Claus J J, Walstra G J, Bossuyt P M, Teunisse S, Van Gool W A
Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands.
Psychol Med. 1999 Mar;29(2):485-9. doi: 10.1017/s0033291798007375.
We studied whether heterogeneous profiles of cognitive function are relevant to survival in patients with early Alzheimer's disease.
CAMCOG subscales of cognitive function were used as predictors of survival, together with gender in 157 consecutively referred patients with early Alzheimer's disease. Statistical analysis was performed with Cox proportional hazards analysis and Kaplan-Meier survival curves. Survival rates were compared with those in the general population.
Eighty patients (51%) died during the follow-up that extended to 5.7 years, with a median survival of 4.4 years after entry. Only the praxis subscore was statistically significant related to survival (P < 0.0001). Its predictive power was based on only two items, including copying ability for a spiral and a three-dimensional house, independent of age, sex, education, overall CAMCOG score, dementia severity and symptom duration. Kaplan-Meier curves for the combined score of these items (0, 1, or 2) showed three groups with significantly different survival rates for both men and women. Comparison of gender specific survival rates with data from the general population showed that excess mortality was statistically significant (P < 0.01) higher in men (51%) than in women (21%) after follow-up extending to 5 years.
A simple test of copying ability defines subgroups of AD patients with large differences in survival rates. This suggests that parietal lobe impairment is an important predictor of mortality in AD. Also, the course of AD may be more benign in women than in men.
我们研究了认知功能的异质性特征是否与早期阿尔茨海默病患者的生存情况相关。
在157例连续转诊的早期阿尔茨海默病患者中，将认知功能的CAMCOG分量表与性别一起用作生存的预测指标。采用Cox比例风险分析和Kaplan-Meier生存曲线进行统计分析。将生存率与一般人群的生存率进行比较。
在长达5.7年的随访期间，80例患者（51%）死亡，入组后中位生存期为4.4年。只有操作子得分与生存具有统计学显著相关性（P < 0.0001）。其预测能力仅基于两个项目，包括螺旋线和三维房屋的临摹能力，独立于年龄、性别、教育程度、CAMCOG总分、痴呆严重程度和症状持续时间。这些项目综合得分（0、1或2）的Kaplan-Meier曲线显示，男性和女性的三组生存率有显著差异。将特定性别的生存率与一般人群的数据进行比较，结果显示，随访至5年后，男性（51%）的超额死亡率在统计学上显著高于女性（21%）（P < 0.01）。
一项简单的临摹能力测试可定义出生存率差异很大的阿尔茨海默病患者亚组。这表明顶叶损伤是阿尔茨海默病死亡率的重要预测指标。此外，阿尔茨海默病的病程在女性中可能比在男性中更良性。
