老年轻度认知障碍者笔迹特征及其应用价值研究  

Characteristics and Application Value of Handwriting in Elderly Patients with Mild Cognitive Impairment

作　　者：卫珠琴 张若愚 张晨 苏丽明 黄诚 张军伟 钱敏才[4] 祁亨年 王丽娜[1] WEI Zhuqin;ZHANG Ruoyu;ZHANG Chen;SU Liming;HUANG Cheng;ZHANG Junwei;QIAN Mincai;QI Hengnian;WANG Lina(School of Medicine,Huzhou University,Huzhou 313000,China;School of Information Engineering,Huzhou University,Huzhou 313000,China;Department of Public Health,Binhu Subdistrict Community Health Center of Renhuangshan,Huzhou 313001,China;Psychosomatic Department,Huzhou Third People's Hospital,Huzhou 313000,China)

机构地区：[1]湖州师范学院医学院,浙江省湖州市313000 [2]湖州师范学院信息工程学院,浙江省湖州市313000 [3]湖州市仁皇山滨湖街道社区卫生服务中心公卫科,浙江省湖州市313001 [4]湖州市第三人民医院心身科,浙江省湖州市313000

出　　处：《中国全科医学》2023年第10期1224-1233,共10页Chinese General Practice

基　　金：国家自然科学基金面上项目(72174061);国家自然科学基金青年项目(71704053);浙江省卫生健康科技计划(2022KY370);浙江省大学生科技创新活动计划暨新苗人才计划(2022R431B022)。

摘　　要：背景书写笔迹特征分析技术已在痴呆、帕金森病等相关认知障碍检测领域得到了广泛研究,针对老年轻度认知障碍(MCI)人群的笔迹特征研究仍有待于拓展。目的揭示老年MCI者笔迹特征与认知功能正常老年人的差异性,探讨笔迹特征在MCI筛查中的应用价值。方法于2022年1—4月,采用便利抽样法,选取湖州市社区老年MCI者33例作为观察组,同期另选取在年龄、性别和受教育程度上与33例社区老年MCI者相匹配的社区认知功能正常老年人43例作为对照组,采用一般资料调查表、简易精神状态量表(MMSE)、蒙特利尔认知评估基础量表(MoCA-B)、日常生活能力量表(ADL)和老年抑郁量表(GDS-15)对其进行调查,并邀请受试者使用点阵数码笔完成6项书写任务(包含4项汉字书写任务、2项图形书写任务),采集受试者笔迹特征的运动学参数,通过判别分析、受试者工作特征(ROC)曲线分析笔迹特征及另设区分方案在MCI识别中的应用价值。结果与对照组相比,在图形书写任务中,观察组受试者书写平均压力更高(Z=-2.122,P=0.034),书写思考时间(Z=-4.302,P<0.001)、落笔时间(Z=-3.663,P<0.001)及任务完成总时间(t’=-5.565,P<0.001)更长,书写平均速度(Z=-2.458,P=0.014)、x方向平均速度(Z=-2.950,P=0.003)、y方向平均速度(Z=-2.094,P=0.040)更慢,书写x方向速度最大值(Z=-2.206,P=0.027)、x方向平均加速度(Z=-2.667,P=0.008)更小,书写正确性总分更低(Z=-3.593,P<0.001);在汉字书写任务中,观察组受试者书写思考时间(Z=-3.464,P=0.001)、任务完成总时间(Z=-2.940,P=0.003)更长。与汉字书写任务完成总时间相比,图形书写任务完成总时间在鉴别老年MCI者和认知功能正常老年人中的特异度更高(93.0%比55.8%),ROC曲线下面积(AUC)为0.828;采用图形书写任务笔迹特征集对受试者进行MCI筛查时,灵敏度为87.9%,特异度为79.1%,准确率达80.3%(61/76),且图形书写任务笔迹特征集对�Background Handwriting synthesis techniques have been extensively studied in the detection of cognitive impairment in dementia and Parkinson’s disease.But handwriting characteristics in older adults with mild cognitive impairment(MCI)still need to be studied further.Objective To explore the differences between the handwriting characteristics of elderly patients with MCI and normal elderly people,and to assess the value of handwriting features in MCI screening.Methods By use of convenience sampling,33 older adults with MCI were recruited from Huzhou communities from January to April 2022(observation group),and were compared to age-,sex-and education level-matched 43 community-living older adults with normal cognitive function(control group).The General Information Questionnaire,the Mini-Mental State Examination(MMSE),the Montreal Cognitive Assessment-Basic(MoCA-B),the Activity of Daily Living Scale(ADL),and the 15-item Geriatric Depression Scale(GDS-15)were used to survey subjects.Subjects were invited to complete six handwriting tasks(four are Chinese characters tasks and the other two are graphical drawing tasks)using a dot matrix digital pen to collect their kinematic parameters of handwriting.The classification accuracy,sensitivity and specificity of handwriting characteristics for the diagnosis of MCI were analyzed by discriminant analysis and receiver operating characteristic(ROC)curve,and predictive values of different schemes for MCI were analyzed.Results Compared with the control group,the observation group had higher average pressure in writing(Z=-2.122,P=0.034),longer time in air(Z=-4.302,P<0.001),writing time(Z=-3.663,P<0.001)and total time(t’=-5.565,P<0.001),lower average writing velocity(Z=-2.458,P=0.014),horizontal(Z=-2.950,P=0.003)and vertical(Z=-2.094,P=0.040)average writing velocity and maximum horizontal writing velocity(Z=-2.206,P=0.027),lower average acceleration of writing in horizontal direction(Z=-2.667,P=0.008)and overall score for writing correctness(Z=-3.593,P<0.001)in completing gra

关 键 词：老年人 轻度认知障碍 笔迹特征 运动学参数 筛查工具 

分 类 号：R741[医药卫生—神经病学与精神病学]