Petrovitch H, White L R, Ross G W, Steinhorn S C, Li C Y, Masaki K H, Davis D G, Nelson J, Hardman J, Curb J D, Blanchette P L, Launer L J, Yano K, Markesbery W R
Pacific Health Research Institute, Honolulu, HI 96813, USA.
Neurology. 2001 Jul 24;57(2):226-34. doi: 10.1212/wnl.57.2.226.
To determine diagnostic accuracy for AD in a population-based study of Japanese-American men. AD is neuropathologically confirmed for more than 80% of cases at major referral centers (primarily Caucasians); however, information on diagnostic accuracy in population-based studies and studies of different ethnic groups is limited.
There were 3,734 men who participated in the Honolulu-Asia Aging Study 1991 through 1993 dementia examination and 2,603 in the 1994 through 1996 examination. Diagnoses were based on published criteria. Neuropathologists blinded to clinical data quantified neurofibrillary tangles (NFT) and neuritic plaques (NP).
Of 220 autopsied subjects, clinical evaluation revealed 68 with normal cognition, 73 intermediate, and 79 with dementia: 20 AD, 27 vascular dementia, 19 AD + other, and 13 other dementia. Among 20 cases with pure AD, the median value for maximum neocortical NFT density was 6.9/mm(2) and for neocortical NP density was 8.0/mm2. Corresponding densities for other groups were <3.0/mm2. Using established neuropathologic criteria, 25% (5/20) of clinical AD cases had enough NP to meet definite AD criteria, whereas 65% (13/20) had sufficient NP to meet neuropathologic definite or probable AD criteria. Among nine AD cases with moderately severe dementia, only two (22%) had NP densities great enough to meet definite neuropathologic criteria, whereas seven (78%) met neuropathologic criteria for probable AD.
Neuropathologic confirmation and NP density among decedents with clinical AD in this population-based study were lower than reported by referral centers and similar to reports from two other community studies. Ethnic differences in propensity for amyloid deposition as well as differences in clinical severity and representativeness of cases might contribute to these findings.
在一项针对日裔美国男性的基于人群的研究中确定阿尔茨海默病（AD）的诊断准确性。在主要转诊中心（主要为白种人），超过80%的AD病例在神经病理学上得到确诊；然而，基于人群的研究以及不同种族群体研究中关于诊断准确性的信息有限。
有3734名男性参与了1991年至1993年的檀香山-亚洲老龄化研究痴呆症检查，2603名男性参与了1994年至1996年的检查。诊断基于已发表的标准。对临床数据不知情的神经病理学家对神经原纤维缠结（NFT）和神经炎斑块（NP）进行了定量分析。
在220名接受尸检的受试者中，临床评估显示68人认知正常，73人处于中间状态，79人患有痴呆症：20例为AD，27例为血管性痴呆，19例为AD合并其他疾病，13例为其他类型痴呆。在20例单纯AD病例中，最大新皮质NFT密度的中位数为6.9/mm²，新皮质NP密度为8.0/mm²。其他组的相应密度<3.0/mm²。根据既定的神经病理学标准，25%（5/20）的临床AD病例有足够的NP符合明确的AD标准，而65%（13/20）有足够的NP符合神经病理学明确或可能的AD标准。在9例中度严重痴呆的AD病例中，只有2例（22%）的NP密度足以符合明确的神经病理学标准，而7例（78%）符合可能AD的神经病理学标准。
在这项基于人群的研究中，临床诊断为AD的死者的神经病理学确诊率和NP密度低于转诊中心的报告，与其他两项社区研究的报告相似。淀粉样蛋白沉积倾向的种族差异以及临床严重程度和病例代表性的差异可能导致了这些结果。
