Absher J R, Sultzer D L, Mahler M E, Fishman J
Department of Neurology, UCLA School of Medicine.
Med Decis Making. 1994 Oct-Dec;14(4):393-402. doi: 10.1177/0272989X9401400410.
A modified receiver operating characteristic (ROC) analysis technique was applied to a sample of 161 consecutive volunteers seen in a dementia clinic. Clinical, imaging, neuropsychological, and laboratory evaluation guided experienced clinicians in clinical diagnosis, taken as the "gold standard." Two symptom inventories, the Hachinski Ischemic Score and the Dementia of the Alzheimer's Type Inventory, were obtained by clinicians who were blind to final clinical diagnosis; scores on these inventories correlate with the likelihoods of multi-infarct dementia and Alzheimer's disease, respectively. A disjunctive sequential testing strategy was analyzed such that subthreshold scores on the first test identified patients for whom the second test was considered. Both tests were analyzed at all possible cutoff-point combinations and in both possible testing sequences. Diagnoses based on these tests were compared with the clinical "gold standard" diagnoses to determine the accuracy of the testing procedures. The best strategy correctly classified 154/161 (95.6%) of the dementia patients and required cutoff points (5 for the HIS and 10 for the Dementia of the Alzheimer's Type Inventory) that were lower than those usually recommended for either test used alone (i.e., 7 and 14, respectively). The Hachinski Ischemic Score--then Dementia of the Alzheimer's Type Inventory testing sequence was superior to the reverse strategy. A sensitivity analysis (varying prevalences of Alzheimer's disease, multi-infarct dementia, and other dementias) revealed similar test performances across a wide range of prevalences. These data suggest that simple clinical tests that take approximately 30 minutes to administer can produce diagnostic classifications of dementia that are similar to those of clinicians experienced in dementia diagnosis.
一种改良的接受者操作特征（ROC）分析技术应用于在一家痴呆症诊所就诊的161名连续志愿者样本。临床、影像学、神经心理学和实验室评估指导经验丰富的临床医生进行临床诊断，将其作为“金标准”。两名临床医生在不知道最终临床诊断结果的情况下获取了两个症状量表，即哈金斯基缺血量表和阿尔茨海默病类型痴呆量表；这些量表的得分分别与多发性梗死性痴呆和阿尔茨海默病的可能性相关。分析了一种析取顺序测试策略，使得第一次测试中低于阈值的分数能够确定需要进行第二次测试的患者。对两次测试在所有可能的截断点组合以及两种可能的测试顺序下进行了分析。将基于这些测试的诊断结果与临床“金标准”诊断结果进行比较，以确定测试程序的准确性。最佳策略正确分类了161名痴呆症患者中的154名（95.6%），并且所需的截断点（哈金斯基缺血量表为5分，阿尔茨海默病类型痴呆量表为10分）低于单独使用这两种测试中任何一种时通常推荐的截断点（即分别为7分和14分）。先进行哈金斯基缺血量表测试，然后进行阿尔茨海默病类型痴呆量表测试的顺序优于相反的策略。一项敏感性分析（改变阿尔茨海默病、多发性梗死性痴呆和其他痴呆症的患病率）显示，在广泛的患病率范围内，测试表现相似。这些数据表明，大约需要30分钟进行的简单临床测试能够产生与痴呆症诊断经验丰富的临床医生相似的痴呆症诊断分类。
