中国临床心理学杂志

两种画钟测验评估阿尔茨海默病的差异研究

作者：沈树红¹ 郭起浩² 王少石¹

单位：1. 上海市第一人民医院分院神经内科上海 200081
2. 复旦大学附属华山医院神经内科上海 200040

分类号：R749.1

出版年,卷(期):页码：2009,17(5):541-543

摘要：

目的：探讨自发画钟测验和模仿画钟测验(CDT)在评估不同严重度阿尔茨海默病(AD)中的价值。方法：30例正常中老年人、20例遗忘型轻度认知障碍(aMCI)患者、20例轻度AD患者、19例中度AD患者和14例重度AD患者完成自发画钟测验和模仿画钟测验等一系列神经心理测验。结果：自发CDT，MCI组与正常组比较，“锚定部分”(首先画出“12-3-6-9”4个关键点)有显著差异(P<0.05)，数字部分、指针部分无显著差异(P>0.05)，而轻度AD组与正常组比较，锚定部分、数字部分、指针部分均有显著差异(P<0.05)。根据CDT的成分分析，锚定部分在五组中下降早而且速度快；数字部分在五组中下降最缓慢，指针部分介于两者之间。就CDT模仿总分来说，轻度AD组与中度AD组比较、中度AD组与重度AD组比较有显著差异(P<0.05)，而正常组与MCI组比较、MCI组与轻度AD组比较无显著差异。结论：自发CDT有助于早期识别MCI和轻度AD，模仿CDT有助于区分AD的不同严重度。

Objective:To probe the significance of spontaneous and mimicking clock drawing tests (CDT) to evaluate the severity of Alzheimer'sdisease (AD).Methods:30 normal middle aged to senile people as the control, and 20 amnestic mild cognitive impairment patients, 20 mild AD patients, 19 moderate AD patients and 14 severe AD patients were asked to finish the series of neuropsychologic test including the spontaneous and mimicking clock drawing tests.Results:For spontaneous CDT, there was significant difference in the "anchoring part"(draw the four key points-12-3-69 first) between the MCI patients and normal controls (P<0.05), but there was no significant difference in the digital part and the finger part between them. There was apparent discrepancy in the three forementioned parts between the mild AD patients and the normal controls. Analysis of the CDT components showed that the anchoring part declined earlier and faster than the others, the digital part was the slowest to decline and the finger part was in between. For the total score of mimicking CDT, there was obvious difference between the mild AD and the moderate AD groups (P<0.05), so was the moderate and the severe groups. But there was no discrepancy between the normal controls and MCI patients, nor was MCI and mild AD patients.Conclusion:Spontaneous CDT helps to recognize the MCI and mild AD patients and mimicking CDT helps to differentiate the severity of AD patients.

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参考文献：

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