The validity of the family history method for identifying Alzheimerdisease
G. Li
Bok Engelsk 1997
| Utgitt | 1997
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| Omfang | Side 634- 640
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| Opplysninger | Objective: To examine the validity of the family history method foridentifying Alzheimer disease (AD) by comparing family history andneuropathological diagnoses.Methods: Seventy-seven former residents of the Jewish Home andHospital for the Aged, New York, NY, with neuropathologicalevaluations on record were blindly assessed for the presence ofdementia and, if present, the type of dementia through familyinformants by telephone interviews. The Alzheimer's Disease RiskQuestionnaire was used to collect demographic information and screenfor possible dementia. If dementia was suspected, the DementiaQuestionnaire was administered to assess the course and type ofdementia, ie, primary progressive dementia (PPD, likely AD), multipleinfarct dementia, mixed dementia (ie, PPD and multiple infarctdementia), and other dementias based on the modified Diagnostic andStatistical Manual of Mental Disorders, Third Edition, criteria.Results: Sixty (77.9%) of 77 elderly subjects were classified ashaving dementia and 17 (22.1%) were without dementia by familyhistory evaluation. Of the 60 elderly subjects with dementia, 57(95%) were found at autopsy to have had neuropathological changesrelated to dementia. The sensitivity of the family history diagnosisfor dementia with related neuropathological change was 0.84 (57 of68) and the specificity was 0.67 (6 of 9). Using family historyinformation to differentiate the type of dementia, the sensitivityfor definite or probable AD (with or without another condition) was0.69 (36 of 51) and the specificity was 0.73 (19 of 26). The majority(9 of 15) of patients testing false negative for PPD had a history ofstroke associated with onset of memory changes, excluding a diagnosisof PPD.Conclusions: Identifying dementia, in general, and AD, in particular,has an acceptable sensitivity and specificity. As is true for directclinical diagnosis, the major issue associated with misclassifying ADin a family history assessment is the masking effects of a coexistingnon-AD dementia or dementia-related disorders, such as stroke.Including mixed cases, ie, PPD and multiple infarct dementia inestimates of the familial risk for AD can reduce the extent ofunderestimation of PPD.
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| Emner |
