Llebaria Gisela, Pagonabarraga Javier, Kulisevsky Jaime, García-Sánchez Carmen, Pascual-Sedano Berta, Gironell Alexandre, Martínez-Corral Mercè
Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona and CIBERNED (Centro de Investigaciones Biomédicas en Red - Enfermedades Neurodegenerativas), Barcelona, Spain.
Mov Disord. 2008 Aug 15;23(11):1546-50. doi: 10.1002/mds.22173.
The prevalence of dementia in Parkinson's disease (PD) is close to 30%, and its incidence is 4 to 6 times higher than in age-matched general population. PD with dementia (PDD) is mainly characterized by a predominant and progressive frontal-subcortical impairment. The Mattis Dementia Rating Scale (MDRS) is a commonly used screening test that sensitively measures the degree of frontal-subcortical defects. Although the MDRS has been validated as a screening test of cognitive dysfunction in nondemented PD patients (PD-ND), its utility for screening dementia in PD is unknown. In order to validate the MDRS for diagnosis of PDD it was prospectively administered to 92 PD patients (57 PD-ND, 35 PDD) fulfilling UK-PDSBB criteria. Dementia was diagnosed according to DSM-IV-TR and a Clinical Dementia Rating (CDR) scale score >or=1. Univariate, logistic regression, and ROC curve analysis were carried out to measure the discriminative power of MDRS in PDD. Regression analysis showed MDRS total scores to independently differentiate PD-ND from PDD (P < 0.001). Age and education did not predict the presence of dementia. ROC curve analysis showed a cut-off score of <or=123 on the MDRS total scores to yield high sensitivity (92.65%), specificity (91.4%), positive and negative predictive values (PPV 83.3%, NPV 96.4%). A brief version of the MDRS obtained by the addition of the memory, initiation/perseveration, and conceptualization subscores yielded similar discriminant properties. The MDRS has an excellent discriminant ability to diagnose dementia in PD and provides an objective measure to distinguish PD-ND from PDD.
帕金森病（PD）中痴呆的患病率接近30%，其发病率比年龄匹配的普通人群高4至6倍。帕金森病痴呆（PDD）主要特征为以额叶-皮质下损害为主且呈进行性发展。马蒂斯痴呆评定量表（MDRS）是一种常用的筛查测试，可灵敏地测量额叶-皮质下缺陷的程度。尽管MDRS已被确认为非痴呆型PD患者（PD-ND）认知功能障碍的筛查测试，但其在PD患者中筛查痴呆的效用尚不清楚。为验证MDRS对PDD的诊断价值，对92例符合英国帕金森病脑库（UK-PDSBB）标准的PD患者（57例PD-ND，35例PDD）进行了前瞻性研究。根据《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）及临床痴呆评定量表（CDR）评分≥1诊断痴呆。进行单因素分析、逻辑回归分析和ROC曲线分析以评估MDRS对PDD的判别能力。回归分析显示MDRS总分可独立区分PD-ND和PDD（P<0.001）。年龄和受教育程度不能预测痴呆的存在。ROC曲线分析显示，MDRS总分≤123分时，敏感性高（92.65%）、特异性高（91.4%）、阳性预测值和阴性预测值分别为83.3%和96.4%。通过将记忆、起始/持续和概念化子评分相加得到的MDRS简版具有相似的判别特性。MDRS对PD患者痴呆具有出色的判别能力，为区分PD-ND和PDD提供了客观指标。
