42例痴呆老年人的临床与病理诊断比较

Clinical and pathological comparison of 42 elderly patients with dementia

目的比较痴呆老年人的临床诊断与病理诊断的符合情况,以及影响诊断的因素。方法对42例痴呆老年人应用NINCDS诊断标准,以及Hachinski、Rosen、Loeb和Gandolfo3种缺血指数量表分别评分;在患者去世后进行全身系统的病理学检查,比较临床诊断及3种缺血指数量表评分与病理诊断的符合情况。结果病理诊断为老年性痴呆(AD)、血管性痴呆(VaD)、老年性痴呆+血管性痴呆(AD+VaD)、帕金森病痴呆(PDD)的各组老年人的平均发病年龄及生存年限无显著性差异,临床与病理诊断的符合率分别为80.0%、52.4%、18.2%和0.0%,有显著性差异;根据3种缺血指数量表评分做出的诊断与病理诊断的符合率约40%～70%;不同类型痴呆及3种缺血指数量表与病理诊断的符合率之间无显著性差异;本组不同类型痴呆患者的帕金森病发病率间无显著性差异。结论影响老年人痴呆诊断的因素主要是多种疾病并存;Hachinski、Rosen、Loeb和Gandolfo3种缺血指数量表评分对痴呆的诊断无显著性差异。

Objective To compare the clinical and the pathological diagnosis of elderly with dementia, assess the related factors affecting the diagnosis. Methods The 42 autopsied elderly patients with dementia were assessed with the National Institute for Neurological Disorders and Stroke （NINDS） criteria and the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo for the clinical diagnosis of dementia. Specificity was calculated using the neuropathologic diagnosis as a gold standard. Results The patients were differentiated with pathology verified Alzheimer＇s disease fAD）, vascular dementia （VaD）, and “mixed” （AD plus VaD） dementia, Parkinson＇s disease dementia （PDD）. Comparing clinical criteria and neuropathology, the consistent rate was 80.0% for AD, 52.4 % for VaD, 18.2% for AD＋VaD and 0.0% for PDD. The consistent rate between 3 scores and the pathological diagnosis was about 40% -70%. There were no significant differences between the average age of onset and the survival time, and the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo among the 4 types of dementia. There was no significant difference in the specificity of the NINDS criteria among the 4 types of dementia. Conclusion Dementia associated with cerebrovascular disease and Parkinson＇s disease is the main factor affecting the diagnosis of elderly with dementia. There is no significant difference for the diagnosis of dementia among the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo.