扩瞳试验诊断阿尔茨海默病

目的　比较阿尔茨海默病 (AD)患者与血管性痴呆患者 (VD)及正常老年对照者 (CN)对稀释扩瞳药物托吡卡胺滴眼液的扩瞳反应 ,验证扩瞳试验诊断AD的临床应用价值。方法　AD组 1 9人 ,VD组 1 0人 ,CN组 2 5人。将 0 0 1 %托吡卡胺滴眼液用于左眼作为试验眼 ,生理盐水滴眼液用于右眼作为对照。以头盔式红外线双眼瞳孔同步自动测量分析仪连续摄录并且分析双眼瞳孔直径用药前 5分钟和用药后 40分钟的变化 ,计算左眼瞳孔扩大倍数。比较 3组扩瞳反应程度 ;分析性别、年龄、文化程度、痴呆病程和严重程度对扩瞳的影响 ;判断扩瞳试验的最佳分界点和临床诊断价值。结果　用药后第 1 9分钟及第 2 9分钟 ,AD组瞳孔扩大倍数均大于VD组和CN组 ,与CN组相比 ,差异显著 (P分别小于 0 0 5及 0 0 0 1 )。AD组性别、年龄、文化程度、痴呆病程及严重程度对瞳孔扩大倍数无明显影响 (P >0 0 5)。AD与CN组最理想分界值为第 2 9分钟扩瞳 1 1 3倍。此时 ,诊断试验的敏感性 0 79,特异性 0 56,阴性预测值 0 78。结论　提示AD患者扩瞳反应明显敏感于正常老年人 ,与正常老年人及VD患者有一定重叠。在临床上可作为阿尔茨海默病早期诊断的筛选工具之一     

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。     

Stroop色词测验在早期识别阿尔茨海默病中的作用

目的评估中文版Stroop色词测验(CWT)在识别轻度认知功能损害(MCI)与轻度阿尔茨海默病(AD)中的作用。方法正常老人94名,遗忘型MCI组86名和轻度AD组51名完成包括简易智力状态检查量表(MMSE)和CWT在内的8种神经心理测验。正常老人、MCI和轻度AD组的MMSE总分分别为(28.2±1.5)分、(26.9±1.9)分和(20.1±2.5)分。CWT由3张卡片、每张50字、4种颜色组成。分析指标包括完成每张卡片的耗时数、正确阅读数和干扰量(SIE)。结果SIE与反映执行功能的连线测验、言语流畅性测验有显著的相关性。不管是正常老人还是认知损害患者,读字(卡片A)均快于颜色命名(卡片B)。以卡片C正确数39个为分界,识别轻度AD的敏感性为80.4%,特异性为86.2%。根据SIE指标发现轻度AD患者在处理速度和正确性的关系方面与MCI组的应答策略不同。结论中文版CWT适合在中国老人中应用,有助于早期识别AD,MCI患者和轻度AD患者针对干扰作用的不同表现。     

轻度认知功能损害的老年成套神经心理测验的特点

目的 观察轻度认知功能损害者（MCI）老年成套神经心理测验（NTBE）的特点。方法 采用横断面研究,在上海,北京和江苏等地区取样;样本分为MCI组,正常老人组和阿尔茨海默病（AD）组。结果 NTBE可判断上述3组,准确率高。MCI组与正常组之间：NTBE的绝大多数单项测验成绩有非常显著的差异;MCI组与AD组之间：NTBE的多数单项测绘有显著差异。MCI组的NTBE成绩介于正常组与AD组之间。结论 MCI组有多方面认知功能损害,包括语言,执行,学习和空间结构等。     

快速认知筛查测验在检测轻度认知损害中的应用研究(英文)

目的轻度认知损害(mild cognitive impairment,MCI)可根据认知表现分为遗忘型MCI(aMCI)和非遗忘型MCI(naMCI)。本研究旨在编制快速认知筛查测验(quick cognitive screening test,QCST)便于快速全面地识别MCI,为进一步研究提供依据。方法符合MCI操作性诊断标准的MCI组121例、符合DSM-Ⅳ有关痴呆诊断标准的阿尔茨海默病(AD)组79例和正常老年人组186例,参与了QCST和标准化全套神经心理测验。参与者教育程度均在5年或以上,年龄55-85岁。QCST项目包括即刻记忆、延迟回忆、命名、动物流畅性、相似性、彩色连线B、画钟、手指结构、数字广度等9个分测验,每个分测验满分10分,总分90分,耗时10-15分钟。结果MCI组、AD组和正常老年人组QCST总分分别为(58.13±8.18)、(44.53±10.54)和(72.92±6.85)分。制定教育程度在5-8年、9-12年、高于13年3个组别的QCST总分的划界分分别为63、65和68分。QCST识别MCI的敏感性为87.6%,其中识别aMCI-s、aMCI-m和naMCI的敏感性分别...     

