Swartz J R, Miller B L, Lesser I M, Booth R, Darby A, Wohl M, Benson D F
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance 90509, USA.
J Geriatr Psychiatry Neurol. 1997 Apr;10(2):67-74. doi: 10.1177/089198879701000206.
Often patients in the early stages of Alzheimer's disease (AD), frontotemporal dementia (FTD), and late-life depression can be difficult to differentiate clinically. Although subtle cognitive distinctions exist between these disorders, noncognitive behavioral phenomenology may provide additional discriminating power. In 19 subjects with AD, 19 with FTD, 16 with late-life psychotic depression (LLPD), and 19 with late-life nonpsychotic depression (LLNPD), noncognitive behavioral symptoms were quantified retrospectively using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and compared using both a one-way ANOVA and a multivariate stepwise discriminant analysis, which utilized a jackknife procedure. The FTD group showed the highest mean total SCAN score, while the AD group showed the lowest. ANOVA showed significant differences in the mean total SCAN scores between the four diagnostic groups (P < .0001). With the discriminant analysis, the four disorders demonstrated different clusters of behavioral abnormalities and were differentiated by these symptoms (P < .0001). A subset of 14 SCAN item group symptoms was identified that collectively classified the following percentages of subjects in each diagnostic category: AD 94.7%, FTD 100%, LLPD 87.5%, and LLNPD 100%. These results indicate that AD, FTD, LLPD, and LLNPD were distinguished retrospectively by the SCAN without using cognitive data. Better definition of the longitudinal course of noncognitive behavioral symptoms in different dementias and psychiatric disorders will be valuable both for diagnosis and to help define behavioral syndromes that are associated with selective neuroanatomic and neurochemical brain pathology.
通常，阿尔茨海默病（AD）、额颞叶痴呆（FTD）早期以及老年期抑郁症患者在临床上可能难以区分。尽管这些疾病之间存在细微的认知差异，但非认知行为现象学可能提供额外的鉴别能力。对19例AD患者、19例FTD患者、16例老年期精神病性抑郁症（LLPD）患者和19例老年期非精神病性抑郁症（LLNPD）患者，使用神经精神病学临床评估量表（SCAN）对非认知行为症状进行回顾性量化，并采用单因素方差分析和多因素逐步判别分析（使用刀切法）进行比较。FTD组的SCAN总分均值最高，而AD组最低。方差分析显示四个诊断组的SCAN总分均值存在显著差异（P <.0001）。通过判别分析，这四种疾病表现出不同的行为异常聚类，并可通过这些症状进行区分（P <.0001）。确定了14个SCAN项目组症状的一个子集，其对各诊断类别的受试者分类百分比分别为：AD 94.7%、FTD 100%、LLPD 87.5%和LLNPD 100%。这些结果表明，在不使用认知数据的情况下，通过SCAN可对AD、FTD、LLPD和LLNPD进行回顾性区分。更好地定义不同痴呆和精神疾病中非认知行为症状的纵向病程，对于诊断以及帮助定义与选择性神经解剖和神经化学脑病理学相关的行为综合征都将具有重要价值。
