Alzheimer Centre and Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
J Clin Psychiatry. 2017 Nov/Dec;78(9):e1197-e1203. doi: 10.4088/JCP.16m11078.
Primary psychiatric disorders (PsD) can present with symptomatology identical to that of behavioral variant frontotemporal dementia (bvFTD). To date, clinical guidelines do not provide a solution for this diagnostic challenge. The aim of our study was to prospectively determine which demographic, clinical, neuropsychological, neuroimaging, and cerebrospinal fluid biomarkers are important in distinguishing PsD from bvFTD.
Patients with late-onset behavioral disturbances (aged 45-75 years, 73% male) were included based on their scores on the Frontal Behavioral Inventory and the Stereotypy Rating Inventory and followed for 2 years from April 2011 to June 2015. Odds ratios (ORs) were calculated with backward stepwise logistic regression analyses to investigate the association between baseline clinical and demographic variables and the 2-year follow-up diagnosis of PsD (n = 46) (DSM-IV) versus probable/definite bvFTD (n = 27) (International Behavioral Variant FTD Criteria Consortium criteria). We separately measured the association between additional investigations and the 2-year follow-up diagnosis. Finally, we combined the selected variables to measure the predictive value of both clinical and additional investigations in a single model.
Male gender (OR = 5.9; 95% CI, 1.3-26.0), less stereotypy (OR = 0.08; 95% CI, 0.02-0.34), and more depressive symptoms (OR = 1.13; 95% CI, 1.04-1.24) explained 49% of the variance predicting PsD versus bvFTD (χ²₃ = 29.4, P < .001) and correctly classified 82.1% of the cases. Neuroimaging (OR = 0.02; 95% CI, 0.002-0.123) explained 55% of the variance (χ²₁ = 37.5, P < .001) and, in combination with clinical variables, 66.1% of the variance (χ²₃ = 44.06, P < .001).
The present study demonstrated that PsD can be distinguished from probable/definite bvFTD with a thorough clinical evaluation by a psychiatrist and neurologist along with use of validated questionnaires for depression and stereotypy; these measures are even more effective in combination with neuroimaging.
原发性精神障碍（PsD）可能出现与行为变异额颞叶痴呆（bvFTD）相同的症状。迄今为止，临床指南并未为这一诊断挑战提供解决方案。我们的研究旨在前瞻性确定哪些人口统计学、临床、神经心理学、神经影像学和脑脊液生物标志物对区分 PsD 和 bvFTD 很重要。
根据额叶行为量表和刻板行为量表的评分，纳入 45-75 岁（73%为男性）的晚发性行为障碍患者，并在 2011 年 4 月至 2015 年 6 月期间进行为期 2 年的随访。采用向后逐步逻辑回归分析计算比值比（OR），以调查基线临床和人口统计学变量与 2 年随访的 PsD（n=46）（DSM-IV）与可能/明确 bvFTD（n=27）（国际行为变异额颞叶痴呆标准联盟标准）之间的关系。我们分别测量了其他检查与 2 年随访诊断之间的关系。最后，我们将选定的变量结合起来，在一个单一的模型中测量临床和其他检查的预测价值。
男性（OR=5.9；95%置信区间，1.3-26.0）、刻板行为较少（OR=0.08；95%置信区间，0.02-0.34）和更多的抑郁症状（OR=1.13；95%置信区间，1.04-1.24）解释了 49%的方差，预测 PsD 与 bvFTD（χ²₃=29.4，P<.001），正确分类 82.1%的病例。神经影像学（OR=0.02；95%置信区间，0.002-0.123）解释了 55%的方差（χ²₁=37.5，P<.001），与临床变量相结合，解释了 66.1%的方差（χ²₃=44.06，P<.001）。
本研究表明，通过精神病学家和神经科医生进行全面的临床评估以及使用经过验证的抑郁和刻板行为问卷，可以将 PsD 与可能/明确的 bvFTD 区分开来；这些措施结合神经影像学甚至更有效。
