使用结构性脑成像进行痴呆症检查时过度诊断血管性痴呆

Overdiagnosing Vascular Dementia using Structural Brain Imaging for Dementia Work-Up.

作者信息

Niemantsverdriet Ellis, Feyen Bart F E, Le Bastard Nathalie, Martin Jean-Jacques, Goeman Johan, De Deyn Peter Paul, Engelborghs Sebastiaan

机构信息

Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, and Biobank, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.

Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, and Biobank, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium Current affiliation: Department of Neurosurgery, Hospital Network Antwerp, Middelheim, Antwerp, Belgium.

出版信息

J Alzheimers Dis. 2015;45(4):1039-43. doi: 10.3233/JAD-142103.

DOI:10.3233/JAD-142103

PMID:25633672

Abstract

Hypothesizing that non-significant cerebrovascular lesions on structural brain imaging lead to overdiagnosis of a vascular etiology of dementia as compared to autopsy-confirmed diagnosis, we set up a study including 71 patients with autopsy-confirmed diagnoses. Forty-two patients in the population (59%) appeared to have definite Alzheimer's disease (AD), whereas 29 (41%) had a non-AD dementia form. The panel clinically diagnosed possible or probable vascular dementia (VaD) in 27 (38%) patients, whereas only five (19%) patients (p = 0.017) had an autopsy-confirmed diagnosis of VaD. Patients with vascular lesions on structural brain imaging were often misdiagnosed as possible or probable VaD as compared to autopsy-confirmed diagnosis.

摘要

我们假设，与尸检确诊的诊断相比，结构性脑成像上无显著意义的脑血管病变会导致对痴呆血管病因的过度诊断，因此我们开展了一项研究，纳入了71例尸检确诊的患者。该人群中有42例患者（59%）似乎患有明确的阿尔茨海默病（AD），而29例（41%）患有非AD痴呆形式。该小组临床诊断出27例（38%）患者可能或很可能患有血管性痴呆（VaD），而只有5例（19%）患者尸检确诊为VaD（p = 0.017）。与尸检确诊的诊断相比，结构性脑成像上有血管病变的患者常被误诊为可能或很可能患有VaD。