画钟测验在认知障碍老人中的鉴别作用  

The differential diagnostic value of Clock Drawing Test in cognitive impairment in old people

作　　者：黄若燕[1] 唐牟尼[1] 佘生林 孙彬[1] 林康广[1] 郁俊昌[1] 陈映梅[1] 郭伟坚[1] 肖頔[1] 王怀坤[1] 

机构地区：[1]广州市精神病医院老年科,广州510370

出　　处：《中国神经精神疾病杂志》2013年第8期458-462,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：广州市医药卫生科技项目(编号:20121A010007)

摘　　要：目的探讨画钟测验（clock drawing test，CDT）对认知障碍老人的诊断作用。方法使用7分法画钟测验对社区流行病调查中有认知功能损害高危因素的222名老人进行检查。对各诊断组建立多分类Logistic回归模型，纳入性别、年龄、教育年限和画钟测验分数为自变量，采用模型所得的各组估计反应概率logit（P）进行受试者工作特征曲线（receiver operating characteristic curve, ROC）分析，并分析模型诊断价值。结果222名老人中82名无认知障碍诊断，75例诊断轻度认知障碍（mild cognitive impairment, MCI），48例轻度阿尔茨海默病（Alzheimer’s disease，AD），17例中重度AD。4组间画钟测验得分差异有统计学意义[（3．61±3．03）vs．（1．92±2．61）vs．（0．45±1．27）vs.（0．00±0．00），P〈0．05]。模型识别有无认知障碍的曲线下面积（area under the curve，AUC）为0．79（95％CI：0．73～0．85），特异度70％，灵敏度77％；识别有无MCI的AUC为0．55（95％CI：0．47～0．63），特异度21％，灵敏度93％；识别有无轻度AD的AUC为0．75（95％CI：0．68～0．82），特异度49％，灵敏度96％；识别有无中重度AD的AUC为0．85（95％CI：0．76～0．93），特异度71％，灵敏度88％。结论含CDT的模型能较好地鉴别痴呆，但是对于MCI的作用有限。Objective To investigate the clock drawing test （CDT） in differentiating the cognitive impairment people from the normal elderly. Methods Seven-point clock drawing test was conducted in 222 cases of elderly people. Multinomial logistic regression model was used to analyze the data using different diagnostic groups as the dependent variable and using the gender, age, years of education and clock drawing test scores as independent variables. Probability of reaction logit （P） of each group was estimated after the model was fitted to the receiver operating characteristic curve （ROC）. Results The clock drawing test scores in normal elderly, and patients with mild cognitive impairment （MCI）, mild Alzheimer＇ s disease （AD） and moderate to severe AD are significantly different [（3.61±3.03） vs. （1.92±2.61） vs. （0.45±1.27） vs. （0.00±0.00）, P〈0.05]. The area under the curve to identify normal elderly, MCI, mild AD and moderate to severe AD were 0.79 （95%CI： 0.73N0.85）, 0.55 （95%CI： 0.47-0.63）, 0.75 （95%CI： 0.68-0.82） and 0.85 （95%CI： 0.76-0.93）, respectively. The specificity of logit （P） was 70%, 21%, 49% and 71% in normal elderly, MCI, mild AD and moderate to severe AD, respectively. The sensitivity of the logit （P） was 77%, 93%, 96% and 88%, respectively. Conclusion The model with CDT is a good screening instrument for dementia but not for MCI.

关 键 词：画钟测验 认知障碍 痴呆 灵敏度 特异度 

分 类 号：R749.1[医药卫生—神经病学与精神病学]