军队体检人群应用两种量表筛查认知功能障碍的临床研究

目的探讨联合应用AD8和简易智力状态评估量表(Mini-Cog)在军队体检人群筛查认知功能障碍的特异性和敏感性。方法纳入我院常规健康体检军队人群1723例,对自愿接受认知功能测评者行AD8量表和Mini-Cog测评,最终同时接受AD8量表和Mini-Cog检测的体检者160例。采用ROC曲线分析量表评估的敏感性、特异性,计算ROC曲线下面积(AUC)。结果AD8量表和Mini-Cog测评提示认知功能障碍者分别为84例(52.5%)和71例(44.4%),两者联合检测提示双异常者为43例(26.9%)。160例受检者中临床诊断为认知功能障碍者66例(41.3%),其中AD8量表检出率为69.7%,Mini-Cog检出率为83.3%,两者联合检出率为56.1%。ROC曲线分析显示,两者联合检测特异性为93.6%,敏感性为56.1%。AD8(≥2分)量表、Mini-Cog及两者联合检测评估认知功能障碍的AUC比较,差异有统计学意义(P<0.01)。与认知正常者比较,双异常者年龄明显增高(P<0.01),在调整年龄的影响因素后,协方差分析显示,双异常者连线A完成时间明显延长,简易智能状态检查量表、延迟回忆、执行功能、工作记忆、词语流畅性评分明显降低(P<0.01)。结论AD8和Mini-Cog操作简单,测评所需时间短,两者联合检测可明显提高痴呆患者检出的特异性,适用于在初级医疗卫生保健机构筛查认知功能障碍患者。     

瑞金简易记忆测试量表对阿尔茨海默病患者筛查效用的初步研究

目的:为研发适合中国人群的记忆力筛查量表,采用瑞金简易记忆测试(RISMET)量表对阿尔茨海默病(AD)患者进行检测,评价其效用。方法:分别对57例AD患者和46名正常对照者行RISMET量表和简易智能状态检查(MMSE)量表测评,比较2组得分情况;以内部相关系数(ICC)计算重测信度,Cronbach’sα系数评价内部一致性;以受试者工作特征(ROC)曲线评价RISMET量表对于筛查AD患者的敏感性和特异性。结果:①MMSE、RISMET量表及其分项得分(包括定向力、瞬间记忆、逆行性记忆、相似性、画钟测验、计算力、语言流畅性和回忆8项)均AD组0.7;③Spearman相关分析显示RISMET量表与MMSE量表呈正相关(P=0.726,P=0.000),每一分项与总分的相关性均大于2个分项的相关性,具有统计学差异(P     

认知障碍初步评价表信度与效度的初步研究

目的对认知障碍初步评价表(COG-12)在阿尔茨海默病(AD)患者中的信度与效度进行评价。方法选择2013年1¹2月就诊于南京医科大学附属脑科医院老年精神科的AD患者148例为AD组,另选择社区志愿者365例为对照组,2组均接受临床痴呆量表、AD8、简易智能状态检查量表、画钟测验评估和COG-12测评。其中100例AD患者知情者在首次评定1个月内重测COG-12。结果 COG-12的克朗巴赫α系数=0.883,重测信度=0.883(P<0.01)。COG-12各条目评分与总分的相关系数为0.4112月就诊于南京医科大学附属脑科医院老年精神科的AD患者148例为AD组,另选择社区志愿者365例为对照组,2组均接受临床痴呆量表、AD8、简易智能状态检查量表、画钟测验评估和COG-12测评。其中100例AD患者知情者在首次评定1个月内重测COG-12。结果 COG-12的克朗巴赫α系数=0.883,重测信度=0.883(P<0.01)。COG-12各条目评分与总分的相关系数为0.41⁰.79(P<0.05,P<0.01);COG-12总分与简易智能状态检量表、画钟测验呈负相关(r=-0.67,r=-0.27,P<0.01),与临床痴呆量表、AD8总分呈正相关(r=0.80,r=0.81,P<0.01)。COG-12鉴别认知正常与轻度AD患者的ROC曲线下面积=0.902,≥6分为认知损害的界限分值敏感性为90.0%,特异性为82.5%;鉴别轻度与中度AD患者的ROC曲线下面积=0.898,敏感性为90.5%,特异性为76.7%。结论 COG-12具有良好的信度和效度,是快速识别痴呆及评估严重程度敏感而准确的筛查评估工具。     

