Nourhashémi Fati, Ousset Pierre Jean, Gillette-Guyonnet Sophie, Cantet Christelle, Andrieu Sandrine, Vellas Bruno
CHU Toulouse, Hôpital Casselardit, Service de médecine interne et gérontologie clinique, Toulouse, France.
Int J Geriatr Psychiatry. 2008 May;23(5):460-5. doi: 10.1002/gps.1904.
Making an early diagnosis of Alzheimer's Disease (AD) is becoming increasingly important. The Clinical Dementia Rating scale (CDR), a semi-structured interview with patient and caregiver, is a global rating scale designed for use in staging dementia. The primary objective of our study was to examine the evolution of AD in individuals with very mild AD (CDR 0.5) across a 2-year follow up.
A cohort of AD patients (n=682) living in the community were followed during 2 years in 16 centres of the French AD network. Each subject underwent extensive medical examination including the MMSE and CDR every 6 months.
Two hundred and thirty-three AD patients were rated CDR 0.5 at baseline (mean MMSE score: 23.15+/-2.57). They were younger and reported an average duration of symptoms of approximately 0.8 years less than patients with CDR >or= 1.During the 2-year follow-up, none of the AD CDR 0.5 subjects improved; 65% of them showed an increase in the CDR score. The rate of cognitive decline was similar between the AD CDR 0.5 and CDR >or= 1 groups. The ADL decline was more significant in patients with CDR >or= 1 at inclusion.
It is certainly possible to identify AD at a very early stage focusing on intra individual change in cognitive and functional impairment. Criteria with a high sensitivity and specificity for detecting AD at an early stage will help to further develop effective pharmacological and behavioural interventions for delaying the onset and progression of the disease.
早期诊断阿尔茨海默病（AD）变得越来越重要。临床痴呆评定量表（CDR）是一种针对患者和照料者的半结构化访谈，是一种用于痴呆分期的整体评定量表。我们研究的主要目的是在两年的随访中，观察极轻度AD（CDR 0.5）患者的AD病情演变。
法国AD网络的16个中心对一组居住在社区的AD患者（n = 682）进行了为期两年的随访。每位受试者每6个月接受包括简易精神状态检查表（MMSE）和CDR在内的全面医学检查。
233例AD患者在基线时评定为CDR 0.5（平均MMSE评分：23.15±2.57）。他们比CDR≥1的患者更年轻，且报告的平均症状持续时间约少0.8年。在两年的随访中，没有CDR 0.5的AD受试者病情改善；其中65%的受试者CDR评分增加。CDR 0.5的AD组和CDR≥1的AD组认知衰退率相似。纳入时CDR≥1的患者日常生活能力衰退更显著。
聚焦于个体认知和功能损害的变化，确实有可能在极早期识别AD。具有高敏感性和特异性的早期检测AD的标准将有助于进一步开发有效的药物和行为干预措施，以延缓疾病的发作和进展。
