特发性正常压力脑积水患者的认知功能损害

Cognitive impairment in patients with idiopathic normal pressure hydrocephalus

目的通过系列神经心理学测试分析特发性正常压力脑积水（iNPH）患者认知功能损害的特点及各种测试方法对诊断的作用。方法运用神经心理学测试方法对18例iNPH患者、20例轻度阿尔茨海默病（AD）患者和20名健康对照者进行记忆力、注意力、执行功能、视空间能力评估，同时用受试者工作特征曲线分析这些测试方法对iNPH诊断的敏感度和特异度。结果与健康对照组比较，iNPH组和AD组的总体认知状态和各认知领域均有受损，差异均有统计学意义。iNPH组与AD组相比较[数值以中位数（四分位数间距）表示]，在额叶功能评定量表评分[9．0（2．8）分与13．0（3．5）分]、言语流畅性测验评分[10．0（8．5）分与12．0（8．0）分]、斯特鲁普色词测验卡片A耗时数[65．0（20．8）S与52．0（24．5）S]、斯特鲁普色词测验卡片B耗时数[157．5（44．3）S与108．0（37．3）S]、斯特鲁普干扰量耗时数[68．5（67．0）S与50．0（25．8）S]、积木测试评分[5．0（3．3）分与6．5（3．5）分]方面差异均有统计学意义（Z=4．047、2．025、2．857、3．864、3．218、2．221，均P〈0．05），而AD评估量表中单词回忆和单词辨认、数字广度测验、画钟测验评分差异均无统计学意义。其中，斯特鲁普色词测验卡片A耗时数、斯特鲁普色词测验卡片B耗时数、斯特鲁普干扰量耗时数对iNPH诊断的受试者工作特征曲线下面积分别为0．874、0．929、0．869，敏感度和特异度分别为88．9％和75．0％，88．9％和85．O％，94．4％和72．5％。结论iNPH患者亦有记忆力、执行功能、注意力、视空间能力损害，其中以执行功能障碍最为突出。另外，斯特鲁普色词测验对iNPH诊断具有很好的识别能力。

Objective To explore the characteristics of cognitive impairment in patients with idiopathic normal pressure hydrocephalus （iNPH） by a battery of neuropsychological tests and evaluate the role of these tests in diagnosis. Methods Eighteen iNPH patients, 20 mild Alzheimer＇ s disease （ AD ） patients and 20 healthy volunteers underwent assessment of memory, attention, executive function and visuospatial ability using various common neuropsychological measures. The diagnostic specifity and sensitivity of these measures were analyzed by receiver operator characteristic curve. Results Compared with the healthy controls, iNPH patients and AD patients had significant loss of overall cognitive status and various cognitive domains. There were significant differences（ Z = 4. 047, 2. 025, 2. 857, 3. 864, 3. 218, 2. 221, all P 〈 0. 05 ） between iNPH patients and AD patients in Frontal Assessment Battery（9. 0 （2. 8 ） scores vs 13.0（ 3.5 ） scores）, Verbal Fluency Test （ 10. 0 （ 8.5 ） scores vs 12. 0 （ 8.0 ） scores ）, time of complete Stroop Color Word Test Card A（65.0（20. 8） s vs 52. 0（24. 5） s） , time of complete Stroop Color Word Test Card B（ 157.5（44. 3） s vs 108.0（37.3） s）, time of Stroop Interence Effects（68.5（67.0） s vs 50. 0 （25.8） s） and Block Design Test （5.0 （ 3.3 ） scores vs 6. 5 （3.5） scores）. However, no significant differences were detected in word recall and word recognition snbtests of the AD Assessment Scale, Digit Span Test and Clock Drawing Test. The areas under the receiver operator characteristic curve for diagnosis of iNPH by time of complete Stroop Color Word Test Card A, time of complete Stroop Color Word Test Card B and time of Stroop Interence Effects were 0. 874, 0. 929 and 0. 869, respectively. And the sensitivity and specifity of the three indexes were 88.9% and 75.0%, 88.9% and 85.0%, 94.4% and 72.5%, respectively. Conclusions Patients with iNPH are impaired in various aspects of cognition involving memory, attention, executive function and visuospatial ability, the most prominent of which is the executive dysfunction. Additionally, Stroop Color Word Test is highly diagnostically discriminative for iNPH.