Moroney J T, Bagiella E, Desmond D W, Hachinski V C, Mölsä P K, Gustafson L, Brun A, Fischer P, Erkinjuntti T, Rosen W, Paik M C, Tatemichi T K
Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
Neurology. 1997 Oct;49(4):1096-105. doi: 10.1212/wnl.49.4.1096.
Our objectives were to investigate the utility of the Hachinski Ischemic Score (HIS) in differentiating patients with pathologically verified Alzheimer's disease (AD), multi-infarct dementia (MID), and "mixed" (AD plus cerebrovascular disease) dementia, and to identify the specific items of the HIS that best discriminate those dementia subtypes. Investigators from six sites participated in a meta-analysis by contributing original clinical data, HIS, and pathologic diagnoses on 312 patients with dementia (AD, 191; MID, 80; and mixed, 41). Sensitivity and specificity of the HIS were calculated based on varied cutoffs using receiver-operator characteristic curves. Logistic regression analyses were performed to compare each pair of diagnostic groups to obtain the odds ratio (OR) for each HIS item. The mean HIS (+/- SD) was 5.4 +/- 4.5 and differed significantly among the groups (AD, 3.1 +/- 2.5; MID, 10.5 +/- 4.1; mixed, 7.7 +/- 4.3). Receiver-operator characteristic curves showed that the best cutoff was < or = 4 for AD and > or = 7 for MID, as originally proposed, with a sensitivity of 89.0% and a specificity of 89.3%. For the comparison of MID versus mixed the sensitivity was 93.1% and the specificity was 17.2%, whereas for AD versus mixed the sensitivity was 83.8% and the specificity was 29.4%. HIS items distinguishing MID from AD were stepwise deterioration (OR, 6.06), fluctuating course (OR, 7.60), hypertension (OR, 4.30), history of stroke (OR, 4.30), and focal neurologic symptoms (OR, 4.40). Only stepwise deterioration (OR, 3.97) and emotional incontinence (OR, 3.39) distinguished MID from mixed, and only fluctuating course (OR, 0.20) and history of stroke (OR, 0.08) distinguished AD from mixed. Our findings suggest that the HIS performed well in the differentiation between AD and MID, the purpose for which it was originally designed, but that the clinical diagnosis of mixed dementia remains difficult. Further prospective studies of the HIS should include additional clinical and neuroimaging variables to permit objective refinement of the scale and improve its ability to identify patients with mixed dementia.
我们的目标是研究哈金斯基缺血评分（HIS）在鉴别经病理证实的阿尔茨海默病（AD）、多发梗死性痴呆（MID）以及“混合型”（AD合并脑血管疾病）痴呆患者中的效用，并确定HIS中最能区分这些痴呆亚型的具体项目。来自六个研究点的研究人员通过提供312例痴呆患者（AD 191例、MID 80例、混合型41例）的原始临床数据、HIS及病理诊断参与了一项荟萃分析。基于不同的临界值，利用受试者工作特征曲线计算HIS的敏感性和特异性。进行逻辑回归分析以比较每对诊断组，从而获得每个HIS项目的比值比（OR）。HIS的均值（±标准差）为5.4±4.5，在各组间存在显著差异（AD组为3.1±2.5；MID组为10.5±4.1；混合型组为7.7±4.3）。受试者工作特征曲线显示，如最初所提出的，AD的最佳临界值为≤4，MID的最佳临界值为≥7，敏感性为89.0%，特异性为89.3%。对于MID与混合型的比较，敏感性为93.1%，特异性为17.2%；而对于AD与混合型的比较，敏感性为83.8%，特异性为29.4%。区分MID与AD的HIS项目为病情逐步恶化（OR，6.06）、病情波动（OR，7.60）、高血压（OR，4.30）、卒中病史（OR，4.30）以及局灶性神经症状（OR，4.40）。只有病情逐步恶化（OR，3.97）和情感失禁（OR，3.39）能区分MID与混合型，只有病情波动（OR，0.20）和卒中病史（OR，0.08）能区分AD与混合型。我们的研究结果表明，HIS在AD和MID的鉴别中表现良好，这也是其最初设计的目的，但混合型痴呆的临床诊断仍然困难。对HIS的进一步前瞻性研究应纳入更多临床和神经影像学变量，以便对该量表进行客观优化，并提高其识别混合型痴呆患者的能力。