蒙特利尔认知评估量表筛查轻度认知功能障碍分界值的研究

目的研究蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)在筛查轻度认知功能障碍(MCI)中的应用价值,初步探讨MoCA筛查MCI的最佳界值。方法分别采用简易智能状态检查量表(MMSE)及MoCA评估入组的男性患者153例,根据诊断标准分为对照组69例、MCI组60例、AD组24例。进行2种量表得分的相关性分析,并且计算MoCA筛查MCI患者的敏感性、特异性、Kappa值、约登指数等,并选取最佳分界值。结果与对照组比较,MCI组和AD组MMSE评分和MoCA评分明显降低(P<0.05)。MMSE评分与MoCA评分呈正相关(r=0.847,P<0.01);以26分为分界值,MoCA诊断MCI的敏感性为98.3%,特异性为85.5%,Kappa值=0.830;绘制ROC曲线得到MoCA筛查MCI的最佳分界值为25分,敏感性为93.3%,特异性为97.1%,Kappa值=0.906。结论本研究人群MMSE评分与MoCA评分有很好的相关性,并且与临床诊断一致性好,推荐25分为该类人群MCI的分界值。     

AD8联合简易智能状态检查量表用于军队健康体检人群认知功能障碍筛查的初步研究

目的探讨AD8和简易智能状态检查量表(mini-mental state examination,MMSE)联合使用在军队健康体检人群中筛查认知功能障碍的特异性和敏感性。方法选择2013年1月1日~12月31日在解放军总医院接受常规健康体检的军队人群1723例,进行AD8和MMSE测评。结果 1723例接受AD8测评中,AD8≥2分326例(18.9%)。161例主诉认知功能减退者同时接受MMSE测评,AD8≥2分84例(52.2%),MMSE异常78例(48.4%)。临床诊断痴呆66例(41.0%),其中AD8筛查阳性46例(69.7%),MMSE异常55例(83.3%)。ROC曲线分析显示,AD8+MMSE联合筛查痴呆的特异性从AD8单项测试的60.0%提高到91.6%。协方差分析显示,在调整年龄的影响因素后,AD8+MMSE双异常者连线A评分较认知正常者明显升高,MMSE、延迟回忆、执行功能、工作记忆、词语流畅性评分较认知正常者明显降低,差异有统计学意义(P0.01)。结论健康体检时AD8+MMSE联合应用可以提高检出痴呆患者的特异性和可靠性,便于在基层医疗卫生机构推广使用。     

肝病生存质量量表在慢性病毒性肝炎患者中的性能评估

目的:探讨肝病生存质量量表(Liver Disease Quality of Life Questionnaire,LDQOL1.0)中文版在慢性病毒性肝炎患者生存质量测试中的信度和效度.方法:使用LDQOL1.0中文版对100例慢性病毒性肝炎患者进行进行生存质量测试,回收有效问卷91例,使用克朗巴赫系数(Cronbachα)、天花板效应和地板效应来检测量表的信度;通过计算各个肝病特异性维度与S F-36的8个维度之间的相关系数来评估量表的标准效度;通过探索性因子分析来评估量表的结构效度;通过比较不同Child Pugh评分的患者的得分,评估量表的区分度.相关性检测使用Pearson相关系数,区分度检测使用方差分析进行多重比较.结果:Cronbach α在各领域中的分值为0.33(95%C I:0.08-0.52)-0.9(95%C I:0.90-0.99),80%领域分值0.7;天花板效应在0%-39.6%,地板效应在0%-34.1%,80%领域20%.标准效度提示12个肝病特异性领域里,有6个领域与SF-36的相近领域相关度较好(Pearson系数0.5,P0.05);因子分析提示肝病特异性12个领域里7个领域因子分析结果与原量表构想相似.区分度检测提示肝病特异性12个领域里7个的区分度较好(F:0.353-21.29,P0.05).结论:LDQOL1.0在中国慢性病毒性肝炎患者中测试生存质量,大部分领域信度、效度和区分度较好,可以用于临床工作.     