听觉事件相关电位对轻度认知功能障碍的诊断价值

目的 研究听觉事件相关电位(AERPs)对轻度认知功能障碍(MCI)的诊断价值.方法 对34例MCI患者、18例Alzheimer病(AD)患者和34名正常对照(NC)者进行AERPs和神经心理学量表检查.并对MCI患者AERPs与神经心理学量表结果的相关性进行分析.结果 与AD组比较,MCI组和NC组AERPs的计数准确率显著升高,反应时间(RT)显著缩短(均P＜0.01).MCI组与NC组AERPs计数的准确率与RT差异均无统计学意义.MCI组的P50波幅明显高于AD组和NC组(P ＜0.05～0.01).与NC组比较,MCI组和AD组的P300潜伏期明显延长、波幅显著降低(P ＜0.05 ～0.01).与AD组比较,MCI组的P300潜伏期明显缩短、波幅明显增高(P ＜0.05～0.01).3组间P50潜伏期及N100、P200、N200的波幅、潜伏期比较,差异无统计学意义.Pearson相关分析显示,各量表的记忆评分与P50波幅、P300潜伏期呈负相关(均P＜0.01).结论 MCI患者的AERPs明显异常,并且与正常老年人及AD患者均有不同的特点,可作为MCI诊断的一项参考指标.     

认知功能筛查量表在MCI和轻度AD患者中的应用

目的:探讨认知功能筛查量表在轻度认知功能损害(Mild Cognitive Impairment,MCI)和轻度阿尔茨海默病(Alzhei mer disease,AD)患者中的应用。方法:对61例MCI患者和47例轻度AD患者进行系列神经心理学测验,同时选择41例正常老年人做对照。结果:MCI组和正常老年人比较,MGR、MMSE的短时记忆亚项、FOM、LM、DR、CDT均有统计学差异。轻度AD组和MCI组比较,MMSE的即刻记忆亚项、RVR、DS、ADL、IADL、POD均有统计学差异。CES-D在三组间无统计学差异。结论:MGR量表可用来鉴别正常人和认知功能损害人群,但不宜用来鉴别MCI和轻度AD患者。RVR和DS量表可以用于鉴别MCI和轻度AD患者。ADL量表在轻度AD患者显示损害,提示AD患者存在日常生活行为能力的损害。     

P300、MMN在诊治轻度认知功能障碍和阿尔茨海默病中的应用价值

目的分析MCI、AD患者认知功能及事件相关电位(P300、MMN)的变化特点,探讨两者之间的关系,为MCI和AD早期诊断提供客观依据。方法选取32名认知功能障碍患者,将患者分为MCI、AD两组,并选取21名健康对照组(NC),分别采集4 h脑电及P300、MMN相关数据;使用SPSS 17. 0统计学软件,进行单因素方差分析和相关性分析,P 0. 05为差异具有统计学意义。结果 AD组P300波幅降低,潜伏期延长;且AD组患者的P300波幅、潜伏期与神经心理学测试存在显著相关性。结论 P300作为一项可靠的指标,能较为灵敏、客观的评估认知功能,其敏感性高(其潜伏期敏感性高于波幅),特异性较低;与视频脑电图相比,P300对于AD诊断更为敏感,尤其是痴呆早期患者。     

六分法快速识别认知损害的初步研究(英文)

目的评价简易精神状态检查表(mini-mental status examination,MMSE)中时间定向与词语延迟回忆得分组成的六分法(Six-Item Screener,SIS)在识别认知损害中的价值。方法在华山医院神经内科记忆障碍门诊部的1976例就诊者中,根据轻度认知损害(mild cognitive impairment,MCI)和痴呆的诊断标准分为认知功能正常的主观抱怨者(475例)、MCI患者(440例)和阿尔茨海默病(Alzheimer’s disease,AD)患者(共1061例,其中轻度AD 555例、中度AD339例、重度AD 167例)。所有就诊者完成包括MMSE在内的全套神经心理测验。分析MMSE中年份、月份、日期以及三个词语延迟回忆(简称三词)的总得分(共6分)在区分不同程度的认知障碍中的作用。结果SIS总分以文盲组≤2分、小学组≤3分、初中及以上组≤4分作为划界分,其识别轻度AD的敏感性为88.5%、特异性为78.3%、准确性为83.8%,识别MCI的敏感性为34.3%、特异性为90.1%、准确性为63.2%。结论六分法对于门急诊快速识别痴呆具有一定的价值,但不适用于识别MCI。     

