摘要
目的探讨遗忘型轻度认知障碍(amnestic mild cognitive impairment,aMCI)患者数字化画钟测验(digital clock-drawing test,dCDT)的表现特征及其与传统画钟测验(traditional clock-drawing test,tCDT)相比对aMCI患者的诊断效力。方法选取2020年11月至2021年5月就诊山西医科大学第一附属医院门诊的中老年81例,其中aMCI患者39例(aMCI组),认知正常者42例(对照组)。使用本团队研发的dCDT软件采集绘图过程参数。根据CDIS评分方法,计算蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)各认知域指数分数,分析dCDT参数与MoCA各认知域指数分数的相关性。采用Logistic回归分析构建预测模型,通过ROC曲线分析比较不同方法对aMCI患者诊断的敏感性、特异性。结果(1)aMCI组的完成总时间[51.25(38.80,63.75)s,42.42(33.64,51.91)s]及思考时间[36.34(26.81,47.25)s,28.47(22.37,33.98)s]明显高于对照组,分针/时针(1.23±0.35,1.39±0.34)、每分钟笔画数[(31.31±10.44)个,(41.05±9.48)个]及tCDT评分[3.0(3.0,4.0)分,4.0(3.0,4.0)分]明显低于对照组,均差异有统计学意义(均P<0.05),余dCDT参数两组间差异无统计学意义(Z=-1.835~-0.440,P>0.05);(2)在调整年龄、性别及受教育程度后,相关分析显示,完成总时间与MoCA记忆指数(r=-0.224,P=0.049)、语言指数(r=-0.237,P=0.037)及注意力指数(r=-0.236,P=0.038)呈负相关;思考时间与MoCA记忆指数(r=-0.268,P=0.018)、语言指数(r=-0.271,P=0.016)、注意力指数(r=-0.259,P=0.022)及定向力指数(r=-0.267,P=0.018)呈负相关;分针/时针与MoCA执行力指数(r=0.259,P=0.022)及视空间指数(r=0.309,P=0.006)呈正相关;每分钟笔画数与MoCA记忆指数(r=0.376,P=0.001)、执行力指数(r=0.290,P=0.010)、视空间指数(r=0.294,P=0.009)、注意力指数(r=0.238,P=0.036)及定向力指数(r=0.301,P=0.007)呈正相关;(3)dCDT模型(第二指针延迟时间、分针/时针及每分钟笔画数)可正确分类77.8%aMCI患者,灵敏度74.36%,特异度80.95%,对aMCI患者的诊断效力显著高于tCDT评分,曲线下面积的差异有统计学意义(Z=2.335,P=0.02)。结论aMCI患者存在的认知损害能被dCDT所检出,而且不同的dCDT参数可反映不同的认知区域受损;与tCDT评分相比,dCDT可提高对aMCI患者的诊断效力。
Objective To explore the performance characteristics of the digital clock-drawing test(dCDT)for amnestic mild cognitive impairment(aMCI),and its diagnostic value for aMCI patients compared with the traditional clock-drawing test(tCDT).Methods Total 81 middle-aged and elderly outpatients in Affiliated Hospital to Shanxi Medical University from November 2020 to May 2021 were selected,including 42 cognitively normal people(control group)and 39 aMCI patients(aMCI group).The dCDT developed by our team was used to collect drawing process parameters(such as stroke length,time and speed).The Cognitive Domain Indexs of Montreal Cognitive Assessment(MoCA)were calculated using the CDIS scoring method,and the correlation between dCDT parameters and MoCA indexs were analyzed.Logistic regression analysis was used to construct the predictive model,and the sensitivity and specificity of different methods for the diagnosis of aMCI patients were compared by the area under the ROC curve.Results(1)The total time(51.25(38.80,63.75)s vs 42.42(33.64,51.91)s)and time in air(36.34(26.81,47.25)s vs 28.47(22.37,33.98)s)of the aMCI group were significantly higher than those of the control group,and the minute hand/hour hand ratio(1.23±0.35 vs 1.39±0.34),strokes per minute((31.31±10.44)vs(41.05±9.48))and tCDT score(3.0(3.0,4.0),4.0(3.0,4.0))were significantly lower than those of the control group,and the differences were statistically significant(all P<0.05).Other dCDT parameters were not statistically significant between the two groups(Z=-1.835--0.440,P>0.05).(2)Correlation analysis showed that the total time was negatively correlated with MoCA MIS(r=-0.224,P=0.049),LIS(r=-0.237,P=0.037)and AIS(r=-0.236,P=0.038);time in air was negatively correlated with MoCA MIS(r=-0.268,P=0.018),LIS(r=-0.271,P=0.016),AIS(r=-0.259,P=0.022)and OISA(r=-0.267,P=0.018);the minute hand/hour hand ratio was positively correlated with MoCA EIS(r=0.259,P=0.022)and VIS(r=0.309,P=0.006);the strokes per minute was positively correlated with MoCA MIS(r=0.376,P=0.001),EIS(r=0.290,P=0.010),VIS(r=0.294,P=0.009),AIS(r=0.238,P=0.036)and OISA(r=0.301,P=0.007).(3)dCDT model composed of the pre-second hand latency,the ratio of minute hand/hour hand,and the strokes per minute can correctly classify 77.8% of aMCI,with a sensitivity of 74.36% and a specificity of 80.95%.Its diagnostic power for aMCI was significantly higher than the tCDT scoring(Z=2.335,P=0.02).Conclusion The cognitive impairment in aMCI can be detected by dCDT,and different dCDT parameters can reflect the impairment of different cognitive domains.Compared with tCDT scoring,dCDT can improve the diagnostic efficacy of aMCI patients.
作者
张肖南
赵娅蓉
吕亮亮
闵国文
王秋艳
李阳
Zhang Xiaonan;Zhao Yarong;Lyu Liangliang;Min Guowen;Wang Qiuyan;Li Yang(First Clinical Medical College,Shanxi Medical University,Taiyuan 030001,China;Department of Neurology,First Affiliated Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《中华行为医学与脑科学杂志》
CAS
CSCD
北大核心
2021年第9期794-799,共6页
Chinese Journal of Behavioral Medicine and Brain Science
基金
中央引导地方科技发展专项资金项目(YDZX20191400002563)
山西省医学重点攻关专项(2020XM22)。
关键词
轻度认知障碍
画钟测验
神经心理学测验
诊断效力
数字化测评
Mild cognitive impairment
Clock drawing test
Neuropsychological test
Diagnostic effectiveness
Digital evaluation
