Gironell Alexandre, García-Sánchez Carmen, Estévez-González Armando, Boltes Anunciación, Kulisevsky Jaime
Cognitive Disorders Section, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain.
J Clin Neurophysiol. 2005 Aug;22(4):279-84. doi: 10.1097/01.wnp.0000173559.60113.ab.
The existing studies about the utility of P300 latency for diagnostically classifying patients in preclinical stages of dementia are cross-sectional rather than longitudinal in design, and their results are inconclusive. The authors investigated the P300 value in a series of patients with subjective memory complaints using a prospective design. The study was performed in a consecutive series of 116 outpatients with subjective memory complaints as the predominant symptom. P300 (auditory oddball task) was performed immediately after the first clinical evaluation, and at 12 and 24 months. Final cognitive syndrome diagnosis (mean follow-up period, 27.7 months) was then made by a neurologist who was blinded to the neurophysiologic results. Diagnosis at the end of follow-up was 30 cases of normal cognition, 30 cases of mild cognitive impairment, 28 cases of dementia of Alzheimer's type (DAT), five cases of vascular dementia, and one case of frontotemporal dementia; 22 patients were lost to follow-up. P300 latency was significantly higher for the DAT group (analysis of variance: P=0.023) throughout the study. The diagnostic value of P300 latency at baseline examination for DAT had a sensitivity of 52.9% and a specificity of 76.9%; the odds ratio was 3.75 (95% confidence interval, 1.23-11.41). Findings from the present study suggest that assessment of evoked related potentials may contribute to the early detection of DAT.
关于P300潜伏期在痴呆临床前期患者诊断分类中的效用,现有研究在设计上是横断面研究而非纵向研究,其结果尚无定论。作者采用前瞻性设计,对一系列有主观记忆主诉的患者的P300值进行了研究。该研究对连续的116例以主观记忆主诉为主要症状的门诊患者进行。在首次临床评估后,以及在12个月和24个月时进行P300(听觉Oddball任务)测试。最终的认知综合征诊断(平均随访期为27.7个月)由一位对神经生理学结果不知情的神经科医生做出。随访结束时的诊断为:30例认知正常,30例轻度认知障碍,28例阿尔茨海默病型痴呆(DAT),5例血管性痴呆,1例额颞叶痴呆;22例患者失访。在整个研究过程中,DAT组的P300潜伏期显著更高(方差分析:P = 0.023)。基线检查时P300潜伏期对DAT的诊断价值,敏感性为52.9%,特异性为76.9%;优势比为3.75(95%置信区间,1.23 - 11.41)。本研究结果表明,评估诱发电位可能有助于DAT的早期检测。