帕金森病患者轻度认知损害的临床调查

目的 研究帕金森病(Parkinson's disease,PD)伴有轻度认知功能缺损(mild cognitiveimpairment,MCI,即PD-MCI)患者患病率及其神经心理学特征.方法 设立PD患者组(n=103)及健康对照组(n=32)进行比较.心理学测验工具由MMSE、痴呆评定量表及其他神经心理学测试组成,汉密尔顿抑郁量表用以评定患者的抑郁程度.结果 (1)21例(20.4%)PD患者被诊断为痴呆,37例(35.9%)患者认知功能完整,45例(43.7%)患者有MCI;(2)与认知正常的PD患者相比,PD-MCI患者年龄更大,PD起病更晚,且运动损害更为严重;(3)PD-MCI的患病率和神经心理学特征与PD症状主要累及何侧及分型有一定关系:左侧组比右侧组患者出现MCI的概率要高(74.2%和42.2%,χ2=7.589,P<0.05);震颤为主型患者与混合型患者相比,Stroop测词试验(SWT)的耗时(s)显著减少(80.8±39.9和94.4±30.0,t=3.332,P<0.01).结论在PD患者中,筛查出PD-MCI患者有着重要的临床意义,有助于临床医生针对性地处理不同PD患者,并易化对其预后的判断.     

阿尔茨海默病的扩瞳试验研究

目的验证扩瞳试验能否用于诊断阿尔茨海默病（AD）。方法用非接触型双侧瞳孔红外同步记录分析仪对滴入0.01%托吡卡胺后的瞳孔变化进行测定,并自动分析瞳孔直径扩大（按对照侧校正）的百分比。共测定AD患者52例、血管性痴呆（VD）患者34例、老年精神分裂症（S）19例和老年健康人（对照组）57名。比较并找出最能明显区别AD与对照组的瞳孔扩大值,以此作为试验结果阳性与否的分界线。结果AD患者的瞳孔在滴药7～10min后便明显扩大,与VD、S或对照组的差异有非常显著性（P<0.01）。如以第18min时扩大值≥15%作为分界线,AD、VD、S及对照组的阳性例数/总例数分别为42/52、6/34、1/19和12/57;用以诊断AD时的敏感性为0.81,特异性为0.79～0.82,一致性Kappa值为0.60～0.62。结论扩瞳试验可以作为筛选AD的诊断标志之一,也可在鉴别AD与VD时作为参考。     

CERAD test performances in amnestic mild cognitive impairment and Alzheimer's disease

OBJECTIVES: The aim of the study was to examine the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test performances cross-sectionally in patients suffering from amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). Moreover, we wanted to determine the sensitivity to amnestic MCI and mild AD, as well as the specificity of different CERAD subtests in our study groups. MATERIAL AND METHODS: Fifteen healthy elderly individuals, 15 amnestic MCI patients and 15 probable AD patients suffering from mild dementia were tested with the CERAD neurocognitive dementia screening test. RESULTS: Significant differences were found in all CERAD tests except Constructional praxis (copy) and Clock drawing between the controls and the AD group. The MCI group was differentiated from the controls only in the Wordlist learning test. In the language tests the sensitivity to MCI and AD was quite low and the specificity very high. In the savings scores the sensitivity to AD was high, but the specificity rather low. The Wordlist recognition test screened no false positives using the current cut-off score and the sensitivity to AD was 0.6, but only one MCI patient was detected using the current cut-off score. Raising the cut-off score also raised the sensitivity to MCI without dramatic loss of specificity. Cut-off scores for the Wordlist learning test and Wordlist delayed recall, which have been found to differentiate normal aging from dementia, are lacking in the Finnish CERAD. The current data indicates that the Wordlist learning test might be relatively sensitive to MCI. CONCLUSIONS: The results indicate that the Finnish CERAD test battery with its current cut-off scores has low sensitivity to MCI, and using it as a sole cognitive screening instrument for MCI and preclinical dementia might result in false negatives.     

