确定唐氏综合征成年人患阿尔茨海默病的诊断阈值：剑桥唐氏综合征及其他智障老年人精神障碍检查（CAMDEX-DS）。
Establishing diagnostic thresholds for Alzheimer's disease in adults with Down syndrome: the Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS).
作者信息
Beresford-Webb Jessica A, Mak Elijah, Grigorova Monika, Daffern Samuel J, Holland Anthony J, Zaman Shahid H
机构信息
Department of Psychiatry, University of Cambridge, UK.
Department of Genetics, University of Cambridge, UK.
出版信息
BJPsych Open. 2021 Apr 13;7(3):e79. doi: 10.1192/bjo.2021.36.
BACKGROUND
Diagnosis of prodromal Alzheimer's disease and Alzheimer's disease dementia in people with Down syndrome is a major challenge. The Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) has been validated for diagnosing prodromal Alzheimer's disease and Alzheimer's disease dementia, but the diagnostic process lacks guidance.
AIMS
To derive CAMDEX-DS informant interview threshold scores to enable accurate diagnosis of prodromal Alzheimer's disease and Alzheimer's disease dementia in adults with Down syndrome.
METHOD
Psychiatrists classified participants with Down syndrome into no dementia, prodromal Alzheimer's disease and Alzheimer's disease dementia groups. Receiver operating characteristic analyses assessed the diagnostic accuracy of CAMDEX-DS informant interview-derived scores. Spearman partial correlations investigated associations between CAMDEX-DS scores, regional Aβ binding (positron emission tomography) and regional cortical thickness (magnetic resonance imaging).
RESULTS
Diagnostic performance of CAMDEX-DS total scores were high for Alzheimer's disease dementia (area under the curve (AUC), 0.998; 95% CI 0.953-0.999) and prodromal Alzheimer's disease (AUC = 0.954; 95% CI 0.887-0.982) when compared with healthy adults with Down syndrome. When compared with those with mental health conditions but no Alzheimer's disease, CAMDEX-DS Section B scores, denoting memory and orientation ability, accurately diagnosed Alzheimer's disease dementia (AUC = 0.958; 95% CI 0.892-0.984), but were unable to diagnose prodromal Alzheimer's disease. CAMDEX-DS total scores exhibited moderate correlations with cortical Aβ (r ~ 0.4 to 0.6, P ≤ 0.05) and thickness (r ~ -0.4 to -0.44, P ≤ 0.05) in specific regions.
CONCLUSIONS
CAMDEX-DS total score accurately diagnoses Alzheimer's disease dementia and prodromal Alzheimer's disease in healthy adults with Down syndrome.
背景
对唐氏综合征患者的前驱期阿尔茨海默病和阿尔茨海默病痴呆进行诊断是一项重大挑战。剑桥唐氏综合征及其他智障老年人精神障碍检查（CAMDEX-DS）已被验证可用于诊断前驱期阿尔茨海默病和阿尔茨海默病痴呆，但诊断过程缺乏指导。
目的
得出CAMDEX-DS知情者访谈阈值分数，以便准确诊断唐氏综合征成年人的前驱期阿尔茨海默病和阿尔茨海默病痴呆。
方法
精神科医生将唐氏综合征参与者分为无痴呆、前驱期阿尔茨海默病和阿尔茨海默病痴呆组。受试者工作特征分析评估了CAMDEX-DS知情者访谈得出的分数的诊断准确性。Spearman偏相关分析研究了CAMDEX-DS分数、区域Aβ结合（正电子发射断层扫描）和区域皮质厚度（磁共振成像）之间的关联。
结果
与健康的唐氏综合征成年人相比，CAMDEX-DS总分对阿尔茨海默病痴呆（曲线下面积（AUC），0.998；95%可信区间0.953 - 0.999）和前驱期阿尔茨海默病（AUC = 0.954；95%可信区间0.887 - 0.982）的诊断性能较高。与有精神健康状况但无阿尔茨海默病的人相比，CAMDEX-DS B部分分数表示记忆和定向能力，能准确诊断阿尔茨海默病痴呆（AUC = 0.958；95%可信区间0.892 - 0.984），但无法诊断前驱期阿尔茨海默病。CAMDEX-DS总分在特定区域与皮质Aβ（r约为0.4至0.6，P≤0.05）和厚度（r约为 - 0.4至 - 0.44，P≤0.05）呈中度相关。
结论
CAMDEX-DS总分能准确诊断健康的唐氏综合征成年人的阿尔茨海默病痴呆和前驱期阿尔茨海默病。
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