Clinical criteria for the diagnosis of vascular dementia -: A multicenter study of comparability and interrater reliability
Clinical criteria for the diagnosis of vascular dementia -: A multicenter study of comparability and interrater reliability
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DOI：
10.1001/archneur.57.2.191
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发表时间：
2000-02-01
影响因子：
--
通讯作者：
Jagust, WJ
中科院分区：
文献类型：
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作者：
Chui, HC;Mack, W;Jagust, WJ
背景：目前已有几个临床标准用于血管性痴呆（VaD）的标准化诊断。根据使用的标准，报告了患者分类的显著差异。很少有研究对评价者间信度进行了研究。目的：评估以下4种VaD临床定义的分类和评价者间信度的一致性：Hachinski缺血评分（HIS）、阿尔茨海默病诊断和治疗中心（ADDTC）、国家神经疾病和中风研究所-国际神经科学研究和教育协会方法：采用美国精神疾病诊断与统计手册第四版（DSM-IV）和NINDS-AIREN（NINDS-AIREN）的诊断标准，对VaD的4个诊断标准、Alzheimer病（AD）的2个诊断标准和痴呆的4个诊断标准进行结构化诊断检查。25个案例的插图，代表了一系列的认知障碍和痴呆亚型，准备在一个标准化的临床格式。一致性的情况下，使用不同的标准和评价者之间的可靠性7 ADDTC给予一组特定的标准进行了评估，使用kappa statistics.Results：VaD的诊断频率是最高的使用修改后的HIS或DSM-IV标准，中间使用原始HIS和ADDTC标准，最低的使用NINDS-AIREN标准。评分者间信度的评分范围为kappa = 0.30（ADDTC）至kappa = 0.61（原始HIS）。结论：VaD的临床标准是不可互换的。根据选择的标准，报告的VaD患病率将有很大差异。传统的HIS评分者间信度高于新的VaD评分标准。需要前瞻性纵向研究与临床病理相关性比较的有效性。
Background: Several clinical criteria have been developed to standardize the diagnosis of vascular dementia (VaD). Significant differences in patient classification have been reported, depending on the criteria used. Few studies have examined interrater reliability.Objective: To assess the concordance in classification and interrater reliability for the following 4 clinical definitions of VaD: the Hachinski Ischemic Score (HIS), the Alzheimer Disease Diagnostic and Treatment Centers (ADDTC), National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), and Diagnostic and Statistical Manual of Mental Disorders, Foul th Edition (DSM-IV).Methods: Structured diagnostic checklists were developed for 4 criteria for VaD, 2 criteria for Alzheimer disease (AD), and 4 criteria for dementia. Twenty-five case vignettes, representing a spectrum of cognitive impairment and subtypes of dementia, were prepared in a standardized clinical format. Concordance in case classification using different criteria and interrater reliability among 7 ADDTCs given a specific set of criteria was assessed using the kappa statistic.Results: The frequency of a diagnosis of VaD was highest using the modified HIS or DSM-IV criteria, intermediate using the original HIS and ADDTC criteria, and lowest using the NINDS-AIREN criteria. Scores for interrater reliability ranged from kappa = 0.30 (ADDTC) to kappa = 0.61 (original HIS).Conclusions: Clinical criteria for VaD are not interchangeable. Depending on the criteria selected, the reported prevalence of VaD will vary significantly. The traditional HIS has higher interrater reliability than the newer criteria For VaD. Prospective longitudinal studies with clinical-pathological correlation are needed to compare validity.