抗细胞膜DNA抗体对系统性红斑狼疮的诊断价值及与其他抗体联合检测的意义

目的 探讨抗细胞膜DNA(mDNA)抗体在系统性红斑狼疮(SLE)患者的表达以及该特异性抗体对SLE患者的诊断价值及与其他抗体联合检测的意义.方法 用间接免疫荧光法观察培养的HL60细胞的特异性细胞膜的荧光图形,以细胞周连续的环状荧光为抗mDNA抗体阳性.同时检测SLE的其他常见抗体,采用pearsonχ~2检验进行统计学处理.结果 抗mDNA抗体在205例SLE患者中有145例阳性,阳性率70.7%,在55例类风湿关节炎(RA)患者中5例阳性,阳性率为9.1%,45例原发性干燥综合征(pSS)患者中10例阳性,阳性率为22.2%,35例皮肌炎/多肌炎(PM/DM)患者中4例阳性,阳性率14.3%,50名健康对照组中均为阴性.抗mDNA抗体对SLE诊断的敏感性为70.7%,特异性为86.7%.抗mDNA抗体阳性+抗核抗体(ANA)阳性联合检测的敏感性94.6%,特异性76.7%;抗mDNA抗体阳性+抗双链DNA(dsDNA)抗体阳性联合检测的敏感性76.8%,特异性95.5%;抗mDNA抗体阳性+抗Sm抗体阳性联合检测的敏感性79.6%,特异性100%;抗mDNA抗体阳性+抗核小体抗体(AnuA)阳性联合检测的敏感性93.0%,特异性100%.结论 抗mDNA抗体是一种诊断SLE的新的标记抗体,其敏感性较高,特异性强,较抗dsDNA抗体、抗Sm抗体检测更先进.与SLE常用其他抗体联合检测可进一步提高敏感性和特异性.     

CEA、CYFRA21-1联合检测在非小细胞肺癌诊断中的价值

目的：用绘制 ROC 曲线的方法评价癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)联合检测在非小细胞肺癌诊断的临床价值。方法收集78例确诊为非小细胞肺癌的患者及同期79例肺部良性疾病患者的临床资料,使用 SPSS 18.0软件绘制 ROC 曲线分析 CEA 及 CYFRA21-1联合检测诊断非小细胞肺癌的敏感性、特异性及诊断准确性,评价其在诊断非小细胞肺癌中的临床价值。结果非小细胞肺癌组血清 CEA、CYFRA21-1水平显著高于肺部良性病变组(P <0.01)。CEA 单独检测的敏感性为64.2%,特异性为97.5%,CYFRA21-1单独检测的敏感性为61.7%,特异性为88.6%,两者联合检测的敏感性为71.6%,特异性为83.5%,明显高于单项检测。两者联合检测的曲线下面积为0.802,高于 CEA、CYFRA21-1的 ROC 曲线下面积(0.760、0.792)。吸烟的男性患者中两者联合检测的曲线下面积为0.841,敏感性为69.2%,特异性为100.0%。结论 CEA、CYFRA21-1两者联合检测可提高对非小细胞肺癌诊断的敏感性,且对男性吸烟患者的诊断准确性最高,具有一定的临床价值。     

蒙特利尔认知评估量表(北京版)筛查农村老年人轻度认知障碍的价值

目的研究蒙特利尔认知评估表(Mo CA)北京版筛查农村老人轻度认知损害(MCI)的应用价值,探讨Mo CA筛查农村MCI患者的分界值。方法随机选取泰安市2 150位60岁以上农村老人,有效调查人数为1 971例,分为正常组(1 185例)、MCI组(651例)、痴呆组(135例)。Mo CA与简易智能状态检查(MMSE)评估后进行Mo CA量表的信度、效度分析,计算Mo CA筛查MCI患者的敏感性、特异性、Kappa值、约登指数,并选取最佳分界值。结果 Mo CA总分和MMSE总分相关性很好(r=0.737,PO.001);经过绘制受试者工作特征(ROC)曲线确定Mo CA得分值≥15为正常,其敏感性和特异性分别为1.000和0.986。结论 Mo CA得分与MMSE得分有较好的相关性。可以使用Mo CA量表筛查农村MCI患者,推荐15分为该类人群MCI的分界值,建议调整Mo CA量表部分条目。     

