Addenbrooke改良认知评估量表对老年人认知障碍诊断效力的研究

Study on the capacity of Addenbrooke's cognitive examination-revised to screen out cognitive impairment in the elderly

目的探讨Addenbrooke改良认知评估量表(ACE-R)对老年人群认知功能障碍(cognitive impairment,CI)的诊断效力。方法选择2013年9月至2016年7月在江苏省老年医院就诊的老年人269例,其中认知正常者139例(正常对照组),轻度认知功能障碍者63例(MCI组),痴呆者67例(痴呆组)。所有研究对象均完成ACE-R量表及简明精神状态量表(MMSE)测评,比较3组的ACE-R总分及各个子项目评分,并绘制ROC曲线,通过计算ROC曲线下面积的方法观察ACE-R对MCI及痴呆诊断的敏感性及特异性。结果 (1)正常组ACE-R总分及MMSE评分分别为(83.94±7.41)分,(28.40±1.29)分,MCI组评分为(67.76±10.97)分和(23.78±1.62)分,痴呆组评分为:(36.09±15.66)分和(14.64±4.74)分。3组间ACE-R总分、MMSE评分及各子项目评分差异均有统计学意义。(2)ACE-R量表以74/75作为分界值时筛查MCI灵敏度达93.5%,特异度达到65.1%,以65/66作为分界值时筛查痴呆灵敏度达98.6%,特异度达到98.3%。(3)ACE-R量表和MMSE量表呈显著正相关(r=0.926,P<0.01)。(4)年龄及性别对ACE-R分值有影响,教育年限对ACE-R分值无影响。结论 ACE-R量表可以很好地反映CI病人相关认知域受损情况,可有效筛查MCI及痴呆病人。

Objective To explore the value of Addenbrooke＇s cognitive examination-revised（ACER） in the assessment of cognitive impairment（CI） in the elderly.Methods A total of 269 elderly patients were enrolled in this research from September 2013 to July 2016 in Jiangsu Provincal Geriatric Hospital,including normal control（NC） group（n = 139）,mild cognitive impairment（MCI） group（n =63） and dementia group（n = 67）.ACE-R and mini-mental state examination（MMSE） were applied to assess cognitive function in all patients.The sensitivity and the specificity of ACE-R were analyzed by the area under curve（AUC） of ROC.Results The scores of ACE-R and MMSE in NC group,MCI group and dementia group were 83.94±7.41 and 28.40±1.29,67.76±10.97 and 23.78±1.62,36.09±15.66 and 14.64±4.74,respectively.There were significant differences in MMSE,ACE-R and all subentries of ACE-R between the three groups.The optimal cut-off score of ACE-R to differentiate MCI from normal controls was 74/75,with a sensitivity rate of 93.5%,a specificity rate of 65.1%.The optimal cut-off score of ACE-R to identify dementia was 65/66,with a sensitivity rate of 98.6%,a specificity rate of 98.3%.ACE-R scores were significantly correlated with the scores of MMSE（r = 0.926,P0.01）.Age and sex showed significant effects on ACE-R scores（P0.01,P0.05）,and years of education showed no effect on ACE-R scores（P〈0.05）.Conclusions ACE-R is a sensitive and specific method to assess a broad spectrum of cognitive abilities,and to detect MCI and dementia.