Reisberg B, Ferris S H, Franssen E H, Shulman E, Monteiro I, Sclan S G, Steinberg G, Kluger A, Torossian C, de Leon M J, Laska E
Aging and Dementia Research Center, New York University Medical Center, New York, USA.
Int Psychogeriatr. 1996 Summer;8(2):291-311. doi: 10.1017/s1041610296002657.
Alzheimer's disease (AD) is associated with an increased mortality in comparison with aged control populations. The relationship between the clinical and the temporal course of AD has not been well studied over significant intervals. Community-residing patients with probable AD (N = 103, 42 men, mean age = 70.2 +/- 8.0 years) were studied at baseline on demographic and clinical variables, including measures of global deterioration (Global Deterioration Scale; GDS), mental status and cognition (e.g., Mini-Mental State Examination; MMSE), and functional impairment (Functional Assessment Staging; FAST). Baseline characteristics included a GDS range of Stage 4, 5, or 6 (38.8%, 39.8%, and 21.4%, respectively) and a mean MMSE score of 15.4 +/- 5.6. The mean follow-up interval was 4.6 +/- 1.4 years. Follow-ups were done blind to baseline measures and when necessary were conducted in residential and nursing home settings. Of locatable subjects (n = 95, 92%), 30 (31.6%) were decreased. Survivors (n = 65) had a mean GDS stage of 6.2 +/- 0.9 and a mean MMSE score of 5.1 +/- 6.9; 51% had MMSE scores of 0. Increased age and male gender, but not baseline clinical dementia variables, increased the risk of death (ps < .01). Change in clinical variables correlated significantly with time elapsed (r = .32, p < .05, for MMSE change, to r = .48, p < .001, for GDS change). Significant variance in temporal change (i.e., time elapsed) was accounted for by change in two of the five clinical measures studied (i.e., GDS and FAST; multiple r = .53). The results support previous estimates of mean duration of the GDS and FAST stages. For subjects with probable AD followed over approximately 5 years, clinical variables changed significantly over time in survivors. However, the majority of temporal variance in the course of AD remains unexplained.
与老年对照人群相比，阿尔茨海默病（AD）患者的死亡率更高。在较长时间段内，AD的临床病程与时间进程之间的关系尚未得到充分研究。对社区居住的可能患有AD的患者（N = 103，男性42例，平均年龄 = 70.2±8.0岁）进行了基线研究，涉及人口统计学和临床变量，包括整体衰退测量（整体衰退量表；GDS）、精神状态和认知（如简易精神状态检查表；MMSE）以及功能损害（功能评估分期；FAST）。基线特征包括GDS处于4期、5期或6期的范围（分别为38.8%、39.8%和21.4%），MMSE平均得分为15.4±5.6。平均随访间隔为4.6±1.4年。随访时对基线测量结果不知情，必要时在住宅和养老院环境中进行。在可找到的受试者中（n = 95，92%），30例（31.6%）病情恶化。存活者（n = 65）的GDS平均分期为6.2±0.9，MMSE平均得分为5.1±6.9；51%的患者MMSE得分为0。年龄增加和男性性别增加了死亡风险，但基线临床痴呆变量并未增加死亡风险（p值 <.01）。临床变量的变化与经过的时间显著相关（MMSE变化的r = 0.32，p <.05，到GDS变化的r = 0.48，p <.001）。所研究的五项临床测量中的两项变化（即GDS和FAST）解释了时间变化（即经过的时间）中的显著差异（多重r = 0.53）。结果支持了先前对GDS和FAST阶段平均持续时间的估计。对于随访约5年的可能患有AD的受试者，存活者的临床变量随时间发生了显著变化。然而，AD病程中的大部分时间差异仍无法解释。
