Université Lille Nord de France, UDSL, CNRS FRE3291, Neurology and Movement Disorders Unit, Lille University Medical Center, Lille, France.
Mov Disord. 2010 Dec 15;25(16):2769-76. doi: 10.1002/mds.23391.
Parkinson's disease (PD) is mainly characterized by its motor manifestations, but it is also frequently associated with dementia. Early diagnosis of PD dementia (PDD) is particularly important because effective cholinesterase inhibitor treatments are available. This study aimed at validating a short procedure for screening for PDD in routine clinical practice and which adopts recently published diagnostic criteria. One hundred eighty-eight patients with PD participated in the study. The examination procedure comprised three steps: standard clinical examination, a short cognitive function assessment fulfilling the requirements of the Movement Disorders Society (Mini Mental State Examination, five-word test, word generation task, and impact on daily life, including a questionnaire on compliance with medication) and an extensive evaluation of cognitive functions and behavior. After each step, the suspected presence or absence of dementia was recorded. After the short cognitive function assessment, PDD was suspected in 18.62% of the patients [95% confidence interval (CI): 13.32-24.93%]. After the extensive assessment, 21.81% (95% CI: 16.13-28.40%) met the criteria for probable PDD. The short battery's sensitivity and specificity were 65.85% (95% CI = 49.41-79.92%) and 94.56% (95% CI = 89.56-97.62%), respectively. A stepwise logistic regression analysis showed that use of a specific cut-off considerably enhanced the short battery's sensitivity (85.37%, 95% CI = 70.83-94.43%) without decreasing its specificity (83.67%, 95% CI = 76.69-89.25%). With an easy-to-use, short battery of tests that are commonly used in routine clinical practice, it is possible to diagnose PDD in accordance with reference criteria and with the same sensitivity and specificity as in a more extensive evaluation.
帕金森病（PD）主要以运动表现为特征，但也常伴有痴呆。早期诊断 PD 痴呆（PDD）尤为重要，因为目前已有有效的胆碱酯酶抑制剂治疗方法。本研究旨在验证一种在常规临床实践中筛查 PDD 的简短程序，并采用最近发表的诊断标准。188 例 PD 患者参与了这项研究。检查程序包括三个步骤：标准临床检查、满足运动障碍协会要求的简短认知功能评估（简易精神状态检查、五个单词测试、词语生成任务以及对日常生活的影响，包括一份关于药物依从性的问卷）和广泛的认知功能和行为评估。在每个步骤之后，记录怀疑是否存在痴呆。在进行简短的认知功能评估后，18.62%的患者（95%置信区间[CI]：13.32-24.93%）被怀疑患有 PDD。在进行广泛评估后，21.81%（95%CI：16.13-28.40%）符合可能的 PDD 标准。简短电池的灵敏度和特异性分别为 65.85%（95%CI=49.41-79.92%）和 94.56%（95%CI=89.56-97.62%）。逐步逻辑回归分析表明，使用特定的截止值可显著提高简短电池的灵敏度（85.37%，95%CI=70.83-94.43%），而不会降低其特异性（83.67%，95%CI=76.69-89.25%）。使用在常规临床实践中常用的简单、简短的测试组合，可以根据参考标准诊断 PDD，其灵敏度和特异性与更广泛的评估相同。
