AD8联合简易智能状态检查量表用于军队健康体检人群认知功能障碍筛查的初步研究

Application of combined AD8 and MMSE in detecting cognitive impairment in servicemen undergoing physical examination

目的探讨AD8和简易智能状态检查量表(mini-mental state examination,MMSE)联合使用在军队健康体检人群中筛查认知功能障碍的特异性和敏感性。方法选择2013年1月1日~12月31日在解放军总医院接受常规健康体检的军队人群1723例,进行AD8和MMSE测评。结果 1723例接受AD8测评中,AD8≥2分326例(18.9%)。161例主诉认知功能减退者同时接受MMSE测评,AD8≥2分84例(52.2%),MMSE异常78例(48.4%)。临床诊断痴呆66例(41.0%),其中AD8筛查阳性46例(69.7%),MMSE异常55例(83.3%)。ROC曲线分析显示,AD8+MMSE联合筛查痴呆的特异性从AD8单项测试的60.0%提高到91.6%。协方差分析显示,在调整年龄的影响因素后,AD8+MMSE双异常者连线A评分较认知正常者明显升高,MMSE、延迟回忆、执行功能、工作记忆、词语流畅性评分较认知正常者明显降低,差异有统计学意义(P<0.01)。结论健康体检时AD8+MMSE联合应用可以提高检出痴呆患者的特异性和可靠性,便于在基层医疗卫生机构推广使用。

Objective To study the sensitivity and specificity of combined AD8 and MMSE in detecting cognitive impairment in servicemen undergoing physical examination.Methods Cognitive impairment in 1723 servicemen undergoing physical examination in our hospital was assesed according to their AD8 and MMSE scores.Results The AD8 score was≥2 in 326（18.9%）out of the 1723 servicemen who underwent AD8 examination and in 84（52.2%）out of the 161 servicemen who complained of cognitive impairment detected by MMSE.The MMSE was abnormal in 78（48.4%）out of the 161 servicemen who complained of cognitive impairment.Of the 66 servicemen（41.0%）who were diagnosed with dementia,46（69.7%）were diagnosed according to their AD8 score and 55（83.3%）were diagnosed according to their MMSE score.ROC curve analysis showed that the specificity（91.6%）of combined AD8 and MMSE was significantly higher than that（60.0%）of simple AD8.Covariance analysis revealed that the score of trail making test-A was significantly higher while that of MMSE,delay recall,executive function,working memory and word fluency was significantly lower in servicemen with abnormal AD8 and MMSE than in those with normal AD8 and MMSE（P〈0.01）.Conclusion Combined AD8 and MMSE can improve its specificity and reliability in detecting dementia in servicemen undergoing physical examination and can thus be popularized in grass-root medical and healthcare institutions.