改编版听觉词语学习测验在遗忘型轻度认知障碍和阿尔茨海默病中的应用

Features of a modified WHO/UCLA AVLT performance in amnestic mild cognitive impairment and mild Alzheimer's disease

目的采用改编版WHO/UCLA听觉词语学习测验(WHO/UCLA AVLT),比较认知正常、遗忘型轻度认知障碍(aMCI)和阿尔茨海默病轻度痴呆组的听觉词语学习和记忆的特征。方法自2016至2018年从社区招募认知正常(CN)自愿者105人,首都医科大学宣武医院记忆门诊入组aMCI患者48例,轻度AD患者50例。所有的被试者均完成包括改编版WHO/UCLA AVLT在内的成套神经心理评估和头颅MR/CT。结果改编版WHO/UCLA AVLT主要指标即刻记忆总分在CN、aMCI和轻度AD组分别为(53.9±6.9)分、(34.6±8.3)分、(23.7±6.2)分(P<0.001);20-min延迟回忆得分在CN、aMCI和轻度AD组分别为(12.5±1.6)分、(4.3±3.0)分、(0.6±1.0)分(P<0.001);线索回忆得分在CN、aMCI和轻度AD组分别为(13.0±1.4)分、(7.0±2.4)分、(2.6±2.0)分(P<0.001)。在AVLT的各主要指标中,延迟回忆得分在CN与aMCI组之间、CN与AD之间具有最强的Cohen′d值[3.8,95%可信区间(CI)3.3~4.4;8.1,95%CI 7.1~9.1],线索回忆在aMCI和AD组之间具有最强的Cohen′d值(2.0,95%CI 1.5~2.5)。AVLT各主要指标与年龄和教育无明显相关性。即刻回忆、延迟回忆等主要指标与MMSE、MoCA有较强的相关性,与连线测验、命名测验和数字广度逆向有中度相关性,与数字广度正向和图形临摹有轻度的相关性。结论改编版中文WHO/UCLA AVLT保留了原版AVLT适用于不同的教育水平、年龄段人群记忆障碍检测的特点,与整体认知和其他认知域有良好的相关性。改编版WHO/UCLA AVLT为轻度认知障碍和轻度阿尔茨海默病的鉴别诊断提供了多种指标。

Objective To compare the features of a modified WHO/UCLA AVLT performance in the cognitive normal, amnestic mild cognitive impairment (aMCI) and mild Alzheimer′s disease (mild AD) patients. Method A total of 105 cases of cognitivenormal (CN), 48 aMCI and 50 mild AD patients were included between 2016 and 2018. All subjects undertook detailed neuropsychological tests and brain MRI/CT scan. Results The total score of five learning trials in CN, aMCI and AD groups were 53.9±6.9, 34.6±8.3 and 23.7±6.2, respectively (P<0.001). The score of 20-min delay recallwere 12.5±1.6, 4.3±3.0 and 0.6±1.0, respectively (P<0.001) in three groups. The score of cued recall were 13.0±1.4, 7.0±2.4 and 2.6±2.0, respectively (P<0.001). The score of 20-min delay recall had the largest effect sizes between CN and aMCI groups (Cohen′d=3.8, 95%CI,3.3-4.4), and CN and mild AD groups (Cohen′d=8.1, 95%CI 7.1-9.1). Cued recall had the largest effect size between aMCI and mild AD groups (Cohen′d=2.04, 95%CI 1.5-2.5). The scores of learning total score, 20-min delay recall, cued recall and recognition had the strong relationships with the scores of mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA), but obtaining moderate relationships with Boston naming test and trail making test (TMT) and weak relationships with digit span and figure copy. Age and education had no relationship with the main indices of this modified AVLT. Conclusions The modified WHO/UCLA AVLT is still an age and education fair test to assess memory domain function. Qualitative analysis of AVLT profiles may be useful to differentiate the CN, aMCI and mild AD in Chinese sample.