行更好的临床和生物学鉴别。
Objective: 1) To examine the clinical differences between AD and AD with Lewy bodies (AD+LB); and 2) to determine the accuracy of Consensus guidelines for the clinical diagnosis of dementia with Lewy bodies (DLB) at different levels of dementia severity. Methods: The authors examined the clinical characteristics of 185 patients with pathologically diagnosed AD alone and 60 with ADS LB. The relationship between clinical symptoms and AD+LB was determined by multivariate analyses, controlled by age, duration of symptoms, presence of cerebrovascular disease, and dementia severity. Results: Mild dementia syndrome: No specific clinical symptom was associated with the presence of AD+LB. The sensitivity of the diagnosis of DLB was 62% and specificity was 54%. Moderate dementia syndrome: Extrapyramidal signs (EPS), especially cogwheel rigidity, and major depression were associated with AD+LB. The sensitivity for DLB was 82% and specificity was 31%. Severe dementia syndrome: Cogwheel rigidity and diurnal hypersomnia were associated with AD+LB. The sensitivity for DLB was 93% and specificity was 16%. Conclusions: The presence of EPS is not useful in differentiating AD+LB from AD in patients with mild dementia. However, as the disease progressed, they emerge as defining features, especially cogwheel rigidity. The accuracy of AD+LB diagnosis varies according the severity of the dementia syndrome. The low sensitivity and specificity in AD+LB patients with mild dementia suggest that in early stages AD+LB patients do not present the clinical characteristics of DLB. By contrast, the high sensitivity and low specificity for the diagnosis of DLB in moderate/severe dementia stages suggests that; AD patients can also have characteristic symptoms of DLB. These results indicate that; the antemortem diagnosis of AD +LB is difficult in all dementia stages, and better clinical and biologic differentiations of these entities are needed.