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.     

轻度认知功能损害诊断:脑血管病因素对神经心理学指标的影响

目的对神经心理学指标在轻度认知功能损害(MCI)诊断中的作用进行评价;了解脑血管病因素对MCI诊断标准的 影响。方法从老年人流行病学凋查人群中随机抽取78人为研究对象,设正常对照组(41人)及MCI组(37例)。 对2组进行以下 观测:简易精神状态检查(MMSE)、总体衰退量表(GDS)、临床痴呆分级量表(CDR)、日常生活能力(ADL)、Pfeffer功能活动量表 (FAQ)、物体记忆测验(FOM)、无意义图形再认(MGR)、词语流畅性测验(RVR)、数字广度测验(DS)、画钟测验(CDT)、流调用抑郁 自评量表(CES—D)、延迟记忆(DR)及逻辑记忆测验(LM)。结果MCI组的FOM、MGR、LM、MMSE、DR、FAQ、CDT、CDR、GDS等测 验成绩明显差于正常对照组。在排除了脑血管病之后,MCI组的MGR、FOM、LM、CDT、DR、CDR、GDS等测验分数仍明显差于正常对 照组,但MMSF、FAQ测验在2组之间的差别不再具有统计学意义。结论脑血管病因素对MCI诊断的某些神经心理学指标有影响: MCI存在异质性,部分可以由脑血管病造成。在诊断MCI时,应该增加排除标准。     

轻度认知障碍和阿尔茨海默病患者认知功能和MRI对照研究

目的探讨轻度认知障碍（MCI）和阿尔茨海默病（AD）的认知功能及影像学特点。方法回顾性分析经临床确诊的21例MCI和24例AD患者的临床资料。所有实验对象均用简易智力量表（MMSE）和蒙特利尔认知评估（MoCA）测定。结果MCI与AD的认知功能损害相比较：除了MMSE的记忆力组间无统计学意义（P＝0．28）,其余均有统计学差异（P〈0．05）。MoCA比MMSE具有更好的敏感性。AD的MRI表现：脑萎缩,特别是海马存在不同程度的萎缩;老年性脑改变;MCI的MRI主要表现为脑白质脱髓鞘病变,少数提示轻度脑萎缩或未见明显异常。结论MCI和AD患者早期均表现为记忆力下降,对记忆力减退人群进行MMSE、MoCA量表筛查有助于AD的早期诊断。AD患者到中晚期治疗较困难,因此早期诊断及干预对延缓病程起积极作用。     

轻度认知功能障碍患者的日常生活能力改变

目的分析轻度认知功能障碍(MCI)患者的日常生活能力的改变情况。方法研究对象为50岁以上患者,根据欧洲AD协会MCI工作组于2005年提出的MCI诊断标准诊断轻度认知功能障碍(MCI)41例,对照(NC)34例,进行蒙特利尔认知评定量表(MoCA)、日常生活活动能力量表(ADL)测试。结果 41例MCI中有8例日常生活活动能力下降,MoCA、MoCA-mem与ADL得分有相关性[相关系数分别为-0.29,P<0.05(P=0.01)、-0.27,P<0.05(P=0.02)];MCI组与NC组在工具性日常生活活动量表(IADL)得分上差异明显[P=0.02(P<0.05)],在ADL得分及躯体生活自理量表(PSMS)得分上差异不明显,(P分别为0.09、0.75)。MCI组PSMS损害程度与IADL损害程度之间的差异明显[P=0.03(P<0.05)]。结论部分轻度认知功能损害患者存在日常生活活动能力的轻微下降,以IADL下降为主。     

晚发型抑郁障碍与轻度认知功能损害患者的认知功能差异研究

目的 探讨晚发型抑郁障碍患者与轻度认知功能损害患者的认知功能损害的差异.方法 研究对象为2012年7月～2013年8月上海市精神卫生中心老年科住院与门诊就诊符合DSM—Ⅳ诊断标准且起病年龄≥60岁的抑郁障碍患者,共26例为晚发型抑郁障碍组（LOD组）,另选择26例轻度认知功能损害的患者（MCI组）与26例正常老年人（NC组）.认知功能评估采用简明精神状态量表（MMSE）、蒙特利尔量表（MoCA）.结果 MMSE总分、MMSE分测验中计算力与注意力及MoCA总分、MoCA分测验中连线、注意、持续注意、计算、复述、延迟回忆在LOD组与MCI组差比较异无统计学意义（P＞0.05）,两组与NC组比较差异有统计学意义（P＜0.05）.三组在MMSE分测验的时间定向、延迟回忆、三步指令、书写书面指令及MoCA分测验的复制图、画钟、命名比较,MCI组均值最低,与NC组比较差异有统计学意义（P＜0.05）,与LOD组比较差异无统计学意义（P＞0.05）.结论 LOD组认知功能在注意力、延迟回忆、连线测验方面与MCI组损害程度相当.MCI组认知功能受损范围较LOD组广泛.     

