Do the ABCS 135 short cognitive screen and its subtests discriminate between normal cognition,mild cognitive impairment and dementia?

BACKGROUND: Cognitive screening instruments are either too long for routine clinical use or not sensitive to distinguish mild cognitive impairment (MCI) from normal cognition (NC) or dementia. OBJECTIVE: To evaluate the sensitivity and specificity of the AB Cognitive Screen (ABCS) and its subtests with a view to improving its ability to differentiate between dementia, MCI and NC. The influence of age and education on sensitivity and specificity is also examined. DESIGN: Cross-sectional study. METHODS: Participants with dementia and MCI were recruited from those presenting to four specialty geriatric clinics in southern Ontario. Participants with NC were recruited from the family and friends of patients. A comprehensive geriatric assessment was done including ABCS, SMMSE and 15 point Geriatric Depression Scale. Analysis of variance and receiver operating characteristic (ROC) curves compared test scores. SMMSE scores were also analysed for comparison purposes. RESULTS: Three hundred and two participants had dementia, 166 had MCI and 174 had NC. ABCS total scores were significantly different between NC and MCI (mean difference 7.1, 1.8-12.5 CI, p = 0.000) while SMMSE scores were not (mean difference 0.5, -0.7-1.7, p < 0.628). Of individual ABCS subtests, verbal fluency and delayed recall were most sensitive to differences between NC and MCI. ROC curve analysis, which presents sensitivity and specificity, showed verbal fluency was better than delayed recall in distinguishing between NC and MCI, among participants 75 years of age or older. CONCLUSION: The AB Cognitive Screen (ABCS) can be administered in 3-5 min. The SMMSE and ABCS total and subtests significantly distinguished between dementia and MCI or NC. Verbal fluency and delayed recall were best at distinguishing between MCI and NC. The analysis illustrates how each subtest contributes to the sensitivity of the ABCS and suggests ways that sensitivity might be improved.     

Olfactory identification and incidence of mild cognitive impairment in older age

CONTEXT: Mild cognitive impairment (MCI) is often a precursor to Alzheimer disease, but knowledge about factors that predict its development is limited. OBJECTIVE: To test the hypothesis that impaired odor identification is related to increased risk of incident MCI. DESIGN: Longitudinal cohort study. SETTING: Academic research. PARTICIPANTS: Subjects were 589 community-dwelling older persons without cognitive impairment at study baseline, at which time odor identification was assessed using the 12-item Brief Smell Identification Test (mean +/- SD score, 9.3 +/- 1.9). MAIN OUTCOME MEASURES: Incidence of MCI and rate of decline in cognitive function. RESULTS: During annual observation of up to 5 years, 177 subjects developed MCI. In a proportional hazards model adjusted for age, sex, and education, odor identification score predicted development of MCI (relative risk, 1.15; 95% confidence interval, 1.07-1.23), with risk increased by 50% in persons with below-average (score of 8 [25th percentile]) compared with above-average (score of 11 [75th percentile]) odor identification scores. Results were not substantially changed in subsequent analyses that controlled for level of cognitive function or disability, presence of stroke, or smoking status at baseline or that required MCI to persist for at least 1 year. Impaired odor identification was also associated with a lower level of global cognition at baseline and with more rapid decline in episodic memory, semantic memory, and perceptual speed. CONCLUSION: Among older persons without manifest cognitive impairment, difficulty in identifying odors predicts subsequent development of MCI.     

Differences in Cognitive Profile between TIA, Stroke and Elderly Memory Research Subjects: A Comparison of the MMSE and MoCA

Background: The Montreal Cognitive Assessment (MoCA) appears more sensitive to mild cognitive impairment (MCI) than the Mini-Mental State Examination (MMSE): over 50% of TIA and stroke patients with an MMSE score of ≥27 ('normal' cognitive function) at ≥6 months after index event, score <26 on the MoCA, a cutoff which has good sensitivity and specificity for MCI in this population. We hypothesized that sensitivity of the MoCA to MCI might in part be due to detection of different patterns of cognitive domain impairment. We therefore compared performance on the MMSE and MoCA in subjects without major cognitive impairment (MMSE score of ≥24) with differing clinical characteristics: a TIA and stroke cohort in which frontal/executive deficits were expected to be prevalent and a memory research cohort. Methods: The MMSE and MoCA were done on consecutive patients with TIA or stroke in a population-based study (Oxford Vascular Study) 6 months or more after the index event and on consecutive subjects enrolled in a memory research cohort (the Oxford Project to Investigate Memory and Ageing). Patients with moderate-to-severe cognitive impairment (MMSE score of <24), dysphasia or inability to use the dominant arm were excluded. Results: Of 207 stroke patients (mean age ± SD: 72 ± 11.5 years, 54% male), 156 TIA patients (mean age 71 ± 12.1 years, 53% male) and 107 memory research subjects (mean age 76 ± 6.6 years, 46% male), stroke patients had the lowest mean ± SD cognitive scores (MMSE score of 27.7 ± 1.84 and MoCA score of 22.9 ± 3.6), whereas TIA (MMSE score of 28.4 ± 1.7 and MoCA score of 24.9 ± 3.3) and memory subject scores (MMSE score of 28.5 ± 1.7 and MoCA score of 25.5 ± 3.0) were more similar. Rates of MoCA score of <26 in subjects with normal MMSE ( ≥27) were lowest in memory subjects, intermediate in TIA and highest after stroke (34 vs. 48 vs. 67%, p < 0.001). The cerebrovascular patients scored lower than the memory subjects on all MoCA frontal/executive subtests with differences being most marked in visuoexecutive function, verbal fluency and sustained attention (all p < 0.0001) and in stroke versus TIA (after adjustment for age and education). Stroke patients performed worse than TIA patients only on MMSE orientation in contrast to 6/10 subtests of the MoCA. Results were similar after restricting analyses to those with an MMSE score of ≥27. Conclusions: The MoCA demonstrated more differences in cognitive profile between TIA, stroke and memory research subjects without major cognitive impairment than the MMSE. The MoCA showed between-group differences even in those with normal MMSE and would thus appear to be a useful brief tool to assess cognition in those with MCI, particularly where the ceiling effect of the MMSE is problematic.     

Predictors of cognitive impairment in an early stage Parkinson's disease cohort

The impact of Parkinson's disease (PD) dementia is substantial and has major functional and socioeconomic consequences. Early prediction of future cognitive impairment would help target future interventions. The Montreal Cognitive Assessment (MoCA), the Mini‐Mental State Examination (MMSE), and fluency tests were administered to 486 patients with PD within 3.5 years of diagnosis, and the results were compared with those from 141 controls correcting for age, sex, and educational years. Eighteen‐month longitudinal assessments were performed in 155 patients with PD. The proportion of patients classified with normal cognition, mild cognitive impairment (MCI), and dementia varied considerably, depending on the MoCA and MMSE thresholds used. With the MoCA total score at screening threshold, 47.7%, 40.5%, and 11.7% of patients with PD were classified with normal cognition, MCI, and dementia, respectively; by comparison, 78.7% and 21.3% of controls had normal cognition and MCI, respectively. Cognitive impairment was predicted by lower education, increased age, male sex, and quantitative motor and non‐motor (smell, depression, and anxiety) measures. Longitudinal data from 155 patients with PD over 18 months showed significant reductions in MoCA scores, but not in MMSE scores, with 21.3% of patients moving from normal cognition to MCI and 4.5% moving from MCI to dementia, although 13.5% moved from MCI to normal; however, none of the patients with dementia changed their classification. The MoCA may be more sensitive than the MMSE in detecting early baseline and longitudinal cognitive impairment in PD, because it identified 25.8% of those who experienced significant cognitive decline over 18 months. Cognitive decline was associated with worse motor and non‐motor features, suggesting that this reflects a faster progressive phenotype. © 2014 International Parkinson and Movement Disorder Society     

轻度认知功能障碍患者的神经心理学研究

目的 探讨轻度认知功能障碍(MCI)患者神经心理学的特点. 方法 对42例MCI患者和55例健康对照者进行多项神经心理学检查,包括简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、临床痴呆评定量表(CDR)、语言流畅性测验(RVR)、韦氏智力测验(WAIS-RC)[包括数字广度测验(DS)、积木测验(BD)、相似性测验]、韦氏记忆测验(WMS-R)(包括逻辑记忆、联想学习、视觉再认、图片回忆)、日常生活能力量表(ADL),比较2组患者上述量表评分和MMSE、MoCA量表各亚项评分的差异.结果 与对照者比较,MCI患者MMSE、MoCA总分和RVR、WAIS-RC、WMS-R分测验,MoCA量表各亚项(地点定向力除外),MMSE量表中计算与注意、延迟回忆两亚项评分较低,差异均有统计学意义(P<0.05).结论 MCI患者不仅记忆受损,其计算与注意力、命名、视空间结构能力、执行功能也可受损,尤以延迟回忆、计算与注意力受损明显.MoCA涵盖了重要的认知领域,能较全面评估MCI患者的认知功能,值的临床推广应用.     

Memory for unfamiliar faces differentiates mild cognitive impairment from normal aging

Memory for unfamiliar faces has received little attention in the effort to identify neuropsychological measures that could differentiate mild cognitive impairment (MCI) from normal aging and/or predict conversion from MCI to dementia. We used the Wechsler Memory Scale–III Faces test to investigate facial memory in normal aging (n = 58), MCI (n = 74), and mild Alzheimer’s disease (n = 22). After adjustment for age, gender, and years of education, MCI patients demonstrated significantly poorer memory for unfamiliar faces than their healthy peers. Lower scores were also associated with worsening cognition and functional abilities but not an increased risk of dementia.     

Alternate forms of logical memory and verbal fluency tasks for repeated testing in early cognitive changes

BACKGROUND: Repeat cognitive testing is an essential diagnostic strategy to measure changes in cognition over time when following people with memory problems. Alternate forms may avert practice effects that can mimic improvements in cognition. We evaluated alternate forms of verbal fluency and logical memory (paragraph recall) tasks to evaluate their equivalence for clinical use. METHODS: Participants with mild cognitive impairment (MCI) and dementia were recruited from five outpatient memory clinics and one nursing home. Participants with normal cognition (NC) were recruited from family members or friends. Verbal fluency categories of animals, cities & towns, fruits & vegetables and first names were used. Scores were recorded for 0-30 seconds, 31-60 seconds and errors. For the logical memory task, participants were read one of three different paragraphs and then were asked to recall the story. Immediate recall and delayed recall scores were recorded. The Standardized Mini-mental State Examination, the AB Cognitive Screen and the 15-point Geriatric Depression Scale were administered as part of the assessment. Analyses were performed using means, frequency distributions, t-tests, receiver-operating characteristic curves and effect sizes. RESULTS: There were 46 NC participants, 45 with MCI and 55 with dementia. For verbal fluency, the mean number of animals, cities & towns, names or fruits & vegetables named in 60 seconds did not differ significantly within each cognitive group. First names was an easier category than the others: NC named 16.9-22.3 items, MCI named 11.6-14.4 items and dementia named 8.1-11.4 items. The mean number of items immediately recalled in logical memory was not significantly different for the three paragraphs. The verbal fluency task (in 60 seconds) and logical memory immediate recall were highly sensitive and specific to differences between NC and MCI (areas under the curves 0.87 and 0.76, respectively). CONCLUSIONS: Alternate forms allow serial testing without learning bias. Verbal fluency and logical memory tasks are sensitive to early cognitive changes.     

肌萎缩侧索硬化患者轻度认知功能损害

目的 探讨肌萎缩侧索硬化(ALS)患者认知功能状态、ALS轻度认知功能损害(ALS-MCI)的受累领域和各种亚型及其可能的危险因素.方法 收集ALS患者29例,健康对照者58名,选用改良Norris量表评价ALS患者的延髓功能及肢体功能.根据美国精神病学会精神障碍诊断和统计手册(DSM-Ⅳ-R)痴呆的诊断标准,将ALS患者分为痴呆和非痴呆;对于非痴呆的ALS患者,通过常用的认知功能(包括精神状态、记忆力、执行功能、注意力、视空间功能)量表、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)进行评分,按照Petersen等修订的MCI诊断标准,将其分为认知功能正常(ALS-CogNL)组和ALS-MCI组,分析ALS-MCI受累的领域及其亚型;比较2组在年龄、起病年龄、病程、起病部位、延髓性麻痹症状、肢体运动功能损害等方面的差异,分析ALS患者出现MCI的相关危险因素.结果 29例ALS患者中,认知功能正常14例(48.3%),MCI有15例(51.7%),未发现痴呆患者.15例ALS-MCI患者中,执行功能损害12例,注意力损害9例,记忆力损害8例,未发现视空间功能损害;其中遗忘型(ALS-aMCI)1例,非记忆单一领域损害型(ALS-sdMCI)6例,多领域受损型(ALS-mdMCI)8例.ALS-MCI组与ALS-CogNL组的教育年限[(8.7±2.8)年与(11.3 ±3.0)年]、Norris量表延髓功能评分[(28.4±7.7)分与(34.0±3.4)分]差异有统计学意义(t=-2.435、-2.576,均P＜0.05),性别、年龄、起病年龄、病程、起病部位、HAMA及HAMD评分、Norris量表肢体功能评分差异无统计学意义.结论 ALS患者常出现MCI,其中以执行功能损害最常见,记忆力、注意力亦有损害,未发现视空间功能损害,ALS-mdMCI是最常见的亚型.文化程度低、严重延髓性麻痹症状是ALS患者出现认知功能损害的危险因素.

Abstract：

Objective To explore the cognitive status of amyotrophic lateral sclerosis (ALS) patients, and to explore the involved cognitive domains, subtypes and risk factors of mild cognitive impairment in ALS ( ALS-MCI).Methods Twenty-nine cases of ALS and 58 healthy volunteers were included.The severity of the bulbar and spinal functions of the patients was evaluated by the Improved Norris Scale.According to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition-Revised( DSM-Ⅳ-R) criteria of dementia, ALS cases were classified as demented and non-demented.For non-demented ALS cases, the common cognitive batteries evaluating mental state, verbal memory, executive, attentional and visuospatial abilities were performed.Hamilton Anxiety Scale ( HAMA) and Hamilton Depression Scale (HAMD) were evaluated too.They were further classified into ALS-cognitively normal (ALS-CogNL) and ALS-MCI groups according to Petersen criteria of MCI.Risk factors possibly correlated with ALS-MCI were analyzed by comparing the differences in age, age of onset, duration of the disease, sites of onset, symptoms of bulbar and limb function between ALS-CogNL and ALS-MCI groups.Results Among 29 ALS cases, 14 (48.3% ) cases with cognitively normal( ALS-CogNL), 15 cases (51.7% ) with ALS-MCI,and none with dementia were identified.Among 15 ALS-MCI cases, 12 cases with executive dysfunction, 8 cases with memory deficits,9 cases with attention impairment and none with visuospatial impairment were found.ALSMCI cases could be further classified into three subtypes; 1 case with amnestic MCI (aMCI) ,6 cases with single domain non-memory MCI ( sdMCI), and 8 cases with multiple domains slightly impaired MCI (mdMCI).Between ALS-MCI and ALS-CogNL groups, there were significant differences (t = -2.435,- 2.576, both P ＜ 0.05) in education ((8.7 ± 2.8) years vs (11.3 ± 3.0) years) and Improved Norrisscale (bulbar score: (28.4 ± 7.7) scores vs ( 34.0 ± 3.4) scores) , however, no significant differences in sex, age, age of onset, duration,site of onset,HAMA or HAMD scores,and Improved Norris scale( spinal score) were found.Conclusions Cognitive deficits commonly exist in ALS patients.For the involved domains, executive dysfunction is the most common, deficits of attention and memory are also common, and deficit in visuospatial function is not found.The most common subtype of ALS-MCI is mdMCI.Severe bulbar symptoms and lower education may be the risk factors of ALS-MCI.     

The Goteborg MCI study: mild cognitive impairment is a heterogeneous condition

BACKGROUND: Mild cognitive impairment (MCI) has been considered a transitional state between normal aging and dementia, characterised by memory impairment but normal general cognitive functioning. Recently other cognitive deficits have been reported. This has led to a modification of MCI criteria. OBJECTIVE: To examine which neuropsychological tests most clearly distinguish MCI subjects from normal controls. METHODS: 112 consecutive MCI subjects and 35 controls were included in the study. The diagnosis of MCI was based on an objective history of cognitive decline and a neuropsychiatric examination, comprising instruments STEP, I-Flex, MMSE, and CDR. Participants were examined with 21 neuropsychological tests in the cognitive domains speed/attention, memory and learning, visuospatial function, language, and executive function. RESULTS: Controls were significantly older. No differences were found in education or general intellectual capacity. Controls performed significantly better than MCI on tests within all five cognitive domains. The clearest differences were seen on language tests, followed by executive function, and learning and memory. Only two subjects (1.8%) were purely amnestic; 17% showed no impairment compared with controls, with a cut off of 1.5 SD below age mean. These subjects were better educated and performed significantly better on measures of general cognitive capacity. CONCLUSIONS: The results illustrate the heterogeneity of MCI, with a significant degree of impairment in all five cognitive domains. When examined with a comprehensive neuropsychological battery, very few subjects had an isolated memory impairment.     

Characterizing mild cognitive impairment in Parkinson's disease

There is growing interest in identifying Parkinson's disease (PD) patients with mild cognitive impairment (PD‐MCI), but widely disparate criteria have been used. We assessed 143 PD patients and 50 matched controls on 20 measures across 4 cognitive domains (executive function, attention and working memory, learning and memory, visuoperception). Twenty‐four patients met criteria for dementia (PD‐D); nondementia patients were classified as either with normal cognition or MCI for 12 neuropsychological criteria. We compared the influence of these criteria on the distribution of global cognitive performance in the resulting PD‐MCI groups relative to the control and PD‐D groups. Different criteria produced substantial variation in the proportion of PD‐MCI cases identified. Fourteen percent PD‐MCI was found when using 2 scores in 1 domain at 2 standard deviations (SD) below normative scores, with no controls identified as MCI, through to 89% PD‐MCI with 1 score in 1 domain at 1 SD below normative scores, when 70% of controls were identified as MCI. The balance of cases with impaired cognition but not those with generally intact cognition was better served by using criteria that required 2 specific deficit scores or deficits across 2 domains. As comparisons with external normative data may have greater applicability across centers, we suggest that 2 scores at ?1.5 SD within any single domain (30% PD‐MCI) or 1 score at ?1.5 SD in each of 2 domains (37% PD‐MCI) provide suitable criteria to minimize the inclusion of cognitively well patients. Clinical dementia rating did not improve the relative identification of cognitively impaired and unimpaired nondementia PD patients. © 2011 Movement Disorder Society     

The characteristics of patients with uncertain/mild cognitive impairment on the Alzheimer disease assessment scale-cognitive subscale

The performances of the uncertain/mild cognitive impairment (MCI) patients on the Alzheimer Disease Assessment Scale-Cognitive (ADAS-Cog) subscale were compared with those of normal controls, Alzheimer disease patients with CDR 0.5, and Alzheimer disease patients with CDR 1.0. The Uncertain/MCI group was significantly different from normal controls and Alzheimer disease CDR 0.5 or 1.0 groups on the ADAS-Cog except on a few non-memory subtests. Age was significantly correlated with total error score in the normal group, but there was no significant correlation between age and ADAS-Cog scores in the patient groups. Education was not significantly correlated with the ADAS-Cog scores in any group. Regardless of age and educational level, there were clear differences between the normal group and the Uncertain/MCI group, especially on the total error scores. We found that the total error score of the ADAS-Cog was the most reliable variable in detecting patients with mild cognitive impairment. The present study demonstrated that the ADAS-Cog is a promising tool for detecting and studying patients with mild cognitive impairment. The results also indicated that demographic variables such as age and education do not play a significant role in the diagnosis of mild cognitive impaired patients based on the ADAS-Cog scores.     

记忆改变测试量表中文版的信效度

目的 初步探讨记忆改变测试量表(M@T)中文版在我国老年人群中应用的信度、效度和可行性.方法 以横断面调查测试的形式测查220名某社区老年人,其中明确诊断为轻度认知功能损害(MCI)患者39例、阿尔茨海默病(AD)患者20例,认知正常者161名,用内部一致性、内容效度、标准效度、主成分和因子分析、影响因素等对测试结果进行评价.结果 M@T筛查量表克朗巴赫α系数(Cronbach α)为0.818.各项目得分与总分相关系数为0.5～0.9;MMSE与M@T相关系数为0.933.因子分析提取5个公因子,能解释总方差的69.449%,且各项目在相应因子上有较满意的因子载荷量(≥0.4).不同认知水平组M@T得分[认知正常组(39.0±3.7)分、MCI组(29.0±3.7)分、AD组(16.9±3.7)分]差异有统计学意义(F=498.419,P<0.05).不同性别、年龄、职业、文化程度人群的M@T得分差异无统计学意义.结论 中文版M@T具有较好的信效度和可行性,基本不受性别、年龄、职业、文化程度等因素的影响.

Abstract：

Objectives To study the reliability,validity and feasibility of the Chinese version of memory alteration test(M@T).Methods Cross-sectional survey with a convenience sample was employed to interview 220 elderly people over 60 years old,39 patients with mild cognitive impairment(MCI),20 with Alzheimer's disease(AD),and 161 normal cognitive elderly.The survey was,then evaluated with internal consistency,content validity,criterion validity,principal component/factor analysis and influencing factors.Results A Cronbach's α coefficient of 0.818 was obtained in M@T. The correlation coefficients which were the score of the subtest and the total were 0.5-0.9.The correlation coefficient of the scores of the Mini.mental State Examination(MMSE)and the M@T Was 0.933.The 5 factors were extracted with the factor analysis,which could explain the total variance of 69.449%,and the corresponding factors of the proieets have a satisfied amount of factor loading(≥0.4).There were significant diffeFences in the score of M@T among the different cognitive level groups with good discriminant validity(cognitive normal group:39.0±3.7,MCI group:29.0±3.7,AD group:16.9±3.7;F=498.419,P<0.05).There were no significant differences in the score of M@T among the different gender,age,occupation and education level groups.Conclusions The Chinese version of M@T has good reliability and validity and feasibility.The score of the M@T is not affected by gender,age,occupation,education level and other factors.     

Regional quantification of white matter hyperintensity in normal aging, mild cognitive impairment, and Alzheimer's disease

BACKGROUND/AIMS: A quantitative method was applied to measure the volume of white matter hyperintensity (WMH) in different brain regions of subjects with Alzheimer's disease (AD), mild cognitive impairment (MCI) and normal healthy age-matched controls, and the relationship between regional WMH and age and cognitive function was investigated. METHODS: Fifty-six subjects were included in this study, 27 AD, 15 MCI and 14 normal age-matched controls. A user-friendly software was developed for WMH quantification in frontal, temporal, and parieto-occipital lobes. Mini-Mental State Examination and cognitive scores in performing naming, language fluency, and memory tasks were obtained for correlation analysis. RESULTS: AD patients had the greatest total WMH volume, followed by MCI, then controls. However, there was a large variation within each group, and the difference did not reach a significant level. There was a positive linear correlation between the total WMH (p = 0.031) and the frontal WMH (p = 0.006) vs. age. After age correction the Boston Naming Test scores were negatively correlated with the total WMH volume in the AD (p = 0.03) and the control (p = 0.03) groups, and with the frontal WMH in controls (p = 0.01). CONCLUSION: We demonstrated a quantitative analysis method to measure regional WMH. Although WMH was not strongly associated with disease severity or cognition, it may provide a characteristic neuroimaging parameter in the study of AD development.     

Development and assessment of a composite score for memory in the Alzheimer’s Disease Neuroimaging Initiative (ADNI)

We sought to develop and evaluate a composite memory score from the neuropsychological battery used in the Alzheimer’s Disease (AD) Neuroimaging Initiative (ADNI). We used modern psychometric approaches to analyze longitudinal Rey Auditory Verbal Learning Test (RAVLT, 2 versions), AD Assessment Schedule - Cognition (ADAS-Cog, 3 versions), Mini-Mental State Examination (MMSE), and Logical Memory data to develop ADNI-Mem, a composite memory score. We compared RAVLT and ADAS-Cog versions, and compared ADNI-Mem to RAVLT recall sum scores, four ADAS-Cog-derived scores, the MMSE, and the Clinical Dementia Rating Sum of Boxes. We evaluated rates of decline in normal cognition, mild cognitive impairment (MCI), and AD, ability to predict conversion from MCI to AD, strength of association with selected imaging parameters, and ability to differentiate rates of decline between participants with and without AD cerebrospinal fluid (CSF) signatures. The second version of the RAVLT was harder than the first. The ADAS-Cog versions were of similar difficulty. ADNI-Mem was slightly better at detecting change than total RAVLT recall scores. It was as good as or better than all of the other scores at predicting conversion from MCI to AD. It was associated with all our selected imaging parameters for people with MCI and AD. Participants with MCI with an AD CSF signature had somewhat more rapid decline than did those without. This paper illustrates appropriate methods for addressing the different versions of word lists, and demonstrates the additional power to be gleaned with a psychometrically sound composite memory score.     

早年创伤对老年轻度认知障碍者学习记忆及事件相关电位的影响

目的探讨早年创伤性经历与老年轻度认知损害（MCI）患者认知功能的关系。方法从2009～2010年调查的石家庄市社区60岁以上老年人认知功能数据库抽取MCI39例,健康对照37名。采用儿童期创伤问卷一简版（CTQ—RF）进行早年精神创伤评估,情景记忆和联想学习量表进行记忆评估,并进行脑电生理学检测事件相关电位（ERP）。结果两组对象间年龄、性别和受教育程度等一般资料差异无统计学意义（P〉0．05）。MCI组联想学习和情景记忆成绩明显差于健康对照组,差异有统计学意义（Z分别为-3．96,-3．24;P〈0．01）。两组间CTQ-RF量表中仅情感忽视、躯体忽视及总分差异有统计学意义（Z分别为-2．86,-3．19,-3．51;P〈0．01）;余因子分以及生活事件评分未见统计学意义（P〉0．05）。经Spearman单因素相关分析,结果显示情感虐待、躯体忽视和CTQ总分与联想学习呈正相关（r分别为0．38,0．86,0．63;P〈0．05）,余未见相关性。MCI组Cz点、Pz点P300和N200潜伏期明显长于健康对照组,Cz点、Pz点P300和N200波幅明显低于健康对照组,差异有统计学意义（P〈0．05）。经Spearman单因素相关分析,结果显示仅躯体忽视和CTQ-RF总分与Fz点N200、Pz点N200的潜伏期呈正相关（P〈0．05）,与Pz点P300波幅呈负相关（P〈0．05）。结论早年创伤能够导致老年期学习记忆功能下降尤其是联想学习和情景记忆,童年期情感虐待、躯体忽视与其密切相关。     

Comparison of the short test of mental status and the mini-mental state examination in mild cognitive impairment

BACKGROUND: The Mini-Mental State Examination (MMSE) is the most widely used brief screening measure of cognition, but it is not sensitive in detecting mild memory or other cognitive impairments. The Short Test of Mental Status (STMS) was specifically developed for use in dementia assessment and was intended to be more sensitive to problems of learning and mental agility that may be seen in mild cognitive impairment (MCI). OBJECTIVE: To compare the STMS and MMSE for detecting or predicting MCI. DESIGN: Comparison of STMS and MMSE scores at baseline among 4 groups of patients: 788 patients with stable normal cognition, 75 patients with normal cognition at baseline but who developed incident MCI or Alzheimer disease during follow-up, 129 patients with prevalent MCI at baseline, and 235 patients with prevalent mild Alzheimer disease. All patients and control subjects for this study were evaluated through the Mayo Alzheimer's Disease Patient Registry or the Mayo Clinic Alzheimer's Disease Research Center, Rochester, Minn, using a standardized diagnostic approach. RESULTS: The STMS was slightly more sensitive than the MMSE in discriminating between patients with stable normal cognition and patients with prevalent MCI. The STMS was superior to the MMSE in detecting deficits in cognition in individuals who had normal cognition at baseline but later developed incident MCI or Alzheimer disease. CONCLUSIONS: Compared with the MMSE, the STMS was better able to document MCI and was more sensitive in detecting deficits in cognition in individuals who had normal cognition at baseline but later developed incident MCI or Alzheimer disease.     

