听觉词语学习测验在阿尔茨海默病和脑小血管病认知障碍鉴别诊断中的应用  

The discriminative value of auditory verbal learning test between Alzheimer’s disease and vascular cognitive impairment of cerebral small vascular disease

作　　者：裴耀华 王焕焕 孙葳[1] 李凡[1] 王朝霞[1] 王婷 白静[1] 孙云闯[1] PEI Yaohua;WANG Huanhuan;SUN Wei;LI Fan;WANG Zhaoxia;WANG Ting;BAI Jing;SUN Yunchuang(Department of Neurology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院神经内科,100034

出　　处：《中国神经免疫学和神经病学杂志》2023年第1期14-18,24,共6页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探索听觉词语学习测验在阿尔茨海默病(Alzheimer disease,AD)和脑小血管病性血管性认知障碍(vascular cognitive impairment,VCI)鉴别诊断中的价值。方法纳入2019年1月至2021年11月于北京大学第一医院收治的AD患者34例、脑小血管病性VCI患者40例。采用华山版听觉词语学习测验(auditory verbal learning test of Huashan version,AVLT-H)评估两组患者记忆功能的差异;应用ROC曲线分析AVLT-H各指标在鉴别AD和VCI中的敏感性、特异性。结果除词语学习、再认记忆及短延迟0分百分比外,AD组患者AVLT-H的短延迟记忆、长延迟记忆、线索提示回忆、再认误中、再认正确减误中、短延迟遗忘率、长延迟遗忘率、长延迟0分百分比均较VCI组低(均P<0.05)。ROC曲线分析结果显示,再认正确减误中的曲线下面积最大(0.808)。两指标联合ROC分析显示,短延迟记忆遗忘率+长延迟记忆遗忘率、短延迟记忆遗忘率+短延迟记忆、短延迟记忆+再认误中数鉴别AD和VCI的敏感性和特异性均达60%以上,尤以短延迟记忆+再认误中数的诊断价值较好。结论AVLT-H在鉴别AD和脑小血管病性VCI中有一定应用价值,采用两项指标联合诊断能弥补单一指标敏感性或特异性偏低的不足。Objective To investigate the discriminative value of auditory word learning test(AVLT)in discriminating Alzheimer’s disease(AD)and vascular cognitive impairment(VCI)of cerebral small vascular disease.Methods From Jan 2019 to Nov 2021,34 patients with AD and 40 CSVD patients with VCI admitted to the neurology department of Peking university first hospital were included,the AVLT of Huashan version(AVLT-H)was assessed and compared between the two groups.The ROC curve was analyzed,the sensitivity and specificity of each variable in AVLT-H in discriminating AD and VCI were calculated.Results There were significant differences in all variables of AVLT-H,except word learning,recognition memory and percentage of zero in short term delayed memory,between the two groups(including the short term delayed recall,long term delayed recall,category cued memory,difference of recognition minus mistake,number of recognition mistake,short and long term percentage of forgetting,percentage of zero in long term delayed memory;all P<0.05).These performances in AD group were worse than those in VCI group.The results of ROC curve showed that the area under the curve of correct recognition numbers minus misrecognition numbers was the largest(0.808).The series connection test of two variables showed that both the specificity and the sensitivity had a proportion of 60%or more(including short term percentage of forgetting plus long term percentage of forgetting,short term percentage of forgetting plus short term delayed recall,short term delayed recall plus number of recognition mistake),in particular of the combinations of the short-term delayed recall and the number of recognition mistake.Conclusions AVLT-H has certain value in differentiating AD from cerebral small vascular disease related VCI.The combination of two indexes in series connection tests can make up for the lower sensitivity or specificity in a single index.

关 键 词：阿尔茨海默病 认知障碍 脑小血管病 听觉词语学习测验 神经心理测验 

分 类 号：R741.04[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]