Alzheimer's disease can be accurately diagnosed in very mildly impaired individuals
Alzheimer's disease can be accurately diagnosed in very mildly impaired individuals
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DOI：
10.1212/wnl.59.7.1022
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发表时间：
2002-10-08
期刊：
影响因子：
9.9
通讯作者：
Katzman, R
中科院分区：
文献类型：
--
作者：
Salmon, DP;Thomas, RG;Katzman, R
背景：患有轻度认知障碍的个体越来越倾向于诊断 AD，增加了假阳性诊断错误的风险。不幸的是，关于极轻度受损患者的 AD 诊断准确性，系统获取的信息很少。目的：确定极轻度受损患者 AD 诊断的准确性，并确定有效区分这些患者与老年正常对照 (NC) 的客观措施。方法：连续至少 3 年对简易精神状态检查分数大于或等于 24 分且接受临床诊断为 AD 的患者进行评估。最初的诊断通过尸检或随后评估中获得的信息进行验证或驳斥。将经验证的 AD 患者的初始神经心理学测试分数与 NC 受试者的初始神经心理学测试分数进行比较，以确定有效的诊断措施。结果：110 名极轻度受损患者中，98 名 (89%) 确诊为 AD（33/36 通过尸检，65/74 通过疾病进展）。 12 名患者 (11%) 的诊断不准确：7 名患者随后被诊断患有其他神经系统疾病，5 名最终被发现正常。延迟回忆、语言流畅性和整体认知状态（即马蒂斯痴呆评定量表）的神经心理学测量为区分非常轻度受损的 AD 患者和 NC 受试者提供了出色的敏感性（大于或等于 96%）和特异性（大于或等于 93%）。结论：当采用综合评估程序时，对于非常轻度受损的个体，可以以相当高的准确度诊断 AD。然而，痴呆症评估应在大约 1 年后重复进行，以确保初步诊断的准确性。
Background: The growing propensity to diagnose AD in individuals with very mild cognitive impairment increases the danger of false-positive diagnostic errors. Unfortunately, there is little systematically acquired information about the accuracy of the AD diagnosis in very mildly impaired patients. Objective: To determine the accuracy of the diagnosis of AD in very mildly impaired patients and to identify objective measures that effectively distinguish these patients from elderly normal controls (NC). Methods: Consecutive patients with Mini-Mental State Examination scores of greater than or equal to24 who received a clinical diagnosis of AD were evaluated annually for at least 3 years. The initial diagnosis was verified or refuted by autopsy or by information obtained in subsequent evaluations. Initial neuropsychological test scores of verified AD patients were compared with those of NC subjects to identify effective diagnostic measures. Results: The diagnosis of AD was confirmed in 98 of 110 (89%) very mildly impaired patients (33/36 by autopsy, 65/74 by disease progression). The diagnosis was inaccurate in 12 patients (11%): Seven were subsequently diagnosed with other neurologic disorders, and five were ultimately found to be normal. Neuropsychological measures of delayed recall, verbal fluency, and global cognitive status (i.e., Mattis Dementia Rating Scale) provided excellent sensitivity ( greater than or equal to96%) and specificity ( greater than or equal to93%) for differentiating between very mildly impaired AD patients and NC subjects. Conclusions: When comprehensive assessment procedures are employed, AD can be diagnosed with reasonably high accuracy in very mildly impaired individuals. However, the dementia evaluation should be repeated after approximately 1 year to ensure the accuracy of the initial diagnosis.