画钟测验在认知功能测评中的作用

随着社会老龄化的进程,痴呆发病率逐年增高,简便、易行、敏感、特异的测查方法是重要的,对目前临床常用的画钟测验(CDT)在认知功能测评中的应用及意义作一综述.     

画钟测验检测认知功能损害

目的　比较画钟测验 (CDT) 4种不同评分方法检测认知功能损害时的信度和效度。方法　认知功能损害组病人 71例 ,对照组为社区健康老人 70名。采用三分制方法、Watson方法、Sunderland方法和CDIS方法 ,由 2名神经科医师独立、盲法检查CDT ,2周后随机抽取 2 0名研究对象由同一名检查者做 2次访问 ,并与简易精神状况检查法 (MMSE)等进行相关性分析。结果　不同评定员之间的重测信度Spearmen相关系数在 0 88～ 0 98之间 ,同一评定员 2次测查的重测信度相关系数在 0 91～ 0 98之间。不同测查方法测查认知功能损害的敏感性、特异性和准确性在 0 80左右 ,而对早期认知功能损害 (MCI)的诊断效度较低 ,敏感性仅为 0 2 0～ 0 60。与MMSE和临床痴呆评定量表 (CDR)的Spearmen相关系数较高 ,分别为 0 85左右和 0 90左右。结论　CDT具有很好的重测信度和诊断效度 ,可用于痴呆的临床和流行病学调查。而对于MCI和正常人群的识别能力有限。     

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.     

神经心理学量表在轻度认知功能障碍筛查中的应用

随着中国老龄化程度的不断加深,痴呆发病率逐年上升,严重危害着人民健康,并带来了巨大的社会和经济负担.2020 年发表的一项全国性横断面研究数据显示,中国 60 岁及以上人群中约有 1507 万痴呆患者,轻度认知功能障碍(mild cogni-tive impairment,MCI)的患病率约为15. 5％,患者数达38...     

蒙特利尔认知评估量表在血管性认知功能障碍中的应用

目的 探讨蒙特利尔认知评估(MoCA)量表(中文版)在血管性认知功能障碍(VCI)中的应用.方法 选择166例具有脑血管病危险因素或脑血管疾病患者,根据VCI诊断标准分为无认知功能障碍(NCI)组(52例)、无痴呆的血管性认知功能障碍(VCIND)组(76例)及血管性痴呆(VD)组(38例),分别给予MoCA量表和简易精神状态检查(MMSE)量表测试.结果 将认知功能障碍MoCA分界值定为26分时,VCIND组MoCA的敏感性为90.79%,MMSE为26.31%;VD组MoCA的敏感性为100%,MMSE为86.84%;MoCA和MMSE特异性分别为84.62%和100%.结论 与MMSE量表相比,MoCA量表更适用于VCI的筛查.     

奥拉西坦治疗血管性认知功能障碍的疗效观察

目的观察奥拉西坦治疗血管性认知功能障碍的临床疗效。方法将43例血管性认知功能障碍患者随机分为治疗组和对照组,治疗组在对照组基础性治疗的基础上给予奥拉西坦口服,3个月后运用简易智力状态检查量表(MMSE)积分法进行评价。结果2组MMSE积分治疗后比治疗前均有提高(P<0.01),治疗组总有效率明显优于对照组(P<0.05)。结论奥拉西坦是治疗血管性认知功能障碍的有效药物之一。     

画钟测验对轻度阿尔茨海默病的诊断作用

目的 探讨画钟测验（CDT）对诊断轻度阿尔茨海默病（AD）患者的敏感度和特异度.方法 轻度AD患者40例,正常对照40例,对所有受试者进行CDT检测,评分采用5分法.应用操作者特征性曲线（ROC）确定CDT对诊断轻度AD的最佳分界值以及诊断的敏感度和特异度.结果 患者组和正常对照组的年龄、性别和教育程度匹配.应用5分评定法,CDT鉴别正常老人和轻度AD的最佳分界值为4分,此时敏感度和特异度分别为90.0%和82.5%.结论 CDT是识别轻度AD患者的一种有效筛查手段.     

轻度认知功能障碍筛查量表研究进展

轻度认知功能障碍(MCI)患者是老年性痴呆(SD)的高危人群。痴呆的发病率随着世界人口老龄化的加剧而迅速攀升,中晚期痴呆的治疗效果欠佳,而对MCI的早期筛查和干预可延缓痴呆病程的进展。文中对国内外MCI筛查量表的研究分析得出,记忆与执行筛查(MES)量表、Dem Tect、中文修订版轻度认知功能障碍测试(CAMCI)和阿尔茨海默病调查问卷(AQ)4种筛查量表可作为MCI筛查的首选筛查量表。     

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.     

中文版MoCA和MMSE在诊断遗忘型轻度认知功能障碍中的应用

目的 研究中文版蒙特利尔认知评估量表(MoCA)在遗忘型轻度认知障碍(aMCI)诊断筛查中的作用. 方法 以2009-05-2010-03在卫生部北京医院神经内科门诊就诊的患者为检查对象,筛选出aMCI患者31例及健康对照者30名,分别进行简易精神状态量表(MMSE)、MoCA等量表检测,计算两量表诊断aMCI的敏感性和特异性并进行比较,分析MoCA在诊断aMCI中的作用和特点. 结果 以26分作为分界值时,MMSE和MoCA诊断aMCI的敏感性分别为9.68%和87.10%,特异性分别为93.33%和73.33%.MoCA的敏感性显著高于MMSE. 结论与MMSE 相比,MoCA以其较高的敏感性在筛查aMCI中具有较大作用,而且可对多个认知领域的功能进行检测,有望在多个认知损害类型的研究中起到重要作用.     

The value of the clock drawing test and the mini-mental state examination for identifying vascular cognitive impairment no dementia

OBJECTIVE: To determine the validity of the Clock Drawing Test (CDT) and the Mini-Mental State Examination (MMSE) respectively or in combination for differentiating Vascular Cognitive Impairment No Dementia (V-CIND) from normal subjects. METHODS: Eighty V-CIND patients and 80 healthy control subjects were blindly evaluated with MMSE, CDT, and additional neuropsychological tests. CDT was scored according to the Rouleau method and AD Cooperative Study method. Sensitivities and specificities of the two CDT measures and MMSE for identifying V-CIND patients were determined. The Areas Under the Receiver Operating Characteristic Curve (AUCs) were compared, and the sensitivity of the combination of CDT with MMSE calculated. RESULTS: V-CIND group performed worse than controls on both MMSE (p < 0.0001) and the two CDTs (p < 0.0001). In differentiating V-CIND patients from normal subjects, the two CDT measures provided sensitivities of 68.7% and 65.0%, and specificities of 78.7% and 86.2% respectively at optimal cutoff scores, which did no better than MMSE (sensitivity 80%, specificity 70%) (comparison of the AUCs, p = 0.992 and 0.428). The sensitivity of MMSE was marginally higher than that of CDT scored with AD Cooperative Study method (p = 0.053). By combining the two CDT measures with MMSE, the sensitivity was improved to 93.7% and 92.5% respectively. CONCLUSIONS: Compared with MMSE, CDT is of only similar or even weaker ability for identifying V-CIND. MMSE at a cutoff of 28 may be of some value in detecting V-CIND patients. CDT and MMSE in combination provide a valid instrument for V-CIND screening.     

蒙特利尔认知评估量表与简易精神状态量表在脑白质疏松患者中的应用比较

目的比较蒙特利尔认知评估量表（MOCA）和简易精神状态量表（MMSE）对脑白质疏松（LA）患者认知功能障碍的筛查能力,并了解lA患者认知功能受损的特点。方法应用MoCA量表及MMSE量表对56倒LA患者及50例对照的认知功能进行测评,比较两组的测试结果,并比较两量表对LA组中VCI患者的诊断能力。结果LA组的MoCA总评分（20．34±3．00）分明显低于对照组（22．20±2．26）分,差异有统计学意义（t-4．02,P〈O．01）;其中,LA组的命名、语言、抽象、定向力评分均小于对照组,差异有统计学意义（t分别为3．92,3．43,4．02,5．35;P〈0．01）。LA组的MMSE总评分（27．54±1．36）分低于对照组（28．06±1．92）分,差异有统计学意义（t-2．36,P〈0．05）,其中LA组的定向力及延迟回忆评分低于对照组,差异有统计学意义（t分别为2．68,2．60;P〈0．05）。在LA组中,MoCA诊断VCI的敏感度为93．9％、特异度63．6％、假阳性率36．4％、假阴性率9．1％、阳性预测值91．3％、阴性预测值70．0％、诊断符合率84．2％、约登指数0．569;MMSE诊断VCI的上述指标分别为26．7％,90．9％,6．7％,73．3％,92．3％,23．3％,43．4％,0．176。结论LA患者的认知功能受损表现在命名、语言、抽象、定向力及延迟回忆等方面。MoCA量表在筛查LA患者认知功能方面比MMSE量表更敏感。     

Clock Drawing Test and the diagnosis of amnestic mild cognitive impairment: Can more detailed scoring systems do the work?

Introduction: The Clock Drawing Test is a frequently used cognitive screening test with several scoring systems in elderly populations. We compare simple and complex scoring systems and evaluate the usefulness of the combination of the Clock Drawing Test with the Mini-Mental State Examination to detect patients with mild cognitive impairment. Method: Patients with amnestic mild cognitive impairment (n = 48) and age- and education-matched controls (n = 48) underwent neuropsychological examinations, including the Clock Drawing Test and the Mini-Mental State Examination. Clock drawings were scored by three blinded raters using one simple (6-point scale) and two complex (17- and 18-point scales) systems. The sensitivity and specificity of these scoring systems used alone and in combination with the Mini-Mental State Examination were determined. Results: Complex scoring systems, but not the simple scoring system, were significant predictors of the amnestic mild cognitive impairment diagnosis in logistic regression analysis. At equal levels of sensitivity (87.5%), the Mini-Mental State Examination showed higher specificity (31.3%, compared with 12.5% for the 17-point Clock Drawing Test scoring scale). The combination of Clock Drawing Test and Mini-Mental State Examination scores increased the area under the curve (0.72; p < .001) and increased specificity (43.8%), but did not increase sensitivity, which remained high (85.4%). Conclusions: A simple 6-point scoring system for the Clock Drawing Test did not differentiate between healthy elderly and patients with amnestic mild cognitive impairment in our sample. Complex scoring systems were slightly more efficient, yet still were characterized by high rates of false-positive results. We found psychometric improvement using combined scores from the Mini-Mental State Examination and the Clock Drawing Test when complex scoring systems were used. The results of this study support the benefit of using combined scores from simple methods.     

