White Lon, Small Brent J, Petrovitch Helen, Ross G Webster, Masaki Kamal, Abbott Robert D, Hardman John, Davis Daron, Nelson James, Markesbery William
Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, USA.
J Geriatr Psychiatry Neurol. 2005 Dec;18(4):224-7. doi: 10.1177/0891988705281872.
In this study, we compare neuropathological findings at autopsy with clinical dementia diagnoses, such as Alzheimer's disease and vascular dementia. Participants consisted of 363 aged Japanese-American men from the Honolulu-Asia Aging Study. Results indicated that the correspondence between clinical and neuropathologic diagnosis was not great, with 56% of patients diagnosed with probable or possible Alzheimer's disease during life but with only 19% having neuritic plaques and/or neurofibrillary tangles as the sole or dominant dementia-related lesions in the brain at autopsy. Although 16% of cases were attributed to mixed causes during life, almost 40% were found to have significant mixtures of dementia-related lesions at autopsy. Finally, both Alzheimer's disease and non-Alzheimer's disease neuropathologic lesions contributed independently to the explanation of variance on a test of overall cognitive performance. The results suggest that clinical diagnosis of dementia made during life may fail to reflect the pathogenic complexity of this condition in very elderly persons.
在本研究中，我们将尸检时的神经病理学发现与临床痴呆诊断进行了比较，如阿尔茨海默病和血管性痴呆。参与者包括来自檀香山-亚洲老年研究的363名日裔美国老年男性。结果表明，临床诊断与神经病理学诊断之间的一致性并不高，56%的患者在生前被诊断为可能或疑似阿尔茨海默病，但尸检时仅有19%的患者大脑中存在神经炎斑块和/或神经原纤维缠结作为唯一或主要的痴呆相关病变。虽然16%的病例在生前被归因于混合病因，但尸检时近40%的病例被发现存在明显的痴呆相关病变混合情况。最后，阿尔茨海默病和非阿尔茨海默病神经病理学病变均独立地对总体认知表现测试中的方差解释有所贡献。结果表明，生前做出的痴呆临床诊断可能无法反映非常年老人群中这种疾病的致病复杂性。
