老年轻度认知功能损害的记忆缺损变化及其预测痴呆的价值  

Changes of memory function in the elderly with mild cognitive impairment and their predictive value for dementia

作　　者：肖世富[1] 薛海波[1] 李冠军[1] 李霞[1] 李春波[2] 吴文源[2] 张明园[1] 

机构地区：[1]上海市精神卫生中心老年精神科,200030 [2]上海同济大学医学院

出　　处：《中华全科医师杂志》2006年第6期340-345,共6页Chinese Journal of General Practitioners

基　　金：上海市卫生系统百人计划项目(98BR033);国家自然科学基金资助项目(30170327)

摘　　要：目的观察和评价老年轻度认知功能损害(MCI)患者记忆功能的变化特点及其预测痴呆的价值。方法前瞻性对照研究。对象为患轻度认知功能损害的老年人(MCI组)和认知功能正常的老年人(对照组)两组。主要用韦氏记忆测验(WMS)和简易智力状态检查(MMSE),在基线和3年随访时分别评价轻度认知功能损害的记忆缺损变化。随访对象发展为痴呆的诊断标准为美国精神疾病诊断分类与统计手册第4版(DSM-Ⅳ)标准。结果MCI组共47例,对照组50例。平均随访时间为(34±2)个月,随访期间MCI组13例和对照组1例发展为痴呆,MCI组痴呆的发病率为27·7%,对照组为2·0%,两组差异有统计学意义(P<0·01)。3年间,MCI组的简易智力状态检查总分平均下降了(2·2±3·7)分,对照组下降了(1·0±1·9)分;MCI组的记忆商下降了(12·6±17·3)分,对照组下降了(3·9±8·4)分;MCI组中发展为痴呆的患者的简易智力状态检查和记忆商下降更为明显,分别下降了(5·5±2·8)分和(29·9±18·0)分。logistic回归分析显示,简易智力状态检查和韦氏记忆测验的定向记忆得分对MCI是否发展为痴呆具有显著性预测意义,2个测验预测的总正确率分别为70·3%、78·4%。结论MCI发展为痴呆的主要记忆功能改变有定向、识记、视觉、触觉等短期记忆显著下降,定向记忆的显著下降作为预测痴呆的因素,有助于痴呆的早期识别和预防。Objective To examine the changes of memory function in the elderly with mild cognitive impairment （MCI） and their predictive value for dementia. Methods A prospective cohort study was conducted. The elderly were divided into two groups, one with MCI and the other of normal cognitive function as controls. Memory function was assessed for all subjects by the Wechsler memory scale （WMS） and mini-mental status examination （MMSE） at baseline and the endpoint of the study. Dementia was diagnosed by the criteria based on Diagnostic and Statistical Manual of Mental Disorders, 4^th ed （ DSM-Ⅳ ） at the endpoint of follow-up. Results Forty-seven elderly persons with MCI and 50 normal controls recruited at baseline were followed-up for （34±2 ） months on average. Thirteen of 47 elderly persons （27.7%） in MCI group and one of 50 （2. 0% ） in control group developed dementia, respectively, during the follow-up, with a statistical significance （P 〈 0. 01 ）. Total score of MMSE decreased by 2. 2 ±3.7 in MCI group and 1.0 ±1.9 in control group, and memory quotient （MQ） decreased by 12. 6 ±17. 3 in the former and 3.9 ±8.4 in the latter on average, respectively, during the 3-year＇ s follow-up, with more decrease of 5. 5 ±2. 8 and 29. 9 ±18.0, respectively in those who developed dementia later. Logistic regression analysis based on baseline assessment suggested that scores of orientation memory in MMSE and WMS were predictive factors for those with MCI to become dementia later. Accuracy for MMSE and WMS tests to predict dementia were 70. 3% and 78.4%, respectively. Conclusions Changes of memory function in the elderly with MCI to develop dementia later are characterized by the decrease in short-term memory function including orientation, auditory verb learning, visual and tactile memory. Significant decrease in orientation memory has predictive value for the recognition and prevention of early dementia in the elderly.

关 键 词：认知障碍 神经心理学测验 痴呆 

分 类 号：R749.1[医药卫生—神经病学与精神病学]