Eisdorfer C, Cohen D, Paveza G J, Ashford J W, Luchins D J, Gorelick P B, Hirschman R S, Freels S A, Levy P S, Semla T P
Department of Psychiatry, University of Miami, FL.
Am J Psychiatry. 1992 Feb;149(2):190-4. doi: 10.1176/ajp.149.2.190.
Although the Global Deterioration Scale has been widely used since its publication in 1982, its stages are based on implicit assumptions about the linearity, temporality, and interdependence of cognitive, functional, and behavioral impairment in Alzheimer's disease. The authors evaluated the validity of these assumptions and tested the hypothesis that psychopathology and functional impairment would occur in earlier stages than the Global Deterioration Scale predicts.
The analyses were based on data on 324 patients with Alzheimer's disease who were selected from a registry of such patients. Data analyses included 1) descriptive statistics on the frequency of psychiatric symptoms and difficulties with activities of daily living and 2) logistic regression, with symptoms and functional impairment as independent variables, to test for significant changes in patients' status between stages of the Global Deterioration Scale.
More than 50% of the patients at stage 2 displayed psychopathology, and 32% had two or more symptoms. The significant increase in psychiatric symptoms occurred between stages 3 and 4, not between stages 5 and 6 as predicted by the Global Deterioration Scale. Impairment in functional status was observed at all stages, and significant increases occurred between stages 3 and 4 as well as between stages 5 and 6.
Psychiatric symptoms and functional impairment occur earlier than predicted by the Global Deterioration Scale, and the rate of change is also different from that specified in the scale. Separate scales to describe cognitive, clinical, and functional status may be the best way to describe the illness until better multidimensional instruments are developed.
尽管全球衰退量表自1982年发布以来被广泛使用，但其阶段划分基于对阿尔茨海默病认知、功能和行为损害的线性、时间性和相互依赖性的隐含假设。作者评估了这些假设的有效性，并检验了精神病理学和功能损害会比全球衰退量表预测的更早阶段出现的假设。
分析基于从此类患者登记册中选取的324例阿尔茨海默病患者的数据。数据分析包括：1）关于精神症状频率和日常生活活动困难的描述性统计；2）以症状和功能损害为自变量的逻辑回归，以检验全球衰退量表各阶段之间患者状态的显著变化。
2期患者中超过50%表现出精神病理学症状，32%有两种或更多症状。精神症状的显著增加发生在3期和4期之间，而非如全球衰退量表所预测的在5期和6期之间。在所有阶段均观察到功能状态受损，且在3期和4期之间以及5期和6期之间出现显著增加。
精神症状和功能损害比全球衰退量表预测的出现得更早，且变化率也与该量表规定的不同。在开发出更好的多维工具之前，用单独的量表来描述认知、临床和功能状态可能是描述该疾病的最佳方式。