Japanese version of the Test Your Memory as a screening test in a Japanese memory clinic

A self-administered cognitive test (Test Your Memory, TYM) is designed as a screening test for the detection of Alzheimer disease (AD). We compared the diagnostic utility of the Japanese version of the TYM (TYM-J) in AD and mild cognitive impairment (MCI) with that of the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale—Cognitive Subscale Japanese version (ADAS-Jcog). We studied 79 patients with mild AD, 46 with MCI and 34 normal controls. The sensitivity and specificity of each test in the diagnosis of AD and MCI were compared. The average total TYM-J scores were 45.7 in controls, 41.7 in MCI, and 35.7 in AD. The TYM-J scores showed good correlations with other neuropsychological tests. The receiver operating characteristic analysis demonstrated that the TYM-J could better discriminate AD from controls and MCI from controls than the other tests. With each optimal cut-off score of the TYM-J, the sensitivity and specificity were 96% and 91% for diagnosing AD, and 76% and 74% for diagnosing MCI, respectively. The TYM-J is useful for the diagnosis of AD and MCI, and can be applied as a screening test in a Japanese memory clinic.     

Characteristic profiles of instrumental activities of daily living in Chinese older persons with mild cognitive impairment

Increasing evidence suggests that performance of the instrumental activities of daily living (IADL) can be impaired at the mild cognitive impairment (MCI) stage. Our study aimed at investigating the profiles of functional impairment in Chinese subjects with MCI. Subjects with MCI were categorized into single-domain amnestic MCI (a-MCI) (n=54) and multiple-domain amnestic MCI (md-MCI) (n=93) groups. Their functional scores of Disability Assessment of Dementia (DAD) were compared with those of cognitively normal elderly controls (NC) (n=78) and those with mild Alzheimer's disease (AD) (n=85).Subjects with md-MCI had intermediate performance in IADL between the NC and those with mild AD. Subjects with a-MCI had functional scores similar to those of normal controls. Age, education, and global cognitive test scores were not associated with functional scores in MCI subjects. Our results demonstrated that Chinese older persons with md-MCI had impairment in IADL, as compared to NC and subjects with a-MCI. This finding suggests that assessment of IADL should be incorporated in the clinical evaluation of MCI.     

Mild cognitive impairment and Alzheimer's disease: an investigation of the CERAD-NP test battery

To investigate the psychometric properties of the German version of the CERAD-NP, neuropsychological deficits were compared between 49 patients with mild cognitive impairment (MCI), 80 patients with Alzheimer's disease (AD), 36 with major depression (MD), and 26 elderly controls. All participants were outpatients of the memory clinic of the Section of Geriatric Psychiatry, Heidelberg University. Diagnoses were established based on clinical examination, laboratory testing, neuroimaging, and routine neuropsychological testing according to the criteria of aging-associated cognitive decline (AACD) for MCI, NINCDS-ADRDA for AD, and DSM-IV for MD, respectively. All CERAD-NP subtests discriminated between controls and AD patients with the latter showing significantly (p< or = 0.05) lower test scores. The subtests verbal fluency and constructive apraxia differed significantly between mildly and moderately AD, while the subtests assessing declarative (epsisodic) memory performance showed only minor, non-significant differences between the respective groups. The LKB patients took an intermediate position between controls and AD patients with significantly lower scores in verbal fluency and declarative memory performance than the controls. When compared with the AD patients, MCI patients were significantly impaired in all subtests except constructive apraxia. Relative to the controls, the patients with MD showed a decreased episodic memory performance but no evidence suggesting an impairment in other neuropsychological domains. Our results indicate that the CERAD-NP is a psychometric instrument which allows a sensitive discrimination between mild and moderate AD, MCI, MD and healthy controls. However, sensitivity of discrimination between different stages of dementia varies with respect to the different subtest. While the subtest for episodic memory showed floor effects already for mild dementia, subtests for verbal fluency and constructive apraxia were able to discriminate even between more advanced stages of the disease.     

