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说明:
阿尔茨海默病(AD)是老年期痴呆的主要类型,其认知功能评定已经发展为一系列标准化的信度与效度俱佳的测验工具,我们评述10余种常见工具的优缺点,简介其应用。
Wechsler成人智力量表(WAIS)、Halstead-Reitan成套神经心理测验(HRB)、Luria-Nebraska成套神经心理测验(LNNB)等常用测验工具极少用于AD认知功能改变的评估。一方面是由于耗时长、难度高、完成率低;另一方面是因为AD以记忆功能缺损为主,而上述工具中仅LNNB有记忆量表分测验(系11个分测验之一,对AD诊断敏感性不高)。
AD认知功能测量须兼顾以下原则:覆盖AD易受损的功能领域(如记忆和语言功能);对这些功能基本特征的检测方法具有良好的可信性;可借以判断和衡量不同严重度;完成率高;完成所需时间不宜过长,一般在30 min以内。
一、 床边用认知筛查量表(brief bedside cognitive examination)
要求敏感性高、假阴性率低、易操作、易携带、时间短(5~10 min左右完成),分析指标为总分。
1.简明精神状态量表(MMSE)[1,2]:MMSE一直是国内外最普及、 最常用的老年痴呆筛查量表,它包括时间与地点定向、语言(复述、命名、理解指令)、心算、即刻与短时听觉词语记忆、结构模仿等项目,满分30分,费时5~10 min,重测信度0.80~0.99,施测者之间信度0.95~1.00,痴呆诊断的敏感性大多在80%~90%,特异性大多在70%~80%。
MMSE作为AD认知筛查工具, 因其敏感性强、易操作、耗时少, 在社区大样本调查及临床医生对可疑病例做初步检查时得到广泛应用, 但其缺点亦不容忽视:
(1)项目内容容易受到受试者受教育程度影响,对文化程度较高的老人有可能出现假阴性,即忽视了轻度认知损害(如Strain报道,MMSE识别轻度认知失调的敏感性仅为0.52),而对低教育及操方言者有可能出现假阳性;
目录:
一、 床边用认知筛查量表(brief bedside cognitive examination)
二、 综合的认知筛查量表(shorter batteries of neuro- psychological tests)
三、 研究用AD记忆功能测验
四、AD诊断用认知功能测验[16]
五、AD认知量表的应用简介
六、几点说明
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