画钟测验的评分方法探讨  

A study of validity of a new scoring system of clock drawing test

作　　者：郭起浩[1] 付建辉[1] 袁晶[2] 赵倩华[1] 曹歆轶[1] 洪震[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040 [2]上海市东方医院神经内科

出　　处：《中华神经科杂志》2008年第4期234-237,共4页Chinese Journal of Neurology

基　　金：国家自然科学基金资助项目（30570601）

摘　　要：目的编制和验证画钟测验（CDT）新的评分方法。方法对188名健康中老年人、170例轻度认知障碍（MCI）患者和81例轻度阿尔茨海默病（AD）患者进行CDT等一系列神经心理测验。CDT30分法包括先锚定12-3-6-94个点，称为“30分法-A”，共4分；反映画钟结果的其余13项，称为“30分法-C”，共26分，总分30分。38例被试者完成氙-CT（Xe-CT）检查，定量测量脑26个区域的局部血流量（rCBF）。结果CDT30分法的14个项目分与总分的相关系数r=0．48～0．71，均有显著的相关性（P〈0．01）。“30分法-C”与空间知觉和执行功能指标的相关性较大（r=0．58～0．64），而“30分法．A”与记忆指标的相关性较大（r=0．67）。“30分法-A”≤2分，识别MCI的敏感性为70．6％，特异性为73．9％，“30分法-C”≤17分，识别MCI的敏感性为38．2％，识别轻度AD的敏感性为75．3％，特异性为75．9％。CDT与Xe-CT检测的rCBF的关系：“30分法-A”和“30分法-C”的回归方程中，入选的自变量分别为左额叶下区和右白质区。结论“30分法”A和C两部分具有不同的意义，“30分法-C”可用于识别AD，而“30分法-A”有助于MCI的识别。Objective To set up and verify a new scoring system of clock drawing test （CDT）. Methods CDT and other neuropsychological tests were applied to 180 normal individuals, 170 subjects with mild cognitive impairment （ MCI）, and 31 patients with mild Alzbeimer＇ s disease （AD）. The first step of the 30-score system of CDT was to anchor the 4 points of ＂12-3-6-9＂, totaling a score of 4 which was the ＂30-score system A （Anchoring） part ＂ ; and the other 13 items reflecting the drawing results and totaling a score of 26 made up the so called ＂30-score system C （Clockface） part＂ , the two together had a total score of 30. Thirty-eight subjects underwent Xe-enhanced computed tomography （Xe-CT） scanning for quantitively measuring regional cerebral blood flow （rCBF） of 26 regions of brain. Results Correlations coefficients of the scores of 14 items with the total score in 30-score system of CDT were in the range of 0. 48 to 0. 71 （ P 〈 0. 01 ） . 30-score system C part was closely correlated with indicators of visuospatial and executive function, while 30-score system A part with memory indicators. The sensitivity and specificity of the 30-score system A part score ≤ 2 for detecting MCI were 70. 6% and 73.9%, respectively. The sensitivity the specificity of 30-score system C part score ≤ 17 for mild AD were 75.3% and 75.9% , respectively. In the regression equation of 30-score system A and C part, the combined independent variables were the CBF of left frontal cortex and right white matter, respectively. Conclusion The 30-score system A and C part have different meanings： 30-score system C part could be used to identify AD while 30-score system A part is helpful for identifing MCI.

关 键 词：阿尔茨海默病 认知障碍 神经心理学测验 

分 类 号：R686[医药卫生—骨科学]