蒙特利尔认知评估量表在轻度认知功能障碍中的应用

目的探讨蒙特利尔认知评估量表在轻度认知功能障碍患者中的应用。方法测试年龄及教育程度相匹配的42例MCI患者及39例正常对照组进行MoCA测查。结果与对照组（27.36±1.38）相比,MCI组的MoCA总分（23.93±3.69）更差,差异有统计学意义（P〈0.01）;MCI组在命名、语言及定向方面与对照组无明显差异（P〉0.05）。MCI组在视空间与执行功能（HC 4.46±0.78,MCI 3.57±1.23）、注意（HC 5.95±0.22,MCI 5.61±0.73）、抽象思维（HC 1.61±0.54,MCI1.21±0.68）及延迟回忆（HC 3.54±0.88,MCI 1.97±1.20）方面,均较对照组更差,差异有统计学意义（P〈0.01）。结论MCI患者不仅在记忆上较正常人差,可能在视空间与执行功能、注意、抽象思维方面存在损害。MoCA量表对MCI患者各认知方面可起到初筛作用。     

图片学习测验在识别老年人轻微认知功能损害中的作用

目的　分析图片学习测验在识别老年人轻微认知功能损害 (MCI)中的作用。方法　选择符合MCI诊断标准的老年人 4 8例与正常对照组 5 6名完成图片学习测验、简易智能状态检查、听觉词语学习测验及多种非记忆测验。结果　图片学习测验的 3个记忆指标 (图片短时记忆、延迟记忆和学习记忆 )在MCI与正常对照组之间有非常显著的差异。已经给出这三个图片记忆指标区分MCI与正常老年人的划界分、敏感性和特异性。结论　图片记忆操作简便、信度和效度好 ,可以作为临床医师筛选MCI的有效工具     

轻度认知损害患者的空间结构能力障碍

目的 研究轻度认知损害(mild cognitive impairment,MCI)患者空间结构能力的缺损与保持状况.方法 将被试者分为3组:健康对照组122名,其中男51名、女71名;MCI组205例,男95例、女110例,其中遗忘型MCI(aMCI)133例,非遗忘型MCI(naMCI)72例;阿尔茨海默病(AD)组75例,男36例、女39例.全部进行Rey-Osterrieth复杂图形测验(CFT)、画钟测验(CDT)、搭火柴测验3个结构能力测验,同时完成简易精神状态量表(MMSE)等测验.健康对照组、MCI组和AD组MMSE平均得分分别为28.24±1.74、27.39±1.83和19.98±3.23.采用SPSS for windows 11.5统计软件,计数资料采用卡方检验,3组间比较采用One-way方差分析,然后采用Bonferroni(LSD)法进行多重比较.结果(1)以健康组为对照,CFT模仿得分和CDT总分与年龄、教育年限没有显著相关性,搭火柴测验-旋转部分(STR)与年龄有相关性(r=-0.179,P＜0.05),与教育年限没有显著相关性.(2)CFT模仿得分与CDT总分(r=0.337)、STR(r=0.232),CDT总分与STR(r =0.235),均有显著相关性(均P＜0.01).(3)CFr模仿和CDT总分分别与反映执行功能的连线测验B、Stroop色词测验卡片C耗时数的相关性最高,而STR与反映记忆的指标听觉词语学习测验的相关性高.CFT模仿、CDT总分和STR在健康对照组、MCI组和AD组之间差异有统计学意义.(4)在识别MCI方面,经过对3组结构测验表现的比较得出STR优于CFT模仿、CDT总分.结论 结构能力损害是MCI的表现之一,空间旋转能力的评估在识别MCI方面优于CFT模仿、CDT总分.