CT和血清CA19-9联合检测在胰腺癌诊断中的价值

目的探讨CT和血清CA19-9联合检测对胰腺癌诊断的价值。方法回顾性分析胰腺病变93例,所有患者术前均行螺旋CT增强扫描及血清CA19-9检测,并对CT、CA19-9以及二者联合检测与病理诊断进行比较。结果 93例胰腺病变患者中,被病理证实为胰腺癌患者63例。经CT诊断为胰腺癌的68例患者中,55例被病理证实为胰腺癌。CT对胰腺癌诊断的敏感性、特异性和符合率分别为87.3%、56.7%和77.4%。胰腺癌患者的血清CA19-9中位值显著高于非胰腺癌患者(426.7 vs 23.7,P<0.001)。60例CA19-9≥37 U/ml的患者中,48例被病理证实为胰腺癌。CA19-9对胰腺癌诊断的敏感性、特异性和符合率分别为76.2%、60.0%和71.0%。CT联合CA19-9检测对胰腺癌诊断的敏感性、特异性和符合率分别为68.3%、90.0%和75.3%。CT、CA19-9以及二者联合检测与病理诊断均有较好的一致性(均P<0.001),但联合检测的一致性更高。以ROC曲线和Youden指数指示的CA19-9判定胰腺癌的最佳阈值(235.1 U/ml)作为诊断分界点时,CA19-9对胰腺癌诊断的敏感性、特异性和符合率分别为65.1%、90%和73.1%,显著提高了诊断的特异性。以235.1 U/ml为诊断分界点,CA19-9与CT联合检测对胰腺癌诊断的敏感性、特异性和符合率分别为60.3%、96.7%和72.1%,进一步提高了诊断的特异性。结论对于无法获取病理组织的患者,CT联合CA19-9检测是临床诊断胰腺癌较好的方法之一。     

The role of routine laboratory studies and neuroimaging in the diagnosis of dementia: a clinicopathological study

OBJECTIVE: To determine the neuropathological diagnoses of longitudinally followed patients with potentially reversible causes of dementia and to examine the results of the "dementia work-up," especially neuroimaging, by comparison with the pathological diagnosis. DESIGN: A neuropathologic series of 61 consecutive patients, with review of clinical, laboratory, neuroimaging, and pathological results. RESULTS: Of the 61 patients, forty-eight (79%) had a clinical diagnosis of probable or possible Alzheimer's disease (AD). Compared with the pathological diagnosis, the sensitivity and specificity of the clinical diagnosis of AD were 96% and 79%, respectively. Of the 61 patients, 9 had abnormal laboratory tests, the correction of which did not improve the subsequent course. These patients were found to have AD8 and frontotemporal dementia on pathology. In two patients, neuroimaging was helpful in the clinical diagnoses of frontotemporal dementia and progressive supranuclear palsy (PSP). Neuroimaging revealed cerebrovascular disease in 18 patients, only two of whom were suspected clinically. Pathology confirmed AD in 17 and PSP in 1 of these patients. Sensitivity and specificity for the clinical diagnosis of cerebrovascular disease in comparison with pathology were 6% and 98%, respectively. With the added information from neuroimaging, that sensitivity increased to 59% and specificity decreased to 81%. CONCLUSIONS: All cases with abnormal laboratory or neuroimaging results had AD or some other neurodegenerative disease on pathology. The "dementia work-up" did not reveal any reversible causes for dementia in this group of patients. Neuroimaging may have a role, especially in the diagnosis of possible AD with concomitant cerebrovascular disease.     

