记忆与执行筛查量表鉴别血管性痴呆与阿尔茨海默病的作用

Roles of distinguish vascular dementia from Alzheimer's disease with memory and executive screening scale

目的探讨记忆与执行筛查量表(MES)鉴别诊断皮质下缺血性血管性痴呆(SIVD)与阿尔茨海默病(AD)的价值。方法回顾性纳入2012年6月至2013年11月首都医科大学附属复兴医院神经内科门诊和病房收治的SIVD和AD患者各50例。选取同期于复兴医院月坛社区体格检查健康者50名为对照组。3组受试者的年龄、性别和教育程度匹配。以简易精神状态量表(MMSE)和MES检测全部受试者并加以比较;记忆与执行评分比值(MES-R)对于SIVD与AD区分度的分析采用受试者工作特征曲线。结果 (1)SIVD组与AD组的MMSE总分差异无统计学意义[(20.6±5.5)分比(20.6±3.3)分,P>0.05]。(2)3组患者MES各指标差异均有统计学意义(均P<0.01)。SIVD组句子记忆1、3、4、5评分均明显高于AD组,差异均有统计学意义(均P<0.05)。执行部分指标:SIVD组左、右手连续动作及指令与动作矛盾刺激评分均低于AD组[(5.1±3.1)分比(7.3±2.1)分,(5.2±3.0)分比(7.7±1.9)分,(3.5±4.4)分比(6.2±4.3)分],差异均有统计学意义(均P<0.01)。SIVD组MES-R值高于AD组(1.2±0.7比0.5±0.2),差异有统计学意义(P<0.01)。(3)MES-R≥0.7时,区分SIVD与AD的敏感度76.7%,特异度为83.3%;而MMSE总分区分SIVD与AD的敏感度为40.0%,特异度仅为0.7%。结论对SIVD与AD患者进行MES测定,反映句子记忆和执行部分的差异,可以较好地区分两种疾病。

Objective To investigate the value of differential diagnosis for subcortical ischemic vascular dementia （SIVD） and Alzheimer＇s disease （AD） with memory and executive screening （MES） scale. Methods Fifty SIVD and 50 AD patients treated in the outpatient and wards of the Department of Neurology, Fuxing Hospital, Capital Medical University from June 2012 to November 2013 were enrolled retrospectively. They were enrolled in either a SIVD group or an AD group. Fifty healthy subjects in Yuetan community of Fuxing hospital were selected as a control group at the same period. The age, sex and education level of the subjects in the 3 groups were matched. The Mini-Mental State Examination （MMSE） and MES were used to measure all subjects and were compared;receiver operating characteristic curves was used to analyze the radio of memory and executive part for SIVD and AD discrimination. Results （1） There was no significant difference in total MMSE score between the SIVD group and the AD group （20.6 ± 5.5 vs. 20. 6 ±3.3;P 〉0.05）. （2） There were significant differences in each MES indexes among the patients of the 3 groups （ all P 〉0.05 ）. The 1,3,4 and 5 scores for the sentence memory in the SIVD group were significantly higher than those of the AD group. There were significant differences （ all P 〈 0.01 ）. The indicators of executive part：the continuous action, instruction and action contradictory stimulation, knock and un-knock with finger scores of the SIVD group were all lower than those of the AD group （ 5.1 ± 3.1 vs. 7.3 ± 2.1, 5.2±3.0 vs.7.7 ±1.9,3.5 ±4.4 vs.6.2 ±4.3;all P 〈0.01）.The MES-R of the SIVD group was higher than that of the AD group （ 1.2± 0.7 vs. 0.5 ± 0.2 ;P 〉 0.05 ）. （ 3 ） When MES-R was 〉10.7,the sensitivity and specificity of differentiating SIVD were 76.7% and 83.3% ,and the total score of MMSE for differentiating the sensitivity and specificity of SIVD were 40.0% and 0.7%. Conclusion The differences of MES reflecting sentence memory and executive part may better distinguish the patients with SIVD and AD.