Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
Parkinsonism Relat Disord. 2011 Sep;17(8):621-4. doi: 10.1016/j.parkreldis.2011.05.017. Epub 2011 Jun 30.
Diagnostic criteria and procedures for dementia in Parkinson's disease (PDD) have been proposed by a Movement Disorders Society Task Force (MDS-TF). The objective of this study was to explore the utility of the new MDS-TF criteria and procedures in clinical practice.
Two hundred ninety nine PD patients (36.5% with PDD as per MDFS-TF criteria; 33.1% according the DSM-IV) were included in the study. A variety of standardized motor, cognitive, psychiatric, and global severity measures were administered. A multivariate logistic regression model was built to determine the variables producing discrepancy between the MDS-TF and DSM-IV criteria for PDD and the clinical features that distinguished false negative cases.
Agreement between MDS-TF and DSM-IV criteria was substantial (87.3%; kappa = 0.72), but the DSM-IV criteria failed to identify 22% of patients fulfilling MDS-TF criteria. False negative cases were older and had more severe motor symptoms but less psychosis than those true non-demented PD. False positives had less severe motor symptoms than true PDD, although the difference did not reach statistical significance.
Our findings suggest that the MDS-TF criteria are more sensitive than the DSM-IV for a diagnosis of PDD. Old age, absence of psychiatric symptoms, and severe motor impairment can hinder the diagnosis of PDD.
帕金森病（PDD）的诊断标准和程序由运动障碍协会工作组（MDS-TF）提出。本研究的目的是探讨新的 MDS-TF 标准和程序在临床实践中的应用。
研究纳入 299 例 PD 患者（36.5% 根据 MDS-TF 标准为 PDD；33.1% 根据 DSM-IV）。采用多种标准化的运动、认知、精神和整体严重程度测量方法进行评估。建立多元逻辑回归模型，以确定 MDS-TF 和 DSM-IV 诊断 PDD 标准之间差异的变量以及区分假阴性病例的临床特征。
MDS-TF 和 DSM-IV 标准之间的一致性较高（87.3%；kappa=0.72），但 DSM-IV 标准未能识别符合 MDS-TF 标准的 22%患者。假阴性病例比真正非痴呆 PD 患者年龄更大，运动症状更严重，但精神病症状更少。假阳性病例的运动症状比真正的 PDD 更轻，尽管差异没有达到统计学意义。
我们的研究结果表明，与 DSM-IV 相比，MDS-TF 标准对 PDD 的诊断更敏感。年龄较大、无精神症状和严重运动障碍可能会阻碍 PDD 的诊断。
