Gay B E, Taylor K I, Hohl U, Tolnay M, Staehelin H B
Geriatric University Clinic, University Hospital Basel, Switzerland.
J Nutr Health Aging. 2008 Feb;12(2):132-7. doi: 10.1007/BF02982566.
Epidemiological studies show that up to 10% of individuals aged 65 years and older suffer from dementia, most commonly from dementia of the Alzheimer Type (DAT) (1). Clinicopathological studies are critical to our understanding of this disease and improving the accuracy of clinical diagnoses.
Our objectives were to examine the validity of clinical diagnoses of DAT, to determine the prevalence of different forms of dementia in this sample, and to investigate the relationship between age at death and polymorbidity.
Clinical data were available from 221 patients who had been examined at the Basel Memory Clinic between 1986 and 1996. From this population, 34% (75 patients) were autopsied in the Department of Pathology, University Hospital Basel, and neuropathological examinations were additionally performed on 62 (83%) of these patients. Clinical and neuropathological data were retrospectively compared.
67.8% of the neuropathologically examined patients received a definitive diagnosis of AD (Alzheimer's disease), vascular dementia (VaD) or mixed dementia (AD and VaD). AD alone or with other histopathological hallmarks of dementia was the most prevalent neuropathological diagnosis (63%). VaD was deemed the only cause of dementia in only 4.8% of patients. The sensitivity for DAT was 75.9%, the specificity 60.6%. Increasing age was associated with an increasing number of clinical and neuropathological diagnoses.
The sensitivity and specificity of the clinical diagnoses of DAT found in our study are similar to previous reports (2-5). Older patients had more etiologies of their dementia than younger patients. This study reaffirms the need for internationally accepted criteria for clinical and neuropathological diagnoses, as well as further clinical-neuropathological investigations to further refine the clinical diagnostic process.
流行病学研究表明，65岁及以上的人群中，高达10%患有痴呆症，最常见的是阿尔茨海默病型痴呆（DAT）（1）。临床病理研究对于我们理解这种疾病以及提高临床诊断的准确性至关重要。
我们的目的是检验DAT临床诊断的有效性，确定该样本中不同形式痴呆症的患病率，并研究死亡年龄与多种疾病并存之间的关系。
临床数据来自1986年至1996年间在巴塞尔记忆诊所接受检查的221名患者。在这些患者中，34%（75名患者）在巴塞尔大学医院病理科进行了尸检，另外对其中62名（83%）患者进行了神经病理学检查。对临床和神经病理学数据进行了回顾性比较。
经神经病理学检查的患者中，67.8%被明确诊断为阿尔茨海默病（AD）、血管性痴呆（VaD）或混合性痴呆（AD和VaD）。单独的AD或伴有其他痴呆组织病理学特征是最常见的神经病理学诊断（63%）。仅4.8%的患者被认为VaD是痴呆的唯一病因。DAT的敏感性为75.9%，特异性为60.6%。年龄增加与临床和神经病理学诊断数量增加相关。
我们研究中发现的DAT临床诊断的敏感性和特异性与先前报告相似（2 - 5）。老年患者痴呆的病因比年轻患者更多。本研究再次强调需要国际认可的临床和神经病理学诊断标准，以及进一步的临床 - 神经病理学研究以进一步完善临床诊断过程。
