Ellis R J, Jan K, Kawas C, Koller W C, Lyons K E, Jeste D V, Hansen L A, Thal L J
Department of Neurosciences, University of California, San Diego, La Jolla 92093-0948, USA.
Arch Neurol. 1998 Mar;55(3):360-5. doi: 10.1001/archneur.55.3.360.
To determine the sensitivity and specificity of postmortem dementia diagnoses based on a retrospective informant interview by comparison with criterion standard neuropathological diagnoses and the results of previous clinical examinations.
Three university-based academic research centers.
Fifty-four deceased elderly persons with Alzheimer disease, another dementing disorder, a neurologic disease resulting in functional impairment but no dementia, or no neurologic disorder.
Blinded nonclinician interviewers administered the Dementia Questionnaire (DQ) by telephone to informants, typically close relatives, who were familiar with the intellectual and functional status of the subjects before death. Two senior clinicians (LJ.T. and C.K.) rated each DQ for the presence or absence of a dementia syndrome during life and for the specific disorders causing the dementia, if present. Raters were blinded to the neuropathological findings and based their assessments only on data provided by responses to the DQ. Comparison was made with diagnoses based on neuropathological assessment. In most cases, the results of antemortem clinical examinations were also available as a check on the clinical diagnosis of the dementia syndrome. Sensitivity and specificity of the DQ diagnoses were computed, and chance-corrected agreement measures were calculated for the 2 independent DQ raters (LJ.T. and C.K.).
Compared with antemortem clinical diagnosis, the average sensitivity of the DQ for the clinical syndrome of dementia was 92.8%, the specificity was 89.5%, and the interrater agreement was 98% (kappa = 0.96). Among 7 subjects with mild dementia (Mini-Mental State Examination score > or = 24 at the last clinical examination), 5 (71%) were correctly identified using the DQ. The DQ correctly indicated the absence of dementia in 8 (80%) of 10 subjects with other neurologic disorders causing functional impairment. Compared with the neuropathological diagnoses, the DQ differentiated Alzheimer disease from other primary causes of dementia with a sensitivity of 89% and a specificity of 72%. The interrater agreement was 93.8% (kappa = 0.85).
Compared with the results of the antemortem clinical examinations, the DQ was sensitive to the presence of dementia, detected most cases of mild dementia, and discriminated dementia from other neurologic disorders causing functional impairment. Compared with the neuropathological diagnoses, the ability of the DQ to differentiate Alzheimer disease from other dementing disorders indicates that it may be useful as a research tool.
通过与标准神经病理学诊断及既往临床检查结果相比较，确定基于回顾性 informant 访谈的死后痴呆诊断的敏感性和特异性。
三个大学附属学术研究中心。
54 名已故老年人，患有阿尔茨海默病、其他痴呆症、导致功能障碍但无痴呆的神经系统疾病或无神经系统疾病。
不知情的非临床访谈者通过电话向 informant（通常是近亲）发放痴呆问卷（DQ），这些 informant 熟悉受试者生前的智力和功能状况。两名资深临床医生（LJ.T. 和 C.K.）根据 DQ 的回答，对每个受试者生前是否存在痴呆综合征以及导致痴呆的具体疾病（如果存在）进行评分。评分者对神经病理学结果不知情，仅根据 DQ 的回答数据进行评估。将其与基于神经病理学评估的诊断进行比较。在大多数情况下，生前临床检查结果也可用于核对痴呆综合征的临床诊断。计算 DQ 诊断的敏感性和特异性，并计算两名独立的 DQ 评分者（LJ.T. 和 C.K.）的机遇校正一致性指标。
与生前临床诊断相比，DQ 对痴呆临床综合征的平均敏感性为 92.8%，特异性为 89.5%，评分者间一致性为 98%（kappa = 0.96）。在 7 名轻度痴呆患者（最后一次临床检查时简易精神状态检查表评分≥24）中，使用 DQ 正确识别出 5 名（71%）。在 10 名因其他神经系统疾病导致功能障碍的受试者中，DQ 正确指出 8 名（80%）不存在痴呆。与神经病理学诊断相比，DQ 区分阿尔茨海默病与其他痴呆主要病因的敏感性为 89%，特异性为 72%。评分者间一致性为 93.8%（kappa = 0.85）。
与生前临床检查结果相比，DQ 对痴呆的存在敏感，能检测出大多数轻度痴呆病例，并能区分痴呆与其他导致功能障碍的神经系统疾病。与神经病理学诊断相比，DQ 区分阿尔茨海默病与其他痴呆症的能力表明它可能作为一种研究工具有用。
