不同认知水平患者的ADAS-cog 10词学习测验的特征研究  

Neuropsychological characteristics of 10-word recall test of ADAS-cog in patients with different levels of cognitive impairment

作　　者：潘晓东[1] 周辰[1] 尹冬华[1] 刘雅玲[1] Pan Xiaodong;Zhou Chen;Yin Donghua;Liu Yaling(Jiangsu Geriatric Research Institute, Nanjing 210024, China)

机构地区：[1]江苏省老年医学研究所,南京210024

出　　处：《中华临床医师杂志（电子版）》2017年第15期2061-2067,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家中医临床研究基地开放课题(JD201525);江苏省卫生厅保健局课题(BJ15024);江苏省省重点研发计划(社会发展)面上项目(BE2015715);江苏省自然科学基金面上项目(BK20161587)

摘　　要：目的分析阿尔茨海默病评估量表认知评分部分(ADAS-cog)的10词学习回忆测试在不同认知水平患者中的细部特征。方法选择2012年5月至2016年5月来江苏省老年医学研究所就诊的老年人,共入组127例,其中认知正常者56例(NC组),轻度认识障碍(MCI)者49例(MCI组),痴呆组(D组)22例。比较3组间在ADAS-cog 10词学习测试的多个细部特征参数上的差异,相关参数的设定参照加利福尼亚词语学习测试(CVLT)。同时,测定蒙特利尔认知量表(MoCA)、简易智能状态检查量表(MMSE)等。计量资料的3组间比较采用单因素方差分析(ANOVA),组间比较采用LSD法。计数资料组间比较采用χ2检验。使用ROC曲线分析量表界值的选择,通过计算ROC曲线下面积的方法观察不同指数量表方法对诊断的敏感性、特异性的差异。结果 3组对象中D组的年龄较大[(78.88±9.55)岁vs(82.16±9.69)岁vs(85.91±5.65)岁,P=0.008];主观记忆力下降的主诉在MCI组最为突出(51.8%vs 77.6%vs 59.1%)。与MoCA总分相比较,"学习总数""回忆总数""前5词学习总数""回忆与第3次学习一致性"等参数与之在判断MCI效果上没有明显差异。"回忆总数"对判断MCI的敏感度为84.4%,特异度为86.0%。"学习总数""回忆总数""第三次学习词数""前5词学习总数""回忆一致性""回忆与第3次学习一致性"等参数在鉴别痴呆的患者上均有较好的敏感度与特异度。结论神经心理学量表的一些细部特征可以为临床诊断提供帮助,提示在做量表测试时,除了总分外,应当注意细部特征可能有的诊断意义。Objective To investigate the detailed characteristics of10-word recall test of ADAS-cogin patients with different levels of cognitive impairment.Methods One hundred and twenty-seven elderindividuals were enrolled in this study from May2012to May2016.According to the level of cognitive impairment,they were divided into three groups:normal group(NC group,n=56),mild cognitive impairment group(MCI group,n=49),and dementia group(D group,n=22).Referring to the California vocabulary leaning test(CVLT),we set some new parameters which reflect the detailed characteristics of the10-word learning test of ADAS-cog.The parameters included list all(sum of the words which were recalled just after learning),recall total(sum of words which were recalled after an5-minute interval),primacy(sum of the recalled words which were in front of the list),learning3nd(sum of words which were recalled just after the3nd learning),consistency(consistency between the recalled words and the learning words),3nd consistency(consistency between the recalled words and the3nd learning words),and so on.We compared the diversity of the parameters in three groups.At the same time,we also completed some other neuropsychological tests such as MoCA and MMSE.Measurement data among the three groups were compared using one-way analysis of variance,and the LSD test was used for multiple comparisons.Categorical data were analyzed using chi-square test.The cutoff values of the scales were determined by ROC curve analysis.The areas under the ROC curves of indexes were calculated to compare their sensitivity and specificity.Results As the cognitive function declined,the age increased in the three groups[(78.88±9.55)years vs(82.16±9.69)years vs(85.91±5.65)years,P=0.008].The proportion of patients complaining subjective cognitive decline was the highest in the MCI group(51.8%vs77.6%vs59.1%).Compared with the total score of MoCA,the parameters such as list total,recall total,primacy,and3nd consistency performed similarly in distinguishing MCI patients.Recall tot

关 键 词：神经心理学量表 阿尔茨海默病评估量表认知评分 认知障碍 

分 类 号：R749.16[医药卫生—神经病学与精神病学]