Villareal Dennis T, Grant Elizabeth, Miller J Philip, Storandt Martha, McKeel Daniel W, Morris John C
Division of Geriatrics and Gerontology, and the Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO 63108, USA.
Neurology. 2003 Sep 9;61(5):661-7. doi: 10.1212/wnl.61.5.661.
To determine whether Alzheimer's disease (AD) associated with comorbidities or atypical features (possible AD) is marked by differences in clinical course and outcomes compared with uncomplicated AD (probable AD).
Annual evaluations were made of patients with AD, for up to 11 years. Six hundred forty subjects with AD were clinically classified into two groups: 1) possible AD (n = 208), and 2) probable AD (n = 432). Data on demographics, Mini-Mental State Examination (MMSE), Short Blessed Test (SBT), psychometric performance, and Clinical Dementia Rating (CDR) were collected at baseline. Kaplan-Meier survival curves and Cox proportional hazards models were conducted to evaluate whether possible AD would have different outcomes on dementia progression, nursing home placement, and death compared with probable AD.
The possible AD group was slightly younger and less well educated than the probable AD group, but there were no group differences at baseline in MMSE, SBT, and CDR scores. Controlling for age and education, the possible AD group had poorer baseline psychometric performance (p = 0.022). There were no group differences, however, for rate of dementia progression, nursing home admission, and death.
Comorbidities and atypical features in this sample of patients with Alzheimer's disease did not substantially affect dementia outcomes. The primary determinant of the clinical course of dementia in this sample was the presence of clinically diagnosed Alzheimer's disease, independent of the presence or absence of comorbidities or atypical features. Therefore, patients with possible Alzheimer's disease may be considered for inclusion in investigations of Alzheimer's disease, including clinical trials, to improve the generalizability of the findings.
确定与共病或非典型特征相关的阿尔茨海默病（AD）（可能的AD）与无并发症的AD（很可能的AD）相比，在临床病程和结局方面是否存在差异。
对AD患者进行了长达11年的年度评估。640名AD患者在临床上被分为两组：1）可能的AD（n = 208），和2）很可能的AD（n = 432）。在基线时收集了人口统计学数据、简易精神状态检查表（MMSE）、简短Blessed测试（SBT）、心理测量表现和临床痴呆评定量表（CDR）。采用Kaplan-Meier生存曲线和Cox比例风险模型来评估与很可能的AD相比，可能的AD在痴呆进展、入住养老院和死亡方面是否会有不同的结局。
可能的AD组比很可能的AD组年龄稍小且受教育程度较低，但在基线时MMSE、SBT和CDR评分方面两组没有差异。在控制年龄和教育因素后，可能的AD组基线心理测量表现较差（p = 0.022）。然而，在痴呆进展率、入住养老院和死亡方面两组没有差异。
该阿尔茨海默病患者样本中的共病和非典型特征并未对痴呆结局产生实质性影响。该样本中痴呆临床病程的主要决定因素是临床诊断为阿尔茨海默病，与共病或非典型特征的有无无关。因此，对于可能患有阿尔茨海默病的患者，可考虑将其纳入阿尔茨海默病的研究，包括临床试验，以提高研究结果的普遍性。
