Dementia diagnosis in developing countries: a cross-cultural validation study
Dementia diagnosis in developing countries: a cross-cultural validation study
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DOI：
10.1016/s0140-6736(03)12772-9
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发表时间：
2003-03-15
期刊：
影响因子：
168.9
通讯作者：
Varghese, M
中科院分区：
文献类型：
--
作者：
Prince, M;Acosta, D;Varghese, M
发展中国家需要对痴呆症进行研究。评估不同地区之间疾病频率的差异可能会增进我们对疾病的了解，但需要解决方法上的困难。我们的目标是开发和测试一种文化和教育上公正的痴呆症诊断工具。方法在一项多中心研究中，10/66痴呆研究小组在25个中心（大多数在印度、中国、东南亚、拉丁美洲和加勒比地区以及非洲的大学）采访了2885名60岁及以上的人，其中729人患有痴呆症，三组没有痴呆症：702人患有抑郁症，694人受过高等教育（按每个中心的定义），760人受过低教育（按每个中心的定义）。当地临床医生诊断为痴呆症和抑郁症。一名不知道痴呆症诊断的访谈者对老年人的精神状态、痴呆症的社区筛查工具和经过修改的建立阿尔茨海默病登记联盟（CERAD）的十字列表学习任务进行了管理。每项测量都独立地预测了痴呆症的诊断。在对一半样本的分析中，由所有三种测量方法得出的算法比任何单独的测量方法得出的结果都要好。将该算法应用于另一半样本，确定了94%的痴呆病例，在抑郁症、高学历和低学历组中，假阳性率分别为15%、3%和6%。我们的算法是在临床和基于人群的研究中对文化和教育敏感的痴呆症诊断的坚实基础，并将其组成措施翻译成发展中国家使用的大多数语言。
Background Research into dementia is needed in developing countries. Assessment of variations in disease frequency between regions might enhance our understanding of the disease, but methodological difficulties need to be addressed. We aimed to develop and test a culturally and educationally unbiased diagnostic instrument for dementia.Methods In a multicentre study, the 10/66 Dementia Research Group interviewed 2885 people aged 60 years and older in 25 centres, most in Universities, in India, China and southeast Asia, Latin America and the Caribbean, and Africa. 729 had dementia and three groups were free of dementia: 702 had depression, 694 had high education (as defined by each centre), and 760 had low education (as defined by each centre). Local clinicians diagnosed dementia and depression. An interviewer, masked to dementia diagnosis, administered the geriatric mental state, the community screening instrument for dementia, and the modified Consortium to Establish a Registry of Alzheimer's Disease (CERAD) ten-word list-learning task.Findings Each measure independently predicted a diagnosis of dementia. In an analysis of half the sample, an algorithm derived from all-three measures gave better results than any individual measure. Applied to the other half of the sample, this algorithm identified 94% of dementia cases with false-positive rates of 15%, 3%, and 6% in the depression, high education, and low education groups, respectively. IInterpretation Our algorithm is a sound basis for culturally and educationally sensitive dementia diagnosis in clinical and population-based research, supported by translations of its constituent measures into most languages used in the developing world.