画钟测验联合MMSE在老年认知功能障碍筛查中的应用

Application of the clock drawing test combined with the Mini--mental State Examination to screen the cog- nitive impairment in the elderly

目的探讨使用画钟测验（CDT）联合简易智力状况检查（MMSE）筛查老年认知功能障碍的可行性。方法采用多阶段分层整群抽样方法，抽取河北省石家庄市、唐山市、张家口市和邯郸市4个地区共3040名60岁以上老人，对所有被试采集一般人口学资料，同时进行CDT和MMSE评估。结果所有被调查者CDT平均（3．01士1．37）分，低于4分者为43．7％；其中男性老年人cDT〈4分者35．0％，明显低于女性的65．0％，差异有统计学意义（χ2=35．58，P〈0．01）。不同年龄段CDT〈4分者分别为60～64岁（32．2％），65～69岁（35．8％），70～74岁（45．6％），75～79岁（57．5％），≥80岁（75．1％）。不同文化程度CDT〈4分者分别为文盲82．8％，小学49．3％，初中35．7％，高中30．0％，大专以上24．8％。在2358名MMSE正常老年人中CDT测验低于正常者890名（37．74％）；在1715名CDT测验正常的老年人中检测出MMSE异常者247名（14．40％）。按照CDTO～4分划分为5组进行MMSE评分比较，5组间比较差异有统计学意义（F=402．68，P〈0．01）。CDT得分与MMSE总分、视空间功能、计算力、命名、记忆力、定向力均呈正相关（r分别为0．575，0．423，0．438，0．106，0．249，0．357；P〈0．01）。结论CDT得分在一定程度上反映老年人认知、执行功能损害的状况，CDT联合MMSE可作为筛查老年人认知功能障碍的有效方法。

Objective To investigate the feasibility of the Clock Drawing Test （CDT） combined with the Mini--mental State Examination （MMSE） to screen the cognitive impairment in the elderly. Methods Muti--stage stratified cluster sampling method was used to select 3 040 the old people whose age were over 60 years old in Shijiazhuang, Tangshan, Handan, Zhangjiakou of Hebei Province. All subjects were collected general demographic data, while were tested by the CDT and MMSE. Results CDT average score was （3.01±1.37）, the percentage of less than 4 points was 43.7 % ; the percentage in the elderly male people was 35.1%, significantly less than 64.9% of women, the difference was statistically significant （Z2 = 35.58,P 〈 0.01）. Less than 4 points of the CDT among different ages was 60--64 years old 32.2% ,65--69 years old 35.8%, 70-- 74 years old 45.6%, 75-- 79 years old 57. 5%, 〈80 years old 75.1%. Different cultural degree of CDT〈4 points was illiterate 82.8%, primary school 49.3%, junior middle school 35.7%, high school 30.0%, college degree or above 24. 8% respectively. In 2 358 the MMSE normal elder people, CDT test lower than the normal were 890（37.74%） In 1 715 the CDT test normal elderly people, the MMSE abnormal were 247 （14.40%） o Five groups were divided in accordance with the clock drawing test （0--4 score） to carry on the MMSE comparison, the difference was statisti- cally significant between 5 groups. The CDT scores and MMSE score, visual space function, calculation, naming, memory, directional forces were positively correlated （r = 0. 575, 0. 423,0. 438,0. 106, 0. 249,0. 357,respectivelyl P〈 0.01）. Conclusions To a certain extent, the CDT score reflects the sta- tus of the cognitive, executive function impairment in the elderly, the CDT combined with the MMSE can be used as an effective approach to screen the cognitive impairment in the elderly.