不同记忆测验识别轻度认知损害的差异  

The distinct roles of different memory tests in identifying mild cognitive impairment

作　　者：郭起浩[1] 虞培敏[1] 赵倩华[1] 洪震[1] 吕传真[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040

出　　处：《中华神经科杂志》2007年第9期610-613,共4页Chinese Journal of Neurology

摘　　要：目的分析不同的记忆测验对于轻度认知损害(MCI)的识别力的差异。方法 2004年5月至2006年5月就诊于本院神经内科记忆障碍门诊的被试共712例,除了客观记忆指标,其余要求均符合 MCI 入组标准的有329例。全部入组者完成听觉词语学习测验(AVLT)、逻辑记忆测验(LM)、Rey-Osterrieth 复杂图形测验(CFT)及 MMSE、画钟测验、五点测验、言语流畅性测验、Stroop 色词测验、连线测验、临床痴呆评定量表。结果对于 MCI 的识别率 AVLT-Ⅱ(51%)>AVLT-Ⅰ(31%)>CFT 回忆(27%)>LM-Ⅰ(21%)=LM-Ⅱ(21%)。AVLT-Ⅱ与 LM-Ⅱ均>划界分者,为主观认知缺损(SCI)组,占47%(155/329);AVLT-Ⅱ与 LM-Ⅱ均≤划界分者,为确定 MCI 组,占19%(63/329);AVLT-Ⅱ与 LM-Ⅱ不一致,其中 AVLT-Ⅱ≤划界分而 LM-Ⅱ>划界分者,为分歧组,占32%(104/329)。通过对各领域神经心理测验结果和临床表现进行比较,分歧组明显不同于 SCI 组,而是接近于确定 MCI 组,也就是说,分歧组是认知功能损害相对较轻的 MCI。结论不同的情景记忆测验对于 MCI 的识别能力存在巨大的差异。AVLT 延迟回忆最敏感,可以作为 MCI"记忆减退的客观证据"。Objective To find the distinct roles of different meomory tests in identifying mild cognitive impairment（ MCI ）. Methods Seven hundred and twelve patients from the dysmnesia clinic in our hospital from May 2004 to May 2006 underwent brain CT scan or MRI. Among these patients, 329 were allocated into research group, who had complain of memory impairment, symptoms lasting more than 3 months, were aged between 50-80 years old, at an 8-year or up educational level, with MMSE≥24 and unknown etiology, normal auditory and visual sense, thus did not meet the diagnostic criteria of dementia according to NINCDS-ADRDA. A battery of neuropsychological tests comprised of auditory verbal learning test（AVLT） , logical memory test（ LM ） , Rey-Osterrieth complex figure test（CFT） , MMSE, clock drawing test, five point test, verbal fluency test, Stroop color word test, trail making test and clinical dementia rating scale. Results （ 1 ） The identified rate of MCI was 51% for AVLT- Ⅱ 〉 31% for AVLT- Ⅰ 〉 27% for recall of CFT 〉21% for LM- Ⅰ =21% for LM-Ⅱ. （2） The patients who had lower cut off score of AVLT- Ⅱ and LM- Ⅱ were classified into MCI group （63/329,19%）. The patients whose score of AVLT- Ⅱ was lower and LM- Ⅱ was higher than the cut off score were classified to incongruent group （ 104/329, 32% ）. （ 3 ） Analyzing of the clinical manifestation and psychological tests revealed patients in incongruent group, unlike the normal aged, were MCI patients whose cognitive impairment was comparatively mild. Conclusions There exists significant differences between the different episode memory tests in identifying MCI in Chinese culture. The delayed memory of AVLT, being the most sensitive, could be used to determine whether the patient had the objective evidence of memory impairment.

关 键 词：认知障碍 神经心理测验 记忆 

分 类 号：R749.1[医药卫生—神经病学与精神病学]