中国临床心理学杂志

Alzheimer病神经心理学特点及其量表在诊断中的价值比较

作者：乔晋杨剑波屈秋民韩建峰罗国刚

分类号：R395.3

出版年,卷(期):页码：2006,14(1):25-27

摘要：

目的：探讨阿尔茨海默病(AD)的神经心理学特点和神经心理学量表在AD诊断中的价值，为AD诊断提供依据。方法：采用常用神经心理学量表测定108例AD患者和100例正常对照组，临床痴呆评定量表(CDR)确定AD痴呆的严重程度。分析AD不同痴呆程度时神经心理学变化特点和各量表诊断的特异度、灵敏度和总的准确率。结果：①总体认知功能在AD轻、中、重度阶段呈持续性减退趋势(MMSE分值分别为17.44±2.64、13.90±4.32、5.50±3.90)。言语流畅性功能变化趋势与总体认知功能损害相似。视空间功能障碍在早期即出现，至中晚期明显丧失。延迟记忆功能在早期即出现衰退，在中、重度阶段已明显衰退。即刻记忆功能早期损害不明显，中期出现，至晚期才明显减退。日常生活能力和社会活动能力在AD不同阶段均呈进行性损害，但社会活动能力损害进展更快。②判别分析各量表总准确率依次为FOM＞RVR＞POD＞MMSE＞BD＞ADL＞DS。ROC曲线下面积依次为FOM＞RVR＞POD＞ADL＞MMSE＞BD＞DS。③MMSE和FOM、RVR、BD、DS中一个或一个以上量表联合应用时，AD诊断的效度明显增高。结论：神经心理学测验有助于AD诊断。MMSE和其他量表联合应用可以提高AD诊断的效度。

Objective: To study the neuropsychological characteristic of Alzheimer Disease(AD)and the value of rating scale in its diagnosis.Methods: 108 AD patients and 100 normal controls were examined with neuropsychological tests and the dementia severity was determined with clinical dementia rating(CDR).Results: ①There was impairement of total cognition function and it declined continuously from mild AD to moderate and severe AD.The trend of decline of the verbal fluency in AD was similar to that of total cognition function.The visuospatial function declined in mild AD and developed very quickly in moderate AD and lost completely in severe AD.Delay Memory function declined in mild AD and the obvious decline was found in moderate AD and severe AD.But there was not apparent decline of immediate memory function in the early stage of AD and its decline was found in moderate AD and became apparent in severe AD.The decline of daily living activity and ability and social activity function showed progressive impairment in different stages of AD.But the decline of social activity function was even quicker.②In general, percentages of correct classifications of the rating scales by discriminant analysis were in turn FOMRVRPODMMSEBDADLDS.The aeras under the curve in turn were FOMRVRPODADLMMSEBDDS ③Combined MMSE with one or more of FOM、RVR 、BD、DS, the validity of diagnosis was improved.Conclusion: Neuropsychological test is useful in diagnosis of AD.The validity is improved when MMSE are combined correctly with other rating scales.

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