阿尔茨海默病不同严重程度时的神经心理学研究

目的 研究阿尔茨海默病（ＡＤ）不同痴呆严重程度时的神经心理模式特点。方法 使用多种神经心理测验测试了符合国际公认的痴呆诊断标准（ＮＩＮＣＤＳ－ＡＤＲＤＡ）“很可能为ＡＤ”的患者,使用临床痴呆评定（ＣＤＲ）确定痴呆严重程度。结果 ＡＤ早期即出现视空间功能障碍,中、重度阶段均明显衰退。认知功能障碍也始于ＡＤ早期,中、重度阶段呈持续性显著衰退趋势,记忆功能在ＡＤ早期即出现大幅度衰退,,中期衰退幅度不大,     

Interdisciplinary research strategies in geriatric psychiatry--studies and results in dementia and depressed patients

Eighty-one patients (mean age: 66 +/- 9 years) who had been in gerontopsychiatric in-patient care were included in the study. As well as physical, psychiatric and neurological examinations, EEG, brain CT scanning and the determination of the Ischemic Scale were performed, in order to confirm the clinical diagnosis of dementia of Alzheimer type (DAT), dementia of vascular type (DVT) or multi-infarct dementia (MID), and depression in old age, as based on the DSM III criteria. A comprehensive psychological test battery was administered, to one section of the subjects. Our results indicate that EEG and Ischemic Score can differentiate patients with DAT and DVT to a satisfactory degree, whereas CT findings and psychometric assessment were apt to confirm the overall diagnosis of dementia (DAT/DVT) and depression. Patients with dementia showed memory impairment to a greater extent than depressive patients, as could be proved by a memory test (Syndrom-Kurztest). However, a dementia screening test (Information-Memory-Concentration Test) could more accurately differentiate dementia and depression. The application of a comprehensive psychometric testing procedure did not prove to be an effective diagnostic tool in the assessment of various stages of dementia. Short dementia tests and rating scales seem to be appropriate to distinguish depression from dementia, especially in cases of mild to moderate dementia. In patients with very mild and insignificant organic brain disturbances these screening methods fall short of diagnostic validity. Beyond this, there is a current need for assessment instruments in the evaluation of alterations in personality and affectivity, such as are seen in depression.     

Screening for Alzheimer's disease: the memory impairment screen versus the conventional three-word memory test

OBJECTIVES: To improve screening for Alzheimer's disease (AD) with the Memory Impairment Screen (MIS), a 4-minute, four-item delayed free and cued recall memory test with controlled learning and high discriminative validity. To assess the discriminative validity of the MIS for AD and to compare it with the conventional three-word memory test, a delayed free recall task, widely recommended as a dementia-screening test in clinical practice. DESIGN: Cross-sectional validation study nested within a longitudinal study of aging and dementia. The MIS and the standard three-word memory task were administered as part of a comprehensive neurological and neuropsychological evaluation. SETTING: Einstein Aging Study at the Albert Einstein College of Medicine, Bronx, New York. PARTICIPANTS: Two hundred forty community-dwelling older adults. MEASUREMENTS: Sensitivity, specificity, and positive predictive value (PPV) were calculated for the MIS and three-word memory test as screening tests for AD. RESULTS: In comparison with the three-word memory task, the MIS had higher sensitivity (.86 vs.65), higher specificity (.97 vs.85), and greater PPV (.80 vs.37) as a screen for AD. CONCLUSIONS: The MIS had high discriminative validity as a screening test for AD and substantially outperformed the three-word memory task. Given its validity and brevity, the MIS has important advantages as an AD screen for use in primary care.     

Neuropsychological tests in Alzheimer's disease.

The recent development of symptomatic pharmacological treatment for Alzheimer's disease (AD) and the probable introduction of new therapies in a near future make the assessment of dementia at its different stages an even greater scientific and public health challenge. Neuropsychological tests, together with clinical data, are at present the only in vivo non-invasive screening and diagnostic tools for AD and related disorders. This chapter reviews the application to AD of standard batteries and short screening tests. It also analyzes the tests to be applied to detect and assess the specific deficits of the disease, and discusses the advantages and flaws of current screening and diagnostic tests of dementia. Emphasis is placed on the need to devise and use tests developed in a rational manner, with high sensitivity and specificity, not only in the moderate stages of the disease, but also in the very early and even "preclinical" stages, as well as during the late stages (severe dementia). It is known that neuropsychological tests allow one to determine various patients' profiles. Future research should determine the possible predictive value of these profiles. This has important implications for therapeutic trials. The current implicit assumption that all patients with AD tend to evolve and decline in a similar fashion needs to be critically re-examined.     

