听理解障碍在识别轻度阿尔茨海默病与遗忘型轻度认知功能障碍中的价值

The value of auditory comprehension disorder in identifying mild Alzheimer's disease and amnestic mild cognitive impairment

目的探讨轻度阿尔茨海默病(mild Alzheimer's disease,mAD)和遗忘型轻度认知功能障碍(amnesia mild cognitive impairment,aMCI)的听理解损害特点,以及听理解障碍在识别mAD与aMCI中的价值。方法对aMCI组(49例)、mAD组(40例)、对照组(40例)使用简易精神状态检查量表(mini-mental state examination,MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)进行神经心理测试,并进行听理解测试;进行各组间认知功能、听理解测试成绩比较;分析mAD、aMCI听理解改变与认知(MMSE、MoCA)的相关性;评估听理解测试在识别mAD和aMCI中的价值。结果三组间听理解总评分及各分测验评分差异均有统计学意义(P<0.05)。与对照组比较,aMCI组与mAD组听理解总分及其分测验得分均减少(均P=0.000),aMCI组与mAD组只在口头指令得分上差异有统计学意义(P=0.010)。aMCI组听理解总分与MMSE、MoCA及是/否问题与MoCA相关(P<0.05)。听理解、是/否问题、听辨认、口头指令区分aMCI和对照组的曲线下面积(AUC)分别为0.986、0.917、0.881、0.903,区分mAD组和对照组的AUC分别为0.987、0.954、0.907、0.962。结论口头指令的听理解测试有利于区分遗忘型轻度认知功能障碍和mAD。听理解测试识别am CI和mAD的整体效能高,有利于mAD的早期诊断。

Objective To analyze the characteristics of cognitive impaihnent in mild Alzheimer＇s disease （mAD） and amnes- tic mild cognitive impairment （aMCI）, and to explore the value of auditory comprehension disorder in the diagnosis of mAD and aMCI. Methods We used the Mini-Mental State Examination （MMSE） and the Montreal cognitive assessment scale （MoCA） for neuropsy- chological tests and auditory comprehension test in 49 patients with aMC1,40 with mAD and 40 normal controls. Cognitive and the audi- tory comprehension testing results were compared among the three groups. The relationship between the scores of MMSE and MoCA and the value of auditory comprehension test in diagnosis of mAD and aMCI was analyzed. Results The total score of auditory comprehen- sion and the scores of each subtest among the three groups had statistically significant difference （ P 〈 0. 05 ）. Compared with the control group,the scores of auditory comprehension test and subtest in aMCI and mAD groups were reduced significantly （ all P = 0. 000）. Compared with the mAD group, the aMCI group had the significant difference only in the oral instruction （P = 0. 010）. The auditory comprehension total ＂scores of aMCI were correlated with the MMSE score and the MoCA score and yes or no problem score of aMCI. ROC curve analysis showed that the AUCs of auditory comprehension, yes or no problem, auditory discrimination, oral instruction to dis- criminate aMCI group from the control group were 0. 986,0. 917,0. 881 and 0. 903,respectively,and to discriminate the mAD group from the control group were 0. 987,0. 954,0. 907 and 0. 962 ,respectively. Conclusion The oral instruction of auditory comprehension test can distinguish aMC! and mAD. The overall efficiency of auditory comprehension test could identify aMCI and mAD with high effi- ciency that is benefit to early diagnosis of Alzheimer＇s disease.