Rey-Osterriche复杂图形测验在轻度阿尔茨海默病和轻度认知损害患者中的应用研究

目的:研究Rey-Osterrich复杂图形测验(CFT)对轻度阿尔茨海默病(AD)和遗忘型轻度认知损害(MCI)的诊断价值。方法:应用CFT、简明精神状态量表(MMSE)对45例轻度AD患者、73例遗忘型MCI和66名正常老年人进行检测,MMSE总得分分别为(20.2±2.5)分、(26.9±1.8)和(28.2±1.6)分。结果:对照组,CFT结构模仿和延迟回忆得分与教育程度有显著正相关性,与年龄、性别无相关性。MCI组的结构模仿得分为(32.4±6.2)分,轻度AD组为(26.1±10.9)分,对照组为(33.6±3.1)分。AD组与对照组及MCI组比差异有显著意义,延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性(P<0.01);MCI组的延迟回忆得分与对照组比差异有显著统计学意义(P<0.01),轻度AD组下降更为明显,与MCI组比差异有显著统计学意义(P<0.01)。结论:CFT延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性。CFT结构模仿不能识别MCI,对轻度AD,其敏感性亦不理想。     

蒙特利尔认知评估量表在轻度认知功能障碍筛查中的应用

目的 探讨蒙特利尔认知评估量表(MoCA)在轻度认知功能障碍(MCI)患者筛查中的应用.方法 应用简易精神状态检查量表(MMSE)、MoCA对32例MCI患者和50例健康对照者进行神经心理评估,比较二者筛查MCI的效果.结果 以26分为分界值,MoCA筛查MCI的敏感性为96.87%、特异性为76%,MMSE筛查MCI的敏感性为56.25%、特异性为96%;MoCA中除抽象思维、地点定向两项外,其余各亚项的评分在MCI组和对照组间差异均有统计学意义(P＜0.05):MMSE中仅计算与注意力、延迟回忆两项在MCI组和对照组间差异有统计学意义(P＜0.05),其余各项差异均无统计学意义(P＞0.05).结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能.且可用于筛查MMSE得分正常的MCI患者.     

记忆与执行筛查量表在判断阿尔茨海默病严重度中的作用

目的 采用记忆与执行筛查量表（MES）评价轻度认知功能损害（MCI）和不同严重度的阿尔茨海默病（AD）患者认知损害特点,探讨MES对于AD患者不同严重度的判断价值.方法 年龄、性别和受文化程度匹配的709例受试者（分为5个组：正常老年人（对照组）164名、MCI组137例、轻度AD组193例、中度AD组136例、重度AD组79例）全部完成简明精神状态量表（MMSE）和MES,比较各组MMSE总分和MSE指标的差别.对照组136例、MCI组116例、轻度AD组178例、中度AD组122例和重度AD组69例进行了ApoE基因型检测.结果 MMSE总分和MES各指标在各组受试者中均随着认知损害的加重呈下降趋势.MMSE总分、MES的10个项目的原始分、因子分、总分在5个组别的两两比较中呈现相对均衡的下降,均差异有显著统计学意义（P＜0.01）,其中句子回忆5（即间隔约5min后的自由回忆）下降最快,而记忆与执行的比例（MES-R）在各组则差异无统计学意义（P＞0.05）,学习能力在正常至MCI阶段、轻度AD至中度AD阶段没有显著变化（P＞0.05）呈平台期,而记忆保留能力呈相对均衡的下降,差异有显著统计学意义（P＜0.01）.ApoEε4非携带者（223例）与ApoEε4携带者（146例）AD患者MMSE总分与MES总分也无显著差异,但MES记忆部分前者优于后者;执行部分相反,MES-R在两组间差异有显著统计学意义（P＜0.01）.结论 MES不需要任何辅助工具、耗时少、受教育程度影响少,可以快速了解情景记忆、执行功能等主要认知领域受损状况,无天花板和地板效应,对轻中重度认知功能损害患者均有较好的鉴别能力,较CDR易于操作,值得在对AD的严重度判断中推广应用.     

