摘要
目的探讨简易精神评价量表(MMSE)五边形复制定性评分测试(QSPT)对路易体痴呆(DLB)与阿尔茨海默病(AD)的鉴别诊断价值。方法选取符合纳入标准的2018年1月至2021年8月在首都医科大学宣武医院神经内科就诊的患者为研究对象,回顾性分析61例DLB患者与71例AD患者。比较两组患者性别、年龄、受教育年限、MMSE评分、蒙特利尔认知评估量表(MoCA)以及临床痴呆评定量表(CDR)评分,同时记录量表中可反映视空间障碍的子项目分值:MoCA中的连线测试、立方体临摹、画钟试验与MMSE中的五边形复制测试,并按照QSPT及改良QSPT评分对患者的五边形复制测试进行进一步评分,在两组患者间进行比较,同时以CDR为0.5分进行亚组分组,对轻度认知障碍患者的上述指标进行比较。利用多因素逐步Logistic回归分析QSPT或改良QSPT联合其他临床心理测评对DLB和AD的区分效力。采用受试者工作特征曲线下面积(AUC)预测QSPT和改良QSPT对两种疾病的区分效果。结果DLB与AD两组患者连线测试、立方体临摹、画钟试验、五边形复制测试、QSPT、改良QSPT评分以及性别比较,差异有统计学意义(P<0.01);两组患者的MMSE、MoCA评分,年龄、受教育年限比较差异无统计学意义(P>0.05)。QSPT鉴别DLB与AD两组患者的灵敏度为71.8%,特异度为67.2%,AUC为0.682(95%CI=0.584~0.772),cut-off值为9.5。改良QSPT鉴别DLB与AD两组患者的灵敏度为68.9%,特异度为84.5%,AUC为0.780(95%CI=0.696~0.862),cut-off值为8.5。Logistic回归分析结果显示改良QSPT、立方体临摹与两种疾病区分相关。DLB与AD轻度认知障碍患者的连线测试、立方体临摹、五边形复制测试、QSPT及改良QSPT评分比较,差异有统计学意义(P<0.05);性别,年龄,受教育年限,MMSE、MoCA评分比较差异无统计学意义(P>0.05)。改良QSPT在鉴别DLB与AD两组中轻度认知障碍患者的灵敏度为64.7%,特异度为91.3%,AUC为0.714(95%CI=0.533~0.894)�
Objective To explore the value of the qualitative scoring of Mini-Mental State Examination(MMSE)pentagon test(QSPT)in the differential diagnosis of dementia with lewy bodies(DLB)and Alzheimer disease(AD).Methods Patients who met the inclusion criteria in the Department of Neurology,Xuanwu Hospital,Capital Medical University from January 2018 to August 2021 were selected as the research objects.A total of 61 patients with DLB and 71 patients with AD were analyzed retrospectively.The gender,age,years of education,MMSE,Montreal Cognitive Assessment Scale(MoCA)and Clinical Dementia Assessment Scale(CDR)were compared between the two groups.At the same time,the scores of sub items in the scale that can reflect visualspatial impairment were recorded,including connection test,cube copy,clock drawing test in MoCA,and pentagon copy test in MMSE.The MMSE pentagon images of these patients were further scored according to QSPT and modified QSPT,and compared between the two groups.In the meantime,the above indexes were compared between the two groups of patients with mild cognitive impairment(CDR=0.5).Multivariate stepwise Logistic regression was used to analyze the differential efficacy of QSPT or modified QSPT combined with other clinical psychological evaluation on DLB and AD.The area under the receiver operating characteristic curve(AUC)was used to predict the differentiation effect of QSPT and modified QSPT on the two diseases.Results There were significant differences between DLB and AD patients in connection test,cube copy,clock drawing test,pentagon copy test,QSPT,improved QSPT scores and gender(P<0.01).There was no significant difference in scores of MMSE,scores of MoCA,age and education(P>0.05).The sensitivity of QSPT in differentiating DLB and AD was 71.8%,the specificity was 67.2%,the area under ROC curve(AUC)was 0.682(95%CI=0.584-0.772),and the cut-off value was 9.5.The sensitivity of modified QSPT in differentiating DLB and AD was 68.9%,the specificity was 84.5%,the AUC was 0.780(95%CI=0.696-0.862),and the cutoff
作者
陆璐
朱思睿
王晶
孟笑生
李丹
李芳玉
鹿媛媛
于跃怡
Lu Lu;Zhu Sirui;Wang Jing;Meng Xiaosheng;Li Dan;Li Fangyu;Lu Yuanyuan;Yu Yueyi(Innovation Center for Neurological Disorders,Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Life Science School,Beijing University of Chinese Medicine,Beijing 102400,China)
出处
《神经疾病与精神卫生》
2022年第5期311-317,共7页
Journal of Neuroscience and Mental Health
基金
国家重点研发计划(2017YFE0118800)。
关键词
阿尔茨海默病
路易体痴呆
鉴别诊断
五边形复制测试
Alzheimer disease
Dementia with Lewy bodies
Differential diagnosis
Pentagon copy test
