Hogervorst E, Bandelow S, Combrinck M, Irani S R, Smith A D
Department of Pharmacology, Oxford Project to Investigate Memory and Ageing, University of Oxford, Oxford, UK.
Dement Geriatr Cogn Disord. 2003;16(3):170-80. doi: 10.1159/000071006.
Data from 204 participants from the Oxford Project to Investigate Memory and Ageing, who were diagnosed post-mortem using the histopathological criteria of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), were used to assess the validity of the clinical criteria for Alzheimer's disease (AD) of the 'National Institute of Neurological and Communicative Disorders and Stroke/the Alzheimer's Disease and Related Disorders Association' (NINCDS/ADRDA). Cases who had been diagnosed as NINCDS/ADRDA 'probable AD' in life were usually confirmed at autopsy, but half of the NINCDS/ADRDA 'negative' cases were not (low specificity). It was hypothesized that the overall clinical impression may have taken precedence over the use of the actual criteria. We therefore investigated the validity and reliability of the clinical criteria using a computerized 'dementia diagnosis system' for each of 6 sets of criteria [Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), NINCDS/ADRDA and three sets of criteria specifically for vascular dementia (VaD): NINCDS-AIREN, State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC), and Vascular Cognitive Impairment (VCI)] to classify a subset (n = 96) of the cases confirmed post-mortem. The use of the computerized system significantly (p = 0.01) increased the specificity (81%, similar to sensitivity) of the NINCDS/ADRDA diagnoses, which were shown to have 'moderate' inter-rater reliability. The DSM-IV criteria had good validity for AD when compared with post-mortem confirmation and showed 'substantial' inter-rater reliability. The ADDTC and VCI criteria for VaD had good specificity (88%) and sensitivity (75%), but only for one rater. The DSM-IV and NINCDS-AIREN criteria for VaD showed poor validity and inter-rater reliability. We conclude that the forced use of decision trees through a computerized system enhances the accuracy of the clinical diagnoses of dementia.
来自牛津记忆与衰老研究项目的204名参与者的数据被用于评估美国国立神经疾病和中风研究所/阿尔茨海默病及相关疾病协会（NINCDS/ADRDA）的阿尔茨海默病（AD）临床诊断标准的有效性。这些参与者在死后根据阿尔茨海默病注册协会（CERAD）的组织病理学标准进行诊断。生前被诊断为NINCDS/ADRDA“可能AD”的病例在尸检时通常得到确认，但NINCDS/ADRDA“阴性”病例中有一半未得到确认（特异性低）。据推测，总体临床印象可能优先于实际诊断标准的使用。因此，我们使用计算机化的“痴呆诊断系统”对6套诊断标准（《精神疾病诊断与统计手册》（DSM-IV）、NINCDS/ADRDA以及专门针对血管性痴呆（VaD）的三套标准：NINCDS-AIREN、加利福尼亚州阿尔茨海默病诊断与治疗中心（ADDTC）和血管性认知障碍（VCI））中的每一套标准，对经尸检确诊的一部分病例（n = 96）进行分类，以研究这些临床诊断标准的有效性和可靠性。使用计算机化系统显著（p = 0.01）提高了NINCDS/ADRDA诊断的特异性（81%，与敏感性相似），其评分者间信度为“中等”。与尸检确诊相比，DSM-IV标准对AD具有良好的有效性，评分者间信度为“高度”。ADDTC和VCI的VaD标准具有良好的特异性（88%）和敏感性（75%），但仅针对一名评分者。DSM-IV和NINCDS-AIREN的VaD标准有效性和评分者间信度较差。我们得出结论，通过计算机化系统强制使用决策树可提高痴呆临床诊断的准确性。
