Drachman D A, O'Donnell B F, Lew R A, Swearer J M
Department of Neurology, University of Massachusetts Medical School, Worcester 01655.
Arch Neurol. 1990 Aug;47(8):851-6. doi: 10.1001/archneur.1990.00530080033007.
Clinical features at the initial examination of 42 patients with probable Alzheimer's disease were tested for prognostic value at subsequent follow-up of 54 +/- 25 months. These potential prognostic features were of three types: degree of severity features (eg, IQ scores); variable clinical features (eg, extrapyramidal signs); and individual distinguishing features (eg, gender, education, and age). The power of these potential prognostic features to predict prognosis was assessed using the Kaplan-Meier life-tables method and the Cox proportional hazards model. Three clinical end points were considered: total dependence in activities of daily living; incontinence; and institutionalization at follow-up. Degree of severity features (subtests of the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale, and the Clinical Severity Score) predicted subsequent dependence in activities of daily living, incontinence, and institutionalization. Historical disease duration, age, gender, family history of dementia, retrospective rate of progression, anxiety, psychosis, depression, and extrapyramidal signs did not influence prognosis. These results suggest that initial degree of severity ("how far") rather than variation in the rate of progression ("how fast") best predicts prognosis in the early to intermediate stages of Alzheimer's disease. The relationship of disease severity to prognosis should be taken into account before concluding that there are subtypes of Alzheimer's disease that have different rates of progression.
对42例可能患有阿尔茨海默病的患者在初次检查时的临床特征进行了测试，以评估其在随后54±25个月随访中的预后价值。这些潜在的预后特征有三种类型：严重程度特征（如智商分数）；可变临床特征（如锥体外系体征）；以及个体区分特征（如性别、教育程度和年龄）。使用Kaplan-Meier生存表法和Cox比例风险模型评估这些潜在预后特征预测预后的能力。考虑了三个临床终点：日常生活活动完全依赖；大小便失禁；以及随访时入住机构。严重程度特征（韦氏成人智力量表修订版和韦氏记忆量表的子测试以及临床严重程度评分）可预测随后在日常生活活动中的依赖程度、大小便失禁和入住机构情况。疾病病程、年龄、性别、痴呆家族史、回顾性进展率、焦虑、精神病、抑郁和锥体外系体征均不影响预后。这些结果表明，在阿尔茨海默病的早期至中期，初始严重程度（“病情多严重”）而非进展速度的变化（“进展多快”）最能预测预后。在得出存在进展速度不同的阿尔茨海默病亚型这一结论之前，应考虑疾病严重程度与预后的关系。
