将美国国立神经疾病和中风研究所（NINDS）-爱伦（AIREN）可能的血管性痴呆标准应用于痴呆中风队列的临床和放射学特征的影响。

Impact of applying NINDS-AIREN criteria of probable vascular dementia to clinical and radiological characteristics of a stroke cohort with dementia.

作者信息

Tang Wai Kwong, Chan Sandra S M, Chiu Helen F K, Ungvari Gabor S, Wong Ka Sing, Kwok Timothy C Y, Mok Vincent, Wong K T, Richards Polly S, Ahuja Anil T

机构信息

Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China.

出版信息

Cerebrovasc Dis. 2004;18(2):98-103. doi: 10.1159/000079256. Epub 2004 Jun 22.

DOI:10.1159/000079256

PMID:15218273

Abstract

BACKGROUND

There are no data concerning the relative representation of clinical vascular risk factors and radiological lesions in cases that have been ruled in and ruled out for probable vascular dementia (VaD) according to NINDS-AIREN criteria.

METHODS

Three months after their index stroke, a psychiatrist interviewed patients and made a diagnosis of VaD according to both DSM-IV and NINDS-AIREN criteria for probable VaD. Patients who fulfilled the DSM-IV criteria for VaD were divided into two groups: those who were ruled in and ruled out according to NINDS-AIREN criteria as probable VaD. Demographic characteristics, vascular risk factors, clinical features of the index stroke and radiological findings were then compared between the two groups.

RESULTS

Of the 297 patients screened, 56 (18.8%) had a DSM-IV diagnosis of dementia. Among these demented patients, 55 (98.2%) and 22 (39.3%) fulfilled DSM-IV and NINDS-AIREN diagnosis of VaD, respectively. The concordance and level of agreement (kappa statistic) between DSM-IV and NINDS-AIREN diagnoses were 40% and 0.02, respectively. Reasons of failure to meet NINDS-AIREN criteria included the lack of temporal relationship between dementia and stroke (n = 20), the absence of focal neurological signs and/or radiological evidence of stroke (n = 6) and both of the above (n = 7). There was no significant difference between the above two groups in terms of demographic data, features of index stroke, vascular risk factors and CT scan findings, except that leukoaraiosis (p = 0.021) and bilateral lesions (p = 0.015) were more frequent in subjects diagnosed according to NINDS-AIREN criteria of probable VaD. The difference between these two groups with respect to the number of lesions was borderline for significance (p = 0.052).

CONCLUSIONS

The use of NINDS-AIREN criteria for VaD for case selection in poststroke dementia research may exclude a number of subjects with VaD.

摘要

背景

对于根据美国国立神经疾病与中风研究所-国际神经科学协会（NINDS-AIREN）标准确诊和排除的可能血管性痴呆（VaD）病例，尚无关于临床血管危险因素和放射学病变相对表现的数据。

方法

在首次中风后三个月，一名精神科医生对患者进行访谈，并根据DSM-IV和NINDS-AIREN标准对可能的VaD做出诊断。符合DSM-IV标准的VaD患者分为两组：根据NINDS-AIREN标准确诊和排除的可能VaD患者。然后比较两组患者的人口统计学特征、血管危险因素、首次中风的临床特征和放射学检查结果。

结果

在筛查的297例患者中，56例（18.8%）有DSM-IV诊断的痴呆。在这些痴呆患者中，分别有55例（98.2%）和22例（39.3%）符合DSM-IV和NINDS-AIREN诊断的VaD。DSM-IV和NINDS-AIREN诊断之间的一致性和一致程度（kappa统计量）分别为40%和0.02。未达到NINDS-AIREN标准的原因包括痴呆与中风之间缺乏时间关系（n = 20）、无局灶性神经体征和/或中风的放射学证据（n = 6）以及上述两者皆有（n = 7）。除了根据NINDS-AIREN标准诊断为可能VaD的患者中白质疏松（p = 0.021）和双侧病变（p = 0.015）更为常见外，上述两组在人口统计学数据、首次中风特征、血管危险因素和CT扫描结果方面无显著差异。两组之间病变数量的差异接近显著水平（p = 0.052）。