Herlitz A, Small B J, Fratiglioni L, Almkvist O, Viitanen M, Bäckman L
Stockholm Gerontology Research Center, Karolinska Institute, Stockholm, Sweden.
Arch Neurol. 1997 Mar;54(3):319-24. doi: 10.1001/archneur.1997.00550150075019.
To investigate the accuracy of cognitive tests and clinical dementia diagnosis in distinguishing between mildly demented and nondemented subjects.
Three-year longitudinal follow-up of a community-based cohort sample. Using the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised as criterion variable, subjects were classified as demented and nondemented based on the results of cognitive test performance at time 1. These subjects were then examined prospectively for development of dementia at time 2.
The sample consisted of 63 mildly demented (Mini-Mental State Examination score > 18 < 24) and 398 nondemented subjects at time 1. At follow-up, due to death and refusal of participation, the sample consisted of 108 demented and 217 nondemented subjects.
The group of subjects who were considered to be demented according to the results of the cognitive tests and nondemented by the clinical diagnosis at time 1 had a higher incidence of dementia at time 2 than did the subjects who were considered to be nondemented according to both cognitive tests and clinical diagnosis. Among the incident dementia cases, subjects considered to be demented according to the cognitive tests but nondemented by the clinical diagnosis performed at a lower level on most cognitive tests were older, had less education, and consisted of more women than did the group of subjects who were considered to be demented by the clinical diagnosis and nondemented by the cognitive tests at time 1.
A combination of cognitive tests, especially tasks assessing episodic memory, can detect many subjects in a preclinical state of dementia who could be missed in the clinical diagnostic procedure due to subjects' relatively high age, low education, and female sex. However, cognitive tests also may miss a sizable proportion of prevalent dementia cases due to possible insensitivity to the same demographic variables. These findings indicate the need of integration between clinical and cognitive data to increase the accuracy in detecting dementia in an early phase.
探讨认知测试及临床痴呆诊断在区分轻度痴呆与非痴呆受试者方面的准确性。
对一个基于社区的队列样本进行为期三年的纵向随访。以《精神疾病诊断与统计手册》第三版修订本作为标准变量，根据时间1的认知测试表现结果将受试者分为痴呆组和非痴呆组。然后对这些受试者进行前瞻性检查，观察时间2时痴呆的发生情况。
样本在时间1时包括63名轻度痴呆患者（简易精神状态检查表评分>18<24）和398名非痴呆受试者。在随访时，由于死亡和拒绝参与，样本包括108名痴呆患者和217名非痴呆受试者。
根据认知测试结果被认为痴呆但在时间1时经临床诊断为非痴呆的受试者组，在时间2时痴呆的发病率高于根据认知测试和临床诊断均被认为非痴呆的受试者组。在新发痴呆病例中，根据认知测试被认为痴呆但经临床诊断为非痴呆的受试者在大多数认知测试中的表现水平较低，他们年龄更大、受教育程度更低，且女性比例高于在时间1时经临床诊断为痴呆但经认知测试为非痴呆的受试者组。
认知测试的组合，尤其是评估情景记忆的任务，可以检测出许多处于痴呆临床前期状态的受试者，这些受试者可能因年龄较大、受教育程度低和女性性别等原因在临床诊断过程中被遗漏。然而，由于可能对相同人口统计学变量不敏感，认知测试也可能遗漏相当一部分现患痴呆病例。这些发现表明需要整合临床和认知数据，以提高早期检测痴呆的准确性。
