四分法画钟测验对轻中度老年血管性痴呆的诊断作用

目的 探讨四分法画钟测验（CDT）对轻中度老年血管性痴呆（VD）患者的识别作用.方法 选择VD患者97例,健康对照组56人.对所有受试者进行简易智能精神状态量表（MMSE）、四分法CDT和临床痴呆量表（CDR）测定.VD患者根据CDR结果又分为轻度VD组（67例）和中度VD组（30例）两个亚组.结果 VD组MMSE和CDT得分明显低于对照组,差异有统计学意义（t分别为14.67,9.71; P＜0.01）.轻度VD组、中度VD组与对照组比较,3组CDT评分差异有统计学意义（H =69.4,P＜0.01）,且轻度VD组与中度VD组比较,差异亦有统计学意义（U=7.52,P＜0.01）.CDT与MMSE评分呈正相关（r=0.679,P＜0.01）.CDT对轻中度VD的敏感性为83.5％,特异性为94.6％,联合应用MMSE检测敏感性及特异性均有明显提升,分别为92.7％,96.4％,敏感性与单用比较差异有统计学意义（x2分别为5.813,8.638;P＜0.01）.结论 四分法CDT对血管性痴呆患者的筛查有一定价值,并在一定程度上可以判定血管性痴呆的严重程度;将CDT与MMSE联合应用有益于轻中度VD的诊断.

The value of four point scoring system for the Clock Drawing Test on diagnosing mild and moderate vascular dementia

Objective To explore the value of the four point scoring system for the Clock Drawing Test （CDT） on diagnosing mild and moderate vascular dementia（VD）. Methods Totals of 97 VD patients and 56 normal controls were comprehensively evaluated with mini-mental state examination （MMSE）, CDT and clinical dementia rating（CDR）. VD patients were divided into mild VD group （67 cases） and moderate VD group （30 cases） according to their CDR scores. Results Compared with normal controls, the scores of MMSE and CDT in patients were significantly decreased （t = 14.67, 9.71 ,respectively; P 〈 0.01）. There was a significant difference in CDT score among mild VD group, moderate VD group, and normal group （H = 69.4,P 〈 0.01）, furthermore, there was a significant difference in CDT score between mild VD patients and moderate VD patients （U = 7.52 ,P 〈 0.01）. The scores of CDT had a positively correlation with the scores of MMSE （r = 0. 679,P 〈 0.01）. The sensitivity of CDT to mild and moderate VD was 83.5%, and the specificity was 94.6% ; the sensitivity and specificity were improved to 92.7% and 96.4% respectively when combined with CDT and MMSE. Significant differences were found in the sensitivity between combined with CDT and MMSE and CDT or MMSE alone （x^2 = 5. 813, 8. 638,respectively; P 〈 0.01）. Conclusions CDT has an important role on screening and diagnosing the degree of VD; combined with CDT and MMSE is helpful to diagnose the mild and moderate VD.