Bature Fidelia, Pang Dong, Robinson Anthea, Polson Norma, Pappas Yannis, Guinn Barbara
Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire Ringgold Standard Institution, Vicarage St., Luton LU2 8LE, United Kingdom.
Moakes Medical Centre, The Moakes, Marsh Farm Luton, LU3 3SR, United Kingdom.
Curr Alzheimer Res. 2018;15(8):723-730. doi: 10.2174/1567205015666180404155358.
Evidence suggests that individuals with Alzheimer's disease (AD) are often diagnosed in the later stages of their disease with a poor prognosis. This study is aimed to identify patterns in signs and symptoms preceding the clinical diagnosis of AD to suggest a predictive model for earlier diagnosis of the disease in the primary care.
A retrospective medical record review; nested case control design.
Participants included one hundred and nine patients from three general practice (GP) surgeries in Milton Keynes and Luton Clinical Commissioning Groups (CCG) (37 cases with AD and 72 controls without AD).
A retrospective analysis using the logistic regression of the presence of signs and symptoms before the diagnosis of AD was attained. Identification of the timing and sequence of appearance of these presentations as first reported before the clinical diagnosis was measured.
Episodic memory with an odds ratio of 1.85 was the most frequent presentation, documented in 1.38% of the controls and 75.6% in cases. Auditory disturbance with an odds ratio of 3.03, which has not previously been noted except in the form of auditory hallucination, could have a diagnostic value.
Auditory disturbance, which occurred mostly in the Caucasian females, could discriminate individuals with AD from those without the disease. The symptom, which presented up to 14.5 (mean time) years prior to clinical diagnosis, was identified in Caucasians and mixed race individuals only.
The study demonstrates that auditory disturbance could allow an earlier diagnosis of AD in Caucasian females. Episodic memory was confirmed as being frequently noted in AD patients prior to a clinical diagnosis as per previous publications. This study supports the development of a scoring system for the earlier diagnosis of AD. The data used was free from the confounding effects of misinformation, as this was written at the point of collection, thereby benefitting from the use of GP data that is diversified, reliable and valid.
Limited sample size that will not allow for generalization of less frequent observations due to their low prevalence in case notes. Randomisation was not achieved; however, the best available nonrandomisation which is consecutive sampling was used. Patterns identified were in LOAD, the baseline could vary with other geographical areas.
有证据表明，阿尔茨海默病（AD）患者常在疾病晚期被诊断出来，预后较差。本研究旨在确定AD临床诊断之前的体征和症状模式，以提出一种在初级保健中对该疾病进行早期诊断的预测模型。
回顾性病历审查；巢式病例对照设计。
参与者包括来自米尔顿凯恩斯和卢顿临床委托小组（CCG）的三家全科诊所（GP）的109名患者（37例AD患者和72例无AD的对照者）。
通过逻辑回归对AD诊断之前体征和症状的存在情况进行回顾性分析。确定这些症状首次报告在临床诊断之前出现的时间和顺序。
事件记忆的优势比为1.85，是最常见的症状，在1.38%的对照者中记录到，在病例中为75.6%。优势比为3.03的听觉障碍，除了以幻听形式出现外，此前未被注意到，可能具有诊断价值。
主要发生在白人女性中的听觉障碍，可以区分AD患者和非AD患者。该症状在临床诊断前长达14.5年（平均时间）出现，仅在白人和混血个体中被发现。
该研究表明，听觉障碍可以使白人女性更早地诊断出AD。根据先前的出版物，事件记忆在AD患者临床诊断之前经常被注意到这一点得到了证实。本研究支持开发一种用于AD早期诊断的评分系统。所使用的数据没有错误信息的混杂影响，因为这是在收集时记录的，从而受益于使用多样、可靠且有效的全科医生数据。
样本量有限，由于在病例记录中出现频率较低，不允许对不太常见的观察结果进行推广。未实现随机化；然而，使用了最佳可用的非随机化方法，即连续抽样。所确定的模式是在晚发性阿尔茨海默病中，基线可能因其他地理区域而有所不同。
