McCormick W C, Kukull W A, van Belle G, Bowen J D, Teri L, Larson E B
Division of Geriatrics ZA-87, University of Washington, Seattle.
J Am Geriatr Soc. 1994 May;42(5):517-21. doi: 10.1111/j.1532-5415.1994.tb04974.x.
To learn whether patients with early Alzheimer's disease tend to under-report or over-report symptoms and to compare their comorbidity with non-demented patients.
Case Control Study in a population-based dementia registry.
Three groups of subjects (mean age 76) were enrolled from an HMO base population: 154 cases had clinically diagnosed probable Alzheimer's disease, 92 subjects were found to be not demented although they had complaints of cognitive impairment, and another 129 cognitively intact controls were enrolled after frequency-matching for age and sex.
Medical records were examined for the 2 years prior to enrollment. Symptoms suggestive of cognitive impairment were evident 7.8 months prior to enrollment (median 6 months) in 95% of cases, in 77% of the not demented subjects, and in 6% of controls. After corrections for multiple comparisons, only symptoms of cognitive impairment were more frequent in cases, whereas several common symptoms not suggestive of cognitive impairment (eg, gastrointestinal discomfort, joint pain, vision problems) occurred more often in controls and the not demented group, even though comorbidity was similar among all three groups (Charlson Index mean scores: case = 0.7, not demented = 0.7, control = 0.5).
Persons with Alzheimer's disease do complain of symptoms clearly related to cognitive impairment early in the course of illness, but may under-report common symptoms not suggestive of cognitive impairment, even though their comorbidity is similar to patients without dementia.
了解早期阿尔茨海默病患者是否倾向于少报或多报症状，并比较他们与非痴呆患者的合并症情况。
基于人群的痴呆症登记处进行的病例对照研究。
从一个健康维护组织（HMO）的基础人群中招募了三组受试者（平均年龄76岁）：154例临床诊断为可能的阿尔茨海默病；92例虽有认知障碍主诉但未被诊断为痴呆；另外129例认知功能正常的对照者按年龄和性别进行频率匹配后入选。
检查入组前2年的病历。在95%的病例中，入组前7.8个月（中位数6个月）出现提示认知障碍的症状；77%的非痴呆受试者出现此类症状；6%的对照者出现此类症状。在进行多重比较校正后，仅认知障碍症状在病例组中更常见，而一些不提示认知障碍的常见症状（如胃肠道不适、关节疼痛、视力问题）在对照组和非痴呆组中出现得更频繁，尽管三组的合并症情况相似（查尔森指数平均得分：病例组=0.7，非痴呆组=0.7，对照组=0.5）。
阿尔茨海默病患者在疾病早期确实会诉说与认知障碍明显相关的症状，但可能会少报不提示认知障碍的常见症状，尽管他们的合并症情况与非痴呆患者相似。