中文修订版智能筛查检测在阿尔茨海默病和轻度认知损害评估中的作用

目的:探讨智能筛查测验(CASI)在不同严重度的阿尔茨海默病(AD)患者中的表现及与MMSE总分的关系。方法:使用2.0版本的CASI、MMSE及临床痴呆量表等对30名正常中老年人、20例轻度认知损害(MCI)和53例不同严重度的AD患者(20例轻度、19例中度、14例重度)进行评估。结果:根据CASI因子分分析发现,MCI组新记忆和概念判断受损、完成测验的耗时数延长,AD组在从轻至重度组中依次出现定向障碍、心算障碍,直到所有因子分均显著减退。除"概判"因子外,其余因子分都随着病情严重度而逐渐降低。除了重度AD组以外,MCI组、轻度AD组和中度AD组均较前一组下降约10分。CASI总分以≤85分为界:识别MCI的敏感度为70.6%;识别轻度AD的敏感度为82.7%;特异度均为73.9%。对于大学及以上文化者,CASI难度过低,容易出现假阴性。结论:CASI可有效判断AD认知损害的严重度,并能从组成项目中获得MMSE总分。     

轻度认知功能障碍的神经心理学和脑血流灌注研究

目的　用神经心理学和脑血流灌注检查探讨轻度认知功能障碍 (MCI)特点 ,分析其与阿尔茨海默病 (AD)和健康衰老的差异。方法　对 2 1例MCI ,18例AD和 19例健康老人进行简易智力状态检查 (MMSE) ,日常生活能力量表(ADL)和总体衰退量表 (GDS)评定 ,韦克斯勒记忆测验 (WMS)及SPECT检查。SPECT结果作半定量分析 (以放射性计数比值 -RAR表示 )。结果　认知功能评定结果 :与健康老人相比 ,MCI除ADL成绩外 ,其余均显著降低 ;与AD相比 ,MMSE、ADL、GDS以及WMS中的短时记忆和语言记忆成绩均显著优于AD(P <0 0 5 )。脑血流灌注比较结果 :MCI组与健康老人各部位的RAR无差异 ;与AD组相比 ,扣带回、左基底节、左枕叶、右颞上回、双侧额叶、双侧颞下回和双侧顶叶RAR均显著增高 (P <0 0 5 )。以顶叶RAR为变量作聚类分析产生两类MCI(MCI 4和MCI 16) ,MCI 16在左丘脑的血流灌注低于健康老人(P <0 0 1) ,在双侧颞下回和右颞上回高于AD(P <0 0 1)。结论　MCI为一组异质性疾病 ,认知功能缺损和脑血流灌注的改变均存在多种类型。顶叶能对MCI进行有效分类。     

不同严重程度血管性痴呆与老年性痴呆的神经心理特点

目的 探讨不同严重程度的血管性痴呆（vascular dementia,VaD）与老年性痴呆（Alzheimer disease,AD）
的神经心理学特点。
方法 对广东省人民医院神经科门诊及病房的252例痴呆患者（VaD组127例,AD组125例）,和正常对
照组159例进行一组神经心理量表检查。神经心理量表包括：简易精神状态检查（mini-mental state
examination,MMSE）、Fuld物体记忆测验（fuld object memory,FOM）、言语流畅性测验（rapid verbal
retrieve,RVR）、数字广度测验（digit span,DS）和积木测验（block design,BD）。分析这两种类型不同
严重程度的痴呆患者认知障碍的特点。
结果 两种类型的轻、中、重度痴呆患者神经心理检查有统计学差异（P <0.01）。轻度痴呆患者MMSE、
RVR评分在VaD、AD组间存在统计学差异（P <0.05）,在中、重度痴呆患者,神经心理评分在VaD、AD组
间无统计学差异（P >0.05）。
结论 神经心理量表评估有助于VaD、AD的严重程度分级,RVR测验可辅助鉴别诊断轻度VaD和AD。     

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.     

