Zusammenfassung:
Zur Früherkennung von Demenzen eingesetzte psychometrische Tests erweisen sich in
der ärztlichen Praxis in Durchführung und Auswertung häufig als zu umfangreich und
schwierig. Andere „Früherkennungstests” wurden hierfür nicht entwickelt und erreichen
lediglich eine geringe Sensitivität und Spezifität bei der Abgrenzung gesund vs. krank.
Zur gleichzeitigen Abgrenzung einer Pseudodemenz wurde bisher kein Test entwickelt.
Ziel der vorliegenden Arbeit war es, einen sensitiven, spezifischen, leicht durchführ-
und auswertbaren Test zur Früherkennung der Demenz zu entwickeln, der auch Depressionen
abgrenzt. Aus einer Analyse früherer Untersuchungsdaten wurden Items selektiert, die
sich besonders für die Früherkennung von Demenzen eignen. Zusätzlich wurden Symptome
einer depressiven Störung erhoben. Mit den resultierenden Items wurden 88 Patienten
mit Alzheimerkrankheit, 52 Patienten mit depressiver Störung und 37 altersvergleichbare
gesunde Kontrollpersonen für den Demenzteil des Tests untersucht. In diesem vordiagnostizierten
Kollektiv erreichte der Test eine hundertprozentige Sensitivität und Spezifität (Vergleich
Kontrollpersonen vs. Patienten mit Alzheimerkrankheit: n = 125, U = 0, p < 0,001;
Patienten mit Depression vs. Patienten mit Alzheimerkrankheit n = 140, U = 0, p <
0,001; und für Kontrollpersonen vs. Patienten mit Depression: n = 89, U = 485,5, p
< 0,001). Die Inter-Rater-Reliabilität betrug rs = 0,996 (p < 0,001, n = 18) für den Demenzteil und rs = 0,753 (n = 18, p < 0,001) für den Depressionsteil des Tests, die Test-Retest-Reliabilität
lag bei rs = 0,868 (p < 0,001, n = 35) für den Demenz- und bei rs = 0,7 (n = 8, p < 0,05) für den Depressionsteil. Der Test erfüllt damit wesentliche
Validierungskriterien für den Einsatz in der ärztlichen Praxis. In seiner Diskriminationsfähigkeit
ist er umfangreicheren Verfahren zumindest ebenbürtig. Er leistet damit einen Beitrag
zur Früherkennung von Demenzen in der niedergelassenen Praxis.
Development and Validity of the Test for the Early Detection of Dementia with Differentiation
from Depression (TE4D):
Psychometric tests used for the early detection of dementia often are seen as too
difficult or too complex. Classical neuropsychologic tests were not developed for
this purpose. Sensitivity and specificity to descriminate “healthy” vs. “ill” are
low. For measuring both dementive and depressive symptoms, so far no test has been
published. The objective of this study was to develop a sensitive and specific test
for dementia that is easy to administer and to evaluate. Moreover, it should discriminate
dementia from depressive pseudodementia. With respect to former studies, items were
selected that recognized patients in the beginning of the disease. Additionally, depressive
symptoms were rated. With the items for dementia, 88 patients with dementia of the
Alzheimer type, 52 patients with depressive disorder and 37 healthy elderly controls
were investigated. In this group of already diagnosed patients, the test reached a
sensitivity and specificity of 100 percent (healthy elderly controls vs. patients
with Alzheimer's disease: n = 125, U = 0, p < 0.001; patients with depressive disorder
vs. patients with Alzheimer's disease: n = 140, U = 0, p < 0.001; healthy elderly
controls vs. patients with depressive disorder: n = 89, U = 485.5, p < 0.001). For
the dementia items, the inter-rater-reliability was rs = 0.996 (p < 0.001, n = 18), for the depression items it was rs = 0.753 (n = 18, p < 0.001). The test-retest-reliability was rs = 0.868 (p < 0.001, n = 35) for the dementia items and rs = 0.7 (n = 8, p < 0.05) for the depression items. These validation data will make
the test useful for practitioners. Its ability to discriminate patients suffering
from dementia of the Alzheimer type from healthy controls is comparable to tests consuming
more time.
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1 Die Arbeit wurde teilweise durch Forschungsfördermittel der Firmen Pharmacia-Upjohn
und Dr. Willmar Schwabe unterstützt.
Priv.-Doz. Dr. med. Dipl.-Psych. Ralf Ihl
Rheinische Kliniken
Psychiatrische Klinik der Heinrich-Heine-Universität
Bergische Landstraße 2
40629 Düsseldorf
Email: E-mail: KN42140@mail.lvr.de
