Merdes A R, Hansen L A, Jeste D V, Galasko D, Hofstetter C R, Ho G J, Thal L J, Corey-Bloom J
Department of Neurosciences, University of California, San Diego 92161, USA.
Neurology. 2003 May 27;60(10):1586-90. doi: 10.1212/01.wnl.0000065889.42856.f2.
To determine whether AD neurofibrillary pathology influences clinical diagnostic accuracy in dementia with Lewy bodies (DLB).
Pathologic diagnosis of DLB mandates Lewy bodies but also allows for AD pathology in the form of plaques and tangles. Because clinical diagnostic accuracy of DLB remains low, the authors questioned whether the severity of AD pathology in the form of tangles might affect the clinician's ability to correctly diagnose DLB in life.
DESIGN/METHODS: Ninety-eight subjects with autopsy-proven DLB who had been evaluated annually at the University of California San Diego AD Research Center were identified. The clinical diagnosis used was the last diagnosis before death. Pathologic diagnosis of DLB was made according to Consensus guidelines, and Braak staging was used to assess the degree of neurofibrillary AD pathology. The clinical characteristics of subjects with DLB with low vs high Braak stages were compared and the clinical diagnostic accuracy for subjects stratified according to Braak stage was determined.
Only 27% of the subjects with DLB demonstrated both visual hallucinations and spontaneous extrapyramidal signs (EPS). The low Braak stage (0 to 2, n = 24) subjects had a higher frequency of visual hallucinations (65%) than did subjects with DLB with higher (3 to 6, n = 66) Braak stages (33%, p = 0.008), and showed a slightly greater but not significant degree of EPS. Although clinical diagnostic accuracy for DLB was relatively low (49%), it was higher for subjects with low (75%) compared to high (39%) Braak stages (p = 0.0039).
The degree of concomitant AD tangle pathology has an important influence on the clinical characteristics and, therefore, the clinical diagnostic accuracy of DLB.
确定阿尔茨海默病（AD）神经纤维病理是否会影响路易体痴呆（DLB）的临床诊断准确性。
DLB的病理诊断要求存在路易小体，但也允许有以斑块和缠结形式出现的AD病理改变。由于DLB的临床诊断准确性仍然较低，作者质疑以缠结形式出现的AD病理严重程度是否会影响临床医生生前正确诊断DLB的能力。
设计/方法：确定了98名经尸检证实为DLB的受试者，这些受试者每年都在加利福尼亚大学圣地亚哥分校AD研究中心接受评估。使用的临床诊断是死亡前的最后诊断。根据共识指南进行DLB的病理诊断，并采用Braak分期来评估神经纤维AD病理的程度。比较了低Braak分期与高Braak分期的DLB受试者的临床特征，并确定了根据Braak分期分层的受试者的临床诊断准确性。
只有27%的DLB受试者同时出现视幻觉和自发性锥体外系症状（EPS）。低Braak分期（0至2期，n = 24）的受试者视幻觉发生率（65%）高于高Braak分期（3至6期，n = 66）的DLB受试者（33%，p = 0.008），且EPS程度略高但无显著差异。虽然DLB的临床诊断准确性相对较低（49%），但低Braak分期的受试者（75%）高于高Braak分期的受试者（39%）（p = 0.0039）。
AD缠结病理的程度对DLB的临床特征有重要影响，因此也对其临床诊断准确性有重要影响。
Zotero 插件