成年起病的癫痫患者认知损害的影响因素研究

目的评估患者性别、教育水平、发作频率、持续时间、抗癫痫药物和视频脑电图(VEEG)尖波出现对成年起病的癫痫患者认知能力的影响。方法 50例成年起病的癫痫患者接受VEEG检查后行简易精神状态量表(MMSE)和蒙特利尔认知评估量表(Mo CA)检查获得认知分数,按照上述6种因素分别分组,应用SPSS16.0软件进行差异统计学分析。结果 VEEG尖波出现明显降低癫痫患者两种量表得分(MMSE P0.01;Mo CA P0.05),而性别、发作频率和持续时间均不影响两种量表的得分(均P0.05)。丙戊酸钠治疗组两种量表的得分低于非丙戊酸钠(拉莫三嗪、奥卡西平、卡马西平和苯妥英钠)治疗组(MMSE P=0.097;Mo CA P=0.061)。研究还发现,较高教育程度癫痫人群Mo CA得分明显高于较低教育水平患者,Mo CA量表评分P0.05,而MMSE量表评分P0.05,提示Mo CA量表对于认知能力影响的评估更加敏感。结论 VEEG尖波出现提示成年发病癫痫患者的认知损害,丙戊酸钠治疗也可能损害癫痫患者的认知水平。另外,教育程度较高的成年发病癫痫患者认知能力较高。而癫痫发作频率、持续时间和患者性别不影响成年发病癫痫患者的认知水平。     

Cortical signature of clock drawing performance in Alzheimer's disease and mild cognitive impairment

It is unclear whether clock drawing test (CDT) performance relies on a widely distributed cortical network, or whether this test predominantly taps into parietal cortex function. So far, associations between cortical integrity and CDT impairment in Alzheimer's disease (AD) and mild cognitive impairment (MCI) largely stem from cortical volume analyses. Given that volume is a product of thickness and surface area, investigation of the relationship between CDT and these two cortical measures might contribute to better understanding of this cognitive screening tool for AD. 38 patients with AD, 38 individuals with MCI and 31 healthy controls (HC) underwent CDT assessment and MRI at 3 Tesla. The surface-based analysis via Freesurfer enabled calculation of cortical thickness and surface area. CDT was scored according to the method proposed by Shulman and related to the two distinct cortical measurements. Higher CDT scores across the entire sample were associated with cortical thickness in bilateral temporal gyrus, the right supramarginal gyrus, and the bilateral parietal gyrus, respectively (p < 0.001 CWP corr.). Significant associations between CDT and cortical thickness reduction in the parietal lobe remained significant when analyses were restricted to AD individuals. There was no statistically significant association between CDT scores and surface area (p < 0.001 CWP corr.). In conclusion, CDT performance may be driven by cortical thickness alterations in regions previously identified as “AD vulnerable”, i.e. regions predominantly including temporal and parietal lobes. Our results suggest that cortical features of distinct evolutionary and genetic origin differently contribute to CDT performance.     

Does education protect against cognitive impairment? A comparison of the elderly in two australian cities

Cognitive impairment was assessed using the Mini-Mental State Examination in commuity surveys of the elderly in Canberra and Hobart. Mean scores on the Mini-Mental were higher in Canberra than in Hobart and the prevalence of cognitive impairment was lower. This difference was found to be attributable to the higher level of education in the Canberra elderly. When education was statistically controlled, the difference between the cities disappeared. These findings may have implications for future cohorts of the elderly, which will have a higher level of education than the present-day elderly. It is argued that the prevalence of congnitive impairment could drop in the future.     

老年急性脑梗死合并代谢综合征患者的认知损伤表现分析

目的：分析老年急性脑梗死合并代谢综合征（metabolic syndrome ,MS）患者的认知损伤表现,为减少老年急性脑梗死患者的认知损伤提供方案。方法回顾性分析我院2008-02-2013-02收治的急性脑梗死患者153例,其中急性脑梗死合并代谢综合征77例为A组,急性脑梗死患者76例为B组,比较2组认知损伤程度。结果 B组蒙特利尔认知评估量表（MoCA）评分（24.65±4.62）明显高于A组的倡18.58±5.59）,差异有统计学意义（P＜0.05）。主要差异体现在记忆能力、语言流.性、注意力和计算力、定向能力、抽象思维能力方面。结论老年急性脑梗死合并代谢综合征患者的认知功能损伤较单纯急性脑梗死患者损伤严重,治疗中控制好血糖、血压及血脂、体质量等,有助于改善患者认知功能。