老年期痴呆和帕金森病患病率调查

目的：了解社区老年期痴呆和帕金森病患病率及相关因素。方法：采用整群随机抽样法,对社区55岁及以上老年人进行调查。采用二阶段调查法,以简易智能状态检查量表（MMSE）、日常生活能力量表（ADL）、帕金森病筛查问卷为筛查工具：以Pfewffer功能活动调查表（POD）、Fud物体记忆测数（FOM）、快速词汇测验（RVR）、Hachinski缺血指数量表（HIS）为细查工具。按ICD－10老年期痴呆诊断标准确诊病例。结果：在1186人55岁及以上老年人中,痴呆患病率2．61％,其中阿尔茨海默病（AD）0．76％,血管性痴呆（VD）0．42％,混合型痴呆1．43％。帕金森病患病率为0．17％。结论 老年期痴呆和帕金森病是危害老年人健康和消耗卫生资源较高的慢性疾病。     

Screening for cognitive impairment: a triage for outpatient care

The current increase in aged individuals in number and proportion of the general population warrants dependable strategies to improve early detection of cognitive impairment. It was the goal of the present study to develop a triage for bedside testing and outpatient services. In a prospective clinical cohort study at the outpatient Memory Clinic, University of Ulm, Germany, 232 subjects were diagnosed with Alzheimer's disease [AD; NINCDS-ADRDA criteria; n = 66; age 65.9 +/- 7.3 years (mean +/- SD); Mini Mental State Examination (MMSE) score 23.4 +/- 4.1], mild cognitive impairment (MCI; criteria of Petersen et al.; n = 48; age 66.4 +/- 7.1 years; MMSE score 28.3 +/- 1.5), and major depressive disorder (DSM-IV criteria; n = 61; age 63.4 +/- 8.0 years; MMSE score 28.6 +/- 1.6). Diagnosis was secured with extensive neuropsychological, clinical, radiological, and laboratory investigations. Six brief screening tests including the Memory Impairment Screen (MIS), Letter Sorting Test (LST), Verbal Fluency (VF), and Clock Drawing Test (CDT) were assessed independently from the diagnostic procedure. We compared single items and composite scores. LST yielded a diagnostic accuracy of 0.81 and 0.62 for AD and MCI patients versus controls, respectively. With the MIS, diagnostic accuracy was 0.89 and 0.71, respectively. With a combination of LST, MIS, VF, and CDT, a sensitivity for AD and MCI patients of 1.00 and 0.83 was achieved. Thus, single-item screening (e.g. LST, VF) taking little more than 1 min and suitable for bedside testing or brief screening in the general practitioner's office yields diagnostic accuracy comparable to standard laboratory tests for other diseases. A composite of screening tests suitable for application in general outpatient care in neurological and psychiatric services reliably detects patients with AD and MCI.     

老年精神分裂症脑脊液中tau蛋白与认知功能

目的：探讨脑脊液中ｔａｕ蛋白与认知功能缺损之间的关系。方法：精神分裂症组３７例，其他神经系统疾病组２６例，Ａｌｚｈｅｉｍｅｒ病组４５例，对精神分裂症患者评定阳性阴性症状量表，Ｆｕｌｄ物体记忆测验，言辞流畅测验，积木测验及数字广度测验。采用酶联免疫吸附分析检测３组患者中ｔａｕ蛋白浓度。     

Discriminative capacity and construct validity of the Clock Drawing Test in Mild Cognitive Impairment and Alzheimer’s disease

Abstract

Objectives: The aim of this study was to analyze the psychometric and diagnostic properties of the Clock Drawing Test (CDT), scored according to the Babins, Rouleau, and Cahn scoring systems, for Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD) screening, and develop corresponding cutoff scores. Additionally, we assessed the construct validity of the CDT through exploratory and confirmatory factor analysis.

Methods: We developed a cross-sectional study of ambulatory MCI and AD patients, divided in two clinical groups (450?MCI and 250 mild AD patients) and a normal control group (N?=?400). All participants were assessed with the CDT, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) for convergent validity.

Results: The selected scoring systems presented adequate validity and reliability values. The proposed cutoff scores showed 60 to 65% sensitivity and 58 to 62% specificity to identify MCI patients. The corresponding values for AD were 84 to 90% sensitivity and 76 to 78% specificity. Exploratory and confirmatory factor analysis revealed that the Babins scoring system had good construct validity and allowed us to propose a three-factor model for this system.

Conclusions: Our results confirmed the complexity of the CDT and support it as a cognitive screening instrument particularly sensitive to AD. The use of the CDT with MCI patients should be interpreted with more caution due to the lower sensitivity and specificity for milder forms of cognitive impairment.     