The prevalence of dementia in a total population: a comparison of two screening instruments.

Two short screening tests for dementia, the Information/Orientation (IO) sub-test of the Clifton Assessment Scale (CAPE) and the Mini-Mental State Examination (MMSE) were included in a survey of 1579 elderly people of a large general practice. All those scoring 21 and under on the MMSE, a one in two sample of those scoring 22, 23 and a one in ten sample of the remainder were investigated further using the Cambridge Examination for Mental Disorders of the elderly (CAMDEX). The prevalences of moderate to severe dementia and mild to severe dementia determined from the CAMDEX interview were 4.8% and 14.2%, respectively. For detection of moderate to severe dementia, a cut-point of 21/22 on the MMSE gave a sensitivity of 100%, specificity of 85% and an overall prevalence of 19.7%; mild to severe dementia was best detected by a cut-point of 23/24 giving a sensitivity of 89%, specificity of 81% and prevalence of 28.5%. A cut-point of 7/8 on the IO sub-test gave a sensitivity and specificity for detecting moderate to severe dementia of 87% and 97%, respectively, with a prevalence of 7.3%; for mild to severe dementia a cut-point of 10/11 gave a sensitivity of 67%, specificity of 94% and prevalence of 14.7%.     

Screening for dementia by telephone using the memory impairment screen

OBJECTIVES: : To develop and assess telephone-based screening tests for dementia, especially Alzheimer's disease (AD). DESIGN: : A cross-sectional validation study nested within a longitudinal study of aging and dementia. SETTING: : The Einstein Aging Study of the Albert Einstein College of Medicine, Bronx, New York. PARTICIPANTS: : Three hundred elderly community volunteers living in Bronx County, 27 of whom were diagnosed with dementia based on in-person clinical evaluation. Of the 27 individuals with dementia, 18 had AD. MEASUREMENTS: : A telephone battery was administered that included the Memory Impairment Screen by telephone (MIS-T, a test of semantic memory), the Category Fluency Test (CF-T), and the Telephone Instrument for Cognitive Status (TICS). An in-person evaluation then followed that included a neurological examination, a neuropsychological battery, demographics, and medical history. RESULTS: : The telephone battery was well accepted. The MIS-T required 4 minutes; the CF-T, 3 minutes; and the TICS, 10 minutes. The MIS-T had excellent sensitivity and specificity when compared with the CF-T and the TICS. Using cutscores on all three tests that provide a sensitivity of 78%, specificity was significantly higher for the MIS-T (93%) than for the CF-T (78%, P<.05) or the TICS (80%, P<.05). Combining the MIS-T and CF-T improved discriminative validity but increased screening time and the complexity of scoring. Normative data for the MIS-T, the CF-T, and the TICS for use in settings with different base rates (prevalence) of dementia are presented in this study. CONCLUSION: : The MIS-T outperforms the CF-T and the TICS as a valid and time-efficient telephone screen for dementia. For applications that require optimal efficiency and accuracy, the MIS-T is recommended.     

Longitudinal diagnosis of memory disorders.

Early referral for specialist assessment is becoming more common with memory disorders and dementia: the mean Mini-Mental State Examination (MMSE) score of new patients at our clinic rose from 18.7 to 20.7 between 1986 and 1990. The clinical diagnosis of mild to moderate dementia has been recognized to be difficult, but several studies have reported cross-sectional diagnosis. We examined the number of visits required to establish a clinical diagnosis of dementia in the first 125 patients attending a Memory Disorders Clinic who had at least two visits (six months apart) and the stability of the diagnoses. Just under half of the patients required at least two visits to establish the clinical diagnosis. The MMSE was not a good guide to the number of visits required but the diagnosis at the first visit remained stable in all patients who scored < or = 10/30. Sixteen per cent of patients interchanged between the categories of Alzheimer's, mixed and vascular dementias. Possible age-associated memory impairment progressed to dementia in six of eight cases, and depression to dementia in three cases. The diagnosis of mild to moderate dementia should not be restricted to a cross-sectional approach, but should involve serial clinical, psychological and affective assessments.