如何检测记忆功能更有助于早期阿尔茨海默病的临床诊断

目的评价经修订了检测方法和计分方法的逻辑记忆量表在正常人群和阿尔茨海默病(Alzheimer's disease,AD)患者中的分布特点、影响因素和诊断效度,确定该量表的修订正常值.方法病例组183名(轻度AD118名,中度AD 65名),对照组1 417名(认知正常1 283名,非痴呆疾病134名),进行修订了检测方法和计分方法的逻辑记忆量表测定.结果多元线性回归分析证实,受教育水平(F=354.36,标化偏回归系数=0.46,P=0.0001)对量表总分的影响最为明显;正常组(P=0.0001)和非痴呆疾病组(P=0.0001)量表总分随文化程度增高而增高;而AD组(P=0.1365)量表总分则未见此变化趋势.经协方差分析去除受教育水平、年龄、性别、城乡的影响后,正常组、非痴呆疾病组、轻度AD组和中度AD组修正得分之间的差异都具有显著性(P=0.0001;P=0.0059).检验本量表对AD的诊断效度时发现,本研究修订的计分法与传统计分法相比,总分在轻度提高特异性(94.11%)的情况下,大大提高了敏感性(71.98%);按不同文化程度延迟回忆 再认得分检验对于AD的诊断效度显示,量表的敏感性随文化程度的增高而增加.按文盲、小学、初中、高中和高中以上不同文化程度制定的分界值修订总分分别为6.5、9.5、10.8、13、15.8,本研究推荐的延迟回忆 再认得分分别为5、6、8、9、10.结论本研究采用修订了检测方法和计分方法的逻辑记忆量表作为AD临床诊断用量表时,是一个特异性和准确性高、敏感性合理的单项神经心理量表,尤其适用于高文化程度者,在痴呆早期就有良好的检出能力.

Memory-assessing methods which help the clinical diagnosis of early Alzheimer's disease

OBJECTIVE: To evaluate distribution and influence factors of logic memory (LM) modified in assessing and scoring method in normal population and Alzheimer's disease (AD) patients, and definite the cut-off point of the modified scale. METHODS: Totally 183 AD patients, including 118 mild and 65 moderate in degree, 1,417 controls, including 1,283 normal individuals and 134 individuals suffered from other diseases, were recruited in this study. Modified LM was conducted. RESULTS: Educational level (F=354.36, STB=0.46, P=0.0001) was the most obvious factor in demographic data to influence total score in normal control group by a fitting of multiple regression models. The total score increased with the rising of educational level in normal controls (P=0.0001) and other diseases controls (P=0.0001), but not in AD cases (P=0.1365). The total scores were significantly different among normal controls (20.2 +/- 0.2), other diseases controls (17.5 +/- 0.5), mild AD patients (9.6 +/- 0.5) and moderate AD patients (7.1 +/- 0.7) (P=0.0001, P=0.0059), after adjusted educational level, age, sex and rural/urban status by multiple analysis covariance. The sensitivity of cut-off points using modified methods to diagnose AD reasonably increased to 71.98%, while the specificity was 94.11%. According to the sum of long-delayed recall and long-delayed recognition, the sensitivity increased with the rising of educational levels. For education levels at illiteracy, elementary school, junior middle school, senior middle school and above senior middle school, the cut-off points for total score of modified method were 6.5, 9.5, 10.8, 13 and 15.8, respectively, and for sum of long-delayed recall and long-delayed recognition the cut-off points were 5, 6, 8, 9, 10. CONCLUSIONS: When modified LM used as a neuropsychological assessment, it is with high specificity, high accuracy and reasonable sensitivity. It is suitable for the diagnosis of AD in early stages, especially for individuals with high educational levels.