Screening for Early Alzheimer's Disease: Is There Still a Role for the Mini-Mental State Examination?

Background: The objective of this study was to compare the performance of the Mini-Mental State Examination (MMSE) total score as well as item scores in separating 4 groups of elderly (55-85 years of age) subjects-normal controls, subjects with mild cognitive impairment (MCI), subjects with mild Alzheimer's disease, and subjects with depression.Method: The MMSE scores of 86 subjects (25 normal elderly controls, 26 subjects with MCI, 10 subjects with mild Alzheimer's disease, and 25 subjects with depression) were analyzed. Statistically significant differences between groups in both overall MMSE score and individual item scores were documented. Receiver operating characteristic curves were constructed to yield further data.Results: The overall MMSE scores of the mild Alzheimer's disease group were significantly below those of subjects in the control, MCI, and depression groups (p < .001). The overall MMSE scores of MCI subjects were significantly lower than those of control subjects (p = .005) but not different from those of subjects with depression. Furthermore, individual item responses were not significantly different between MCI subjects and controls. The delayed recall item scores were statistically lower in the mild Alzheimer's disease group versus the other 3 groups but did not separate the control, MCI, and depression groups from each other.Conclusion: The MMSE effectively separates those with mild Alzheimer's disease from the other 3 groups and MCI from normal aging, but it is relatively ineffective in separating normal elderly individuals from those with depression and individuals with MCI from those with depression. Measures other than the MMSE may need to be implemented to evaluate mental status to more effectively separate MCI from depression and depression from normal aging.     

The relevance of hippocampal subfield integrity and clock drawing test performance for the diagnosis of Alzheimer’s disease and mild cognitive impairment

Objectives: The clock drawing test (CDT) is one of the worldwide most used screening tests for Alzheimer’s disease (AD). MRI studies have identified temporo-parietal regions being involved in CDT impairment. However, the contributions of specific hippocampal subfields and adjacent extrahippocampal structures to CDT performance in AD and mild cognitive impairment (MCI) have not been investigated so far. It is unclear whether morphological alterations or CDT score, or a combination of both, are able to predict AD.

Methods: 38 AD patients, 38?MCI individuals and 31 healthy controls underwent neuropsychological assessment and MRI at 3 Tesla. FreeSurfer 5.3 was used to perform hippocampal parcellation. We used a collection of statistical methods to better understand the relationship between CDT and hippocampal formation. We also tested the clinical feasibility of this relationship when predicting AD.

Results: Impaired CDT performance in AD was associated with widespread atrophy of the cornu ammonis, presubiculum, and subiculum, whereas MCI subjects showed CDT-related alterations of the CA4-dentate gyrus and subiculum. CDT correlates in AD and MCI showed regional and quantitative overlap. Importantly, CDT score was the best predictor of AD.

Conclusions: Our findings lend support for an involvement of different hippocampal subfields in impaired CDT performance in AD and MCI. CDT seems to be more efficient than subfield imaging for predicting AD.     

Validation analysis of the Attention Questionnaire Scale

Screening tests that briefly measure early signs of cognitive dysfunction in Alzheimer's disease (AD) are lacking. We devised a new scale focused on early detecting cognitive dysfunction: the Attention Questionnaire Scale (AQS). We prospectively studied the AQS in 268 subjects with varying degrees of cognitive dysfunction and compared it with the Mini-Mental Status Examination (MMSE), digit span test, trail making test part B, letter cancellation test, Instrumental ADL, Geriatric Depression Scale, and Clinical Dementia Rating Scale. The internal consistency was excellent with the AQS (Cronbach's α = 0.945). There were significant differences in the overall AQS scores across varying degree of cognitive dysfunction (26.80 ± 3.43 in normal elderly, 20.78 ± 4.83 in patients with mild cognitive impairment (MCI), 19.01 ± 4.49 in early AD, 16.00 ± 5.03 in mild AD, and 12.02 ± 6.28 in moderate AD), and subjects with the early stage of cognitive dysfunction could be further distinguished using the AQS than MMSE. The area under the receiver operating characteristic curve was estimated to be 0.93 (95% confidence interval 0.89-0.97) in screening for normal elderly versus patients with MCI or various stages of AD. The AQS provides greater screening ability for early stage cognitive dysfunction, used not only as a screening tool but also an appropriate simple questionnaire.