Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, Illinois 60612, USA.
Mov Disord. 2012 Feb;27(2):248-53. doi: 10.1002/mds.24059. Epub 2011 Dec 9.
The objective of this work was to evaluate the Movement Disorders Society (MDS) Task Force-proposed screening checklist for detecting Parkinson's disease dementia (PD-D) in relation to full neuropsychological testing. An MDS Task Force has proposed diagnostic procedures for PD-D, which have not been fully validated against more extensive neuropsychological testing. PD subjects were recruited from 2 specialty centers. A neuropsychologist evaluated them for dementia as part of routine clinical care. Independent clinical neurologists administered the MDS PD-D screening checklist. Diagnosis of PD-D by the 2 methods was compared. Ninety-one PD subjects had a mean age of 66.3 (SD = 9.7) years and a mean PD duration of 8.8 (SD = 6.1) years. Seven subjects (7.7%) met all 8 screening checklist criteria from the MDS PD-D screening tool and were classified as probable PD-D. Fifteen (16.5%) subjects were classified as PD-D by full neuropsychological assessment. The screening checklist showed 100% specificity, but only 46.7% sensitivity, for diagnosing PD-D compared to the full neuropsychological assessment. PD-D cases missed by the PD-D screening tool were largely due to 2 checklist items that were not endorsed (absence of depression and Mini-Mental State Examination [MMSE] scores <26). There was moderate agreement between these 2 methods for determination of PD-D (kappa = 0.59, P < .001). The MDS-PD-D screening checklist is highly accurate for detecting PD-D if all items are endorsed. However, for cases that do not meet these criteria, full neuropsychological testing is needed to differentiate PD-D from milder cognitive impairment. Revision of the checklist by altering or eliminating the 2 problematic checklist items may improve sensitivity.
这项工作的目的是评估运动障碍学会（MDS）工作组提出的筛查清单，以检测帕金森病痴呆（PD-D）与全面神经心理学测试的关系。MDS 工作组提出了 PD-D 的诊断程序，但尚未通过更广泛的神经心理学测试充分验证。PD 患者从 2 个专科中心招募。神经心理学家对他们进行痴呆评估，作为常规临床护理的一部分。独立的临床神经科医生则对 MDS PD-D 筛查清单进行了评估。比较了这两种方法诊断 PD-D 的结果。91 名 PD 患者的平均年龄为 66.3（SD=9.7）岁，平均 PD 病程为 8.8（SD=6.1）年。7 名患者（7.7%）满足 MDS PD-D 筛查工具中的所有 8 项筛查清单标准，被归类为可能的 PD-D。15 名患者（16.5%）根据全面神经心理学评估被归类为 PD-D。与全面神经心理学评估相比，筛查清单在诊断 PD-D 方面的特异性为 100%，但敏感性仅为 46.7%。PD-D 筛查工具漏诊的 PD-D 病例主要是由于 2 项筛查清单项目未被认可（无抑郁和简易精神状态检查[MMSE]评分<26）。这两种方法在确定 PD-D 方面具有中度一致性（kappa=0.59，P<.001）。如果所有项目均被认可，MDS-PD-D 筛查清单对检测 PD-D 非常准确。然而，对于不符合这些标准的病例，需要进行全面的神经心理学测试以区分 PD-D 与轻度认知障碍。通过改变或消除这 2 个有问题的筛查清单项目，可以提高敏感性。