Screening for Alzheimer's disease with the short cognitive evaluation battery

Because Alzheimer's disease (AD) tends to be underdiagnosed, there is an increasing need for accurate neuropsychological screening tools that are easy to administer by general practitioners or specialists. The aim of the present study was to validate, in French, a sensitive and specific screening battery designed to improve the discrimination between patients with AD, patients with depression and healthy elderly subjects. The Short Cognitive Evaluation Battery (SCEB) consists of 4 brief tests: temporal orientation, 5-word test, clock-drawing test and a semantic verbal fluency task. The SCEB was administered to 123 ambulatory subjects (mean age 76.4+/-2.3 years): 49 patients with mild AD, 27 patients with depressive symptoms and 47 healthy elderly subjects. The mean time for administration of the test was 11.2 min in the AD group, 8.2 min in the depressive group and 7.2 min in the control group (p < 0.001). Multivariate analysis showed that, compared with controls, patients with mild AD were significantly impaired for all four tests. Response operating characteristics analysis of the SCEB showed: 93.8% sensitivity and 85% specificity for discriminating AD from control patients, and 63% sensitivity and 96% specificity for discriminating AD from depressive patients. In summary, the SCEB appears to be a highly sensitive and specific tool for discriminating between patients with mild AD and healthy elderly individuals. Furthermore, in combination with clinical evaluation, the SCEB could improve the specificity of the difficult discrimination between mild AD and depression.     

A clinical memory battery for screening for amnestic mild cognitive impairment in an elderly chinese population

Amnestic mild cognitive impairment (MCI) might be more likely to progress to Alzheimer’s disease than single non-memory MCI and multiple domain MCI. After excluding those who did not conform to the inclusion criteria of amnestic MCI or healthy controls, a neuropsychologic battery that included the Mini-Mental State Examination, Clinical Dementia Rating, Chinese version of the Montreal Cognitive Assessment, Instrumental Activities of Daily Living scale and Auditory Verbal Learning Test was performed on 150 amnestic MCI and 150 normal control patients. The Chinese version of the Montreal Cognitive Assessment was measured for its test-retest reliability, sensitivity and specificity. Blood was collected for apolipoprotein E (APOE) genotyping. Compared with the control group, the amnestic MCI group performed significantly worse on all neuropsychological tests, and non-APOE-??4 carriers in the amnestic MCI group performed better than APOE-??4 carriers in the amnestic MCI group. The set of neuropsychological tests in our study could distinguish amnestic MCI participants from normal elderly participants accurately. APOE did have a role in amnestic MCI patients, but the magnitude and mechanism of its influence are not fully understood.     

Use of the telephone-administered Minnesota Cognitive Acuity Screen to detect mild cognitive impairment

This study determined the sensitivity and specificity of the telephone-administered Minnesota Cognitive Acuity Screen (MCAS) to distinguish mild cognitive impairment (MCI) from healthy controls (HCs) and from Alzheimer's disease (AD). A total of 100 individuals with MCI, 50 individuals with possible/probable AD, and 50 HCs were screened to exclude medical and psychiatric conditions affecting cognition. In-office evaluation included neuropsychological testing, neurologic examination, and neurodiagnostic work-up. Participants with AD obtained significantly lower MCAS total scores than participants with MCI, who in turn performed worse than the HC group. Sensitivity was 86% and specificity was 78% for distinguishing between MCI and HC. Sensitivity was 86% and specificity was 77% for discriminating between MCI and AD. Sensitivity was 91% and specificity was 78% for discriminating between impaired groups (MCI and AD) and HCs. Results suggest that the MCAS successfully discriminates MCI from HC and AD and has potential as an effective telephone-administered screening tool for memory disorders.     

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.     

Exploring the validity of mild cognitive impairment (MCI) subtypes: Multiple-domain amnestic MCI is the only identifiable subtype at longitudinal follow-up

Background: Epidemiological research exploring risk factors for Alzheimer’s dementia resulted in the identification of the mild cognitive impairment (MCI) profile. Subsequently, distinct subtypes of MCI have been proposed; however, the validity of these as diagnostic entities remains uncertain. Design and participants: The aim of the present study was to examine the longitudinal neuropsychological profiles of MCI subtypes. A total of 118 adults aged 60–90 years were classified at screening as amnestic (a-MCI), nonamnestic (na-MCI), and multiple-domain amnestic (a-MCI+) and were assessed at two time points across 20 months on a comprehensive neuropsychological assessment battery. Results: The a-MCI+ group displayed the poorest performance of all groups in terms of episodic memory, working memory, attention, and executive functioning. Conclusions: These findings suggest that the a-MCI+ subtype is the only variant that is recognizable via neuropsychological testing. In contrast, the differentiation between single-domain subtypes and healthy controls is difficult and may not be achievable through current neuropsychological assessment practices.