McKeith I G, Fairbairn A F, Perry R H, Thompson P
MRC Neurochemical Pathology Unit, Brighton Clinic, Newcastle Mental Health (NHS) Trust.
Br J Psychiatry. 1994 Sep;165(3):324-32. doi: 10.1192/bjp.165.3.324.
Current clinical classifications do not contain specific diagnostic categories for patients with senile dementia of the Lewy body type (SDLT), recently proposed as the second commonest neuropathological cause of dementia in the elderly. This study determines how existing clinical diagnosis systems label SDLT patients and suggests how such patients may be identified.
A range of clinical diagnostic criteria for dementia were applied to case notes of autopsy-confirmed SDLT (n = 20), dementia of Alzheimer type (DAT; n = 21) and multi-infarct dementia (MID; n = 9) patients who had received psychogeriatric assessment. The predictive validity of each set of clinical criteria was calculated against the external criterion of neuropathological diagnosis.
Many SDLT patients erroneously met criteria for MID (35% with Hachinski scores > or = 7) or for DAT (15% by NINCDS 'probable AD', 35% by DSM-III-R DAT and 50% by NINCDS 'possible AD'). Up to 85% of SDLT cases could be correctly identified using recently published specific criteria.
SDLT usually has a discernible clinical syndrome and existing clinical classifications may need revision to diagnose correctly such patients.
目前的临床分类中没有针对路易体痴呆型老年痴呆症（SDLT）患者的特定诊断类别，该病症最近被提出是老年人痴呆症的第二大常见神经病理学病因。本研究确定了现有临床诊断系统如何对SDLT患者进行分类，并提出了识别此类患者的方法。
一系列痴呆症临床诊断标准应用于接受过老年精神病学评估的经尸检确诊的SDLT患者（n = 20）、阿尔茨海默型痴呆（DAT；n = 21）和多发梗死性痴呆（MID；n = 9）患者的病历。根据神经病理学诊断的外部标准计算每组临床标准的预测效度。
许多SDLT患者错误地符合MID标准（35%的Hachinski评分≥7）或DAT标准（15%符合NINCDS“可能的AD”，35%符合DSM-III-R DAT，50%符合NINCDS“可能的AD”）。使用最近公布的特定标准，高达85%的SDLT病例能够被正确识别。
SDLT通常有可识别的临床综合征，现有临床分类可能需要修订以正确诊断此类患者。
