Benesch C G, McDaniel K D, Cox C, Hamill R W
Department of Neurology, University of Rochester School of Medicine and Dentistry, NY.
Arch Neurol. 1993 Dec;50(12):1309-15. doi: 10.1001/archneur.1993.00540120024008.
To characterize the cognitive and neurologic features of patients with end-stage Alzheimer's disease using a standard neurologic examination and the Glasgow Coma Scale.
Case series.
Local community nursing homes.
Forty patients with Alzheimer's disease were drawn from previously enrolled subjects in the Rochester Alzheimer's Disease Project with Clinical Dementia Rating scores of 3, 4, or 5.
Scores on the Glasgow Coma Scale and cognitive screening examinations and the prevalence of neurologic manifestations such as primitive reflexes and extrapyramidal signs were compared across the Clinical Dementia Rating groups.
When compared with patients in the Clinical Dementia Rating stages 3 and 4, patients with a stage 5 scored significantly lower on the Glasgow Coma Scale, with the discriminating subscales being verbal and motor responses. Primitive reflexes, myoclonus, and dyskinesia were increasingly prevalent in the more terminal stages. Cognitive screening assessments did not discriminate between groups.
Rudimentary neurologic functions can be readily assessed and, when viewed together with the Glasgow Coma Scale, may circumvent the "floor effect" frequently encountered when using the currently available cognitive and functional scales and, thereby, better define patients with end-stage Alzheimer's disease.
使用标准神经学检查和格拉斯哥昏迷量表来描述终末期阿尔茨海默病患者的认知和神经学特征。
病例系列。
当地社区养老院。
40例阿尔茨海默病患者选自罗切斯特阿尔茨海默病项目之前登记的受试者，临床痴呆评定量表评分为3、4或5。
比较临床痴呆评定量表各分组的格拉斯哥昏迷量表评分、认知筛查检查结果以及诸如原始反射和锥体外系体征等神经学表现的发生率。
与临床痴呆评定量表3期和4期的患者相比，5期患者的格拉斯哥昏迷量表评分显著更低，具有鉴别意义的分量表是言语和运动反应。原始反射、肌阵挛和运动障碍在更晚期阶段越来越普遍。认知筛查评估在各分组之间没有鉴别作用。
基本神经功能可以很容易地进行评估，并且与格拉斯哥昏迷量表一起使用时，可能会规避使用当前可用的认知和功能量表时经常遇到的“地板效应”，从而更好地界定终末期阿尔茨海默病患者。
