基于互联网的连续视觉再认作业MemTrax测试在快速筛查中国人群遗忘型轻度认知障碍中的应用价值  

Validity of MemTrax test based on continuous visual recognition tasks online as a screening test for amnestic mild cognitive impairment in Chinese population

作　　者：陈鑫杰 赵凤 尚群竺 戴淑娟[1] 徐帆 艾青龙[1] 张骏延 刘晓蕾 Chen Xinjie;Zhao Feng;Shang Qunzhu;Dai Shujuan;Xu Fan;Ai Qinglong;Zhang Junyan;Liu Xiaolei(Department of Neurology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Neurology,Dehong People′s Hospital,Dehong,Yunnan 678400,China;Department of Public Health,Chengdu Medical College,Chengdu 610500,China;Bothwin Clinical Study Consultant,Shanghai 201702,China)

机构地区：[1]昆明医科大学第一附属医院神经内科,650032 [2]云南省德宏州人民医院神经内科,678400 [3]成都医学院公共卫生学院,610500 [4]上海博征商务咨询有限公司,201702

出　　处：《中华神经科杂志》2021年第3期184-190,共7页Chinese Journal of Neurology

基　　金：云南省科技厅基础研究计划(2019FE001(-222));昆明医科大学第一附属医院博士基金(2017BS028)。

摘　　要：目的初步探讨基于互联网的连续视觉再认作业MemTrax测试(MTX)在快速筛查遗忘型轻度认知障碍(aMCI)方面的应用价值,为其临床推广使用提供依据。方法纳入2018年8月至2019年12月连续在昆明医科大学第一附属医院神经内科痴呆门诊就诊或住院治疗的aMCI患者64例(aMCI组),以同期该院健康体检中心的64名健康体检者作为对照(对照组)。采用蒙特利尔认知评估(MoCA)量表和MTX对所有受试者的认知功能进行评估,获取所有受试者的MoCA量表校正得分以及MTX正确率、MTX反应时间和MTX综合得分,并进行统计分析。结果aMCI组和对照组MoCA量表校正得分分别为19(14,24)、26(24,27)分(Z=6.795)、MTX正确率分别为74%(60%,80%)、88%(84%,94%;Z=8.359)、MTX综合得分分别为(51.11±14.07)、(70.56±14.91)分(t=7.590),差异均有统计学意义(均P<0.001);MTX反应时间分别为1.401(1.253,1.590)s和1.277(1.163,1.410)s,差异有统计学意义(Z=3.083,P<0.01)。校正年龄、是否脑力劳动、是否有体育锻炼、高血压、高脂血症、脑卒中史以及睡眠时间和是否吸烟后,aMCI组MoCA量表校正得分、MTX正确率、MTX综合得分仍显著降低,差异均有统计学意义(均P<0.001);aMCI组MTX反应时间延长(P=0.071)。当MTX正确率<81%和MoCA量表校正得分<23分时,诊断aMCI的敏感度及特异度之和最高,分别为79.7%、93.8%和68.8%、82.8%;MTX正确率的曲线下面积(AUC)为0.93(95%CI 0.89~0.97,P<0.001),MoCA量表校正得分的AUC为0.85(95%CI 0.78~0.91,P<0.001),二者配对比较的差异有统计学意义(χ^(2)=4.620,P<0.05)。结论MTX在识别aMCI中的作用优于MoCA量表,当MTX正确率<81%可认为存在MCI。Objective To explore the use of internet-based continuous visual recognition task(MemTrax test,MTX)as a rapid screening tool for amnestic mild cognitive impairment(aMCI).Methods Sixty-four patients with aMCI and 64 individuals with normal cognition as healthy controls were enrolled respectively from Department of Neurology and Health Examination Center of the First Affiliated Hospital of Kunming Medical University from August 2018 to December 2019.Montreal Cognitive Assessment(MoCA)scale and MTX were adopted to assess the cognitive function of all subjects.The total adjusted MoCA scale score,correct rate of MTX,reaction time of MTX and MTX score were obtained and statistically analyzed.Results The adjusted MoCA scale scores of aMCI patients and healthy controls were 19(14,24)and 26(24,27;Z=6.795),the correct rate of MTX of aMCI patients and healthy controls were 74%(60%,80%)and 88%(84%,94%;Z=8.359),and the MTX score of aMCI patients and healthy controls were 51.11±14.07 and 70.56±14.91(t=7.590),respectively,all with statistically significant difference(P<0.001).Reaction time of MTX of aMCI patients and healthy controls was 1.401(1.253,1.590)s and 1.277(1.163,1.410)s,respectively(Z=3.083,P<0.01).After adjustment for age,physical or mental occupation,exercise,hypertension,hyperlipidemia,stroke,sleep time,as well as smoke,the linear regression showed that the aMCI patients had a significant decrease of adjusted MoCA score,correct rate of MTX and MTX score(P<0.001),and an extension of reaction time of MTX(P=0.071),compared with the controls.By MTX and MoCA scale assessment,the best cutoff value was 81%for correct rate of MTX and 23 for adjusted MoCA scale score respectively for the prediction of aMCI(with sensitivity of 79.7%,93.8%respectively,and specificity of 68.8%,82.8%respectively).The area under the curve(AUC)of correct rate of MTX was 0.93(95%CI 0.89-0.97,P<0.001),and the AUC of adjusted MoCA score was 0.85(95%CI 0.78-0.91,P<0.001).There was a statistically significant difference in paired comparison of the

关 键 词：认知障碍 遗忘 连续视觉再认作业 蒙特利尔认知评估量表 

分 类 号：R749.1[医药卫生—神经病学与精神病学]