Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China.
Department of Neurology, Haining People's hospital, Jiaxing, China.
BMC Geriatr. 2023 Mar 14;23(1):142. doi: 10.1186/s12877-023-03841-1.
Rapidly progressive dementia (RPD) is a syndrome originating from various diseases. Recent advances have allowed a better understanding of its categories and spectrum; however, it remains challenging to make an accurate differential diagnosis and prognosis prediction.
This study was a retrospective evaluation of all participants admitted to the neurology department of a single center in China from January 2015 to December 2019. The screened patients met the RPD criteria and their characteristics were collected to explore a diagnostic pattern of RPD. In addition, outcomes of RPD were evaluated with the Glasgow Outcome Scale (GOS), activities of daily living scale (ADL), and simplified Mini-Mental State Examination (MMSE), and different prognostic analysis methods were performed to determine the prognostic factors of RPD.
A total of 149 RPD patients among 15,731 inpatients were identified with an average MMSE value of 13.0 ± 4.6 at baseline. Etiological epidemiology revealed infectious, neurodegenerative and toxic/metabolic diseases as the three largest groups, accounting for 26.2%, 20.8% and 16.8% of all cases, respectively. In particular, prevalence rates of Creutzfeldt-Jakob disease (13.4%), Alzheimer's disease (11.4%), carbon monoxide poisoning (8.1%), neurosyphilis (5.4%) and dementia with Lewy bodies (5.4%) were highest in this series. A recommended diagnostic framework for RPD etiology was thus established. Follow-up evaluations showed a negative correlation between age and GOS scores (r=-0.421, P < 0.001), as well as age and simplified MMSE scores (r =- 0.393, P < 0.001), and a positive correlation between age and ADL scores (r =0.503, P < 0.001), and significantly different GOS, ADL and simplified MMSE scores across various etiologies (P = 0.003; F = 9.463, P < 0.001; F = 6.117, P < 0.001).
Infectious, neurodegenerative and toxic-metabolic entities were the most common RPD categories, and establishing a practical approach to RPD etiology would allow better disease management.
快速进展性痴呆（RPD）是一种源于多种疾病的综合征。最近的进展使我们能够更好地理解其类别和谱系；然而，要做出准确的鉴别诊断和预后预测仍然具有挑战性。
本研究对 2015 年 1 月至 2019 年 12 月期间在中国一家单一中心的神经内科收治的所有患者进行了回顾性评估。筛选出的患者符合 RPD 标准，并收集其特征以探讨 RPD 的诊断模式。此外，使用格拉斯哥预后量表（GOS）、日常生活活动量表（ADL）和简化的简易精神状态检查表（MMSE）评估 RPD 的预后，采用不同的预后分析方法确定 RPD 的预后因素。
在 15731 名住院患者中，共发现 149 例 RPD 患者，基线时 MMSE 平均值为 13.0±4.6。病因流行病学显示，感染性、神经退行性和毒性/代谢性疾病是最大的三个疾病组，分别占所有病例的 26.2%、20.8%和 16.8%。在本系列中，克雅氏病（13.4%）、阿尔茨海默病（11.4%）、一氧化碳中毒（8.1%）、神经梅毒（5.4%）和路易体痴呆（5.4%）的患病率最高。因此建立了一个 RPD 病因的推荐诊断框架。随访评估显示，年龄与 GOS 评分呈负相关（r=-0.421，P<0.001），年龄与简化 MMSE 评分呈负相关（r=-0.393，P<0.001），年龄与 ADL 评分呈正相关（r=0.503，P<0.001），不同病因的 GOS、ADL 和简化 MMSE 评分有显著差异（P=0.003；F=9.463，P<0.001；F=6.117，P<0.001）。
感染性、神经退行性和毒性代谢性实体是最常见的 RPD 类别，建立一种实用的 RPD 病因方法将有助于更好地进行疾病管理。
