老年轻度认知功能损害的随访研究  

Outcome and cognitive changes of mild cognitive impairment in the elderly: a follow-up study of 47 cases

作　　者：肖世富[1] 薛海波[1] 李冠军[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：《中华医学杂志》2006年第21期1441-1446,共6页National Medical Journal of China

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

摘　　要：目的观察和评价老年轻度认知功能损害患者的转归及其认知功能的变化特点。方法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(NC组)两组。主要认知评价工具为世界卫生组织老年认知功能评价成套神经心理测验(WHO-BCAI)和韦氏记忆测验(WMS),在基线和随访时分别评价。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统计手册(DSM-IV)的相关标准。结果MCI共入组47例,NC组50例。平均随访时间为34·0个月±1·8月,随访期间MCI组13例,NC组1例发展为痴呆,MCI组痴呆的发病率为27·7%,NC组为2·0%,两组差异具有统计学意义(P<0·01)。3年间,MCI组的简明智力状态检查(MMSE)总分平均下降了2·2分±3·7分,NC组下降了1·0分±1·9分;MCI组的记忆商(MQ)下降了12·6分±17·3分,NC组下降了3·9分±8·4分;MCI组中发展为痴呆的患者的MMSE和MQ下降更为明显,分别下降了5·5分±2·8分和30·0分±18·0分。WHO-BCAI测验结果显示,MCI组随访终点的连线、分类、命名、运动、再认、延迟回忆诸测验的成绩明显差于基线水平和NC组(P<0·01或0·05);MCI中发展为痴呆者的词汇学习、连线、分类、命名、词汇流畅、小标记、再认、视觉推理、延迟回忆等测验成绩显著低于未发展为痴呆的MCI患者(P<0·01或0·05)。Logistic回归分析显示,MMSE总分及其定向因子分,WMS的定向记忆因子分和WHO-BCAI测验的连线、注意和延迟回忆测验对MCI是否发展为痴呆具有显著性预测意义,三类测验预测的总正确率分别为70·3%、78·4%和90·7%。结论根据我们制定的纯MCI或AD型MCI标准入组的随访研究证实,MCI是老年期痴呆,尤其是阿尔茨海默病的前驱期。MCI发展为痴呆的认知变化特点是定向、注意、言语和执行功能等认知水平的显著下降。神经心理测验有助于预测MCI患者是否发展为痴呆,对老年期痴呆的早期诊断和干预治疗具Objective To examine the cognitive changes and outcome of mild cognitive impairment （MCI） in the elderly and to explore the predictive factors of development from MCI into dementia, Method A cross-sectional and longitudinal parallel cohort study design was conducted among 47 patients with MCI （MCI group）, aged 72, 4 ± 7, 1, and 50 sex, marital status, and professional structure- matched normal controls （NC group）, aged 67.9 ± 5, 3, using the Neuropsychological Battery of Cognitive Assessment Instruments developed by World Health Organization （WHO-BCAI） and the Wechsler Memory Scale （WMS） to assess the cognitive function, Follow-up was conducted for 34. 0 ± 1.8 months, The diagnosis of dementia was based on the criteria in the Diagnostic and Statistical Manual-IV, Results Dementia was diagnosed in 13 of the 47 MCI patients with a prevalence rate of 27, 7%, significantly higher than that in the NC group （2.0%, 1/50, P 〈 0.01 ）, The mean total score of mini-mental status examination （MMSE） of the MCI group decreased by 2, 2 ± 3. 7, significantly more than that of the NC group （ 1. 0 ＋ 1. 9, P 〈 0. 01 ）. The mean total mental quotient （MQ） of the MCI group decreased by 12, 6 ± 17, 3, significantly more than that of the NC group （3. 9 ± 8.4, P 〈 0, 01 ）, The values of MMSE and MQ of the 13 cases in the MCI group who developed into dementia patients decreased by 5. 5 ± 2. 8 and 30. 0 ± 18. 0 respectively, The WHO-BCAI assessment demonstrated that the scores of performance of verbal learning, verbal fluency, visual reasoning, trail making, sorting and spatial construct tests of the cases in the MCI group who developed into dementia patients were significantly poorer than those of the NC group （ P 〈 0. 01 ）, Logistic analysis based on the baseline assessment suggested that the total score of MMSE and its subtest of orientation, score of orientation memory of WMS, and the scores of performance of trail making, attention, and delayed recall tested by WHO-BCAI w

关 键 词：认知障碍 神经心理学测验 痴呆 

分 类 号：R749.16[医药卫生—神